Table 1. Comparison of allergen-specific immunotherapies for food allergy currently under study in human subjects.
| Features | OIT | SLIT | EPIT | SCIT with hypoallergen* | LAMP-DNA vaccine* |
|---|---|---|---|---|---|
| Food allergens | Peanut, cow's milk, egg, wheat, multi-food | Peanut, cow's milk, hazelnut, peach | Peanut, cow's milk | Peanut, fish | Peanut |
| Stage of study | Phase I-IV | Phase I-III | Phase I-III | Phase I-II | Phase I |
| Typical protocol | Initial dose-escalation day; doses administered daily throughout protocol, with bi-weekly dose increases during build-up phase (months), followed by maintenance (months-years) | Daily patch application for increasing intervals until 24 hour per day maintenance (years) | Weekly incrementally increasing doses | Current trial: 4 doses every 2 weeks | |
| Maintenance dose | Daily; 300 mg to 4 g | Daily; 2 to 7 mg | Daily; 50 to 500 µg | Weekly 60 ng | Unknown |
| Observed doses | Initial dose escalation; up-dosing every 1 to 2 weeks | Up-dosing every 1 to 2 weeks | Initiation and periodic observation | All; typically weekly for build-up and monthly for maintenance | All are observed |
| Dosing restrictions | Take with food; avoid physical activity 2 hours after; withhold during illness | Avoid eating 30 minutes following dose | none | Period of in-office observation following each dose | Under observation in the office |
| Notable advantages | Improved efficacy compared to SLIT and EPIT; Cost efficient | Improved safety profile compared to OIT | Best safety profile of AIT for food allergy under study in humans; Ease of administration | Dosing only once per week; Observed dosing may improve compliance | Potential to induce tolerance with limited number of doses |
| Notable disadvantages | Frequent office visits during up-dosing; frequent AE which may include anaphylaxis; risk of EoE | Frequent AE; theoretical risk of EoE | Limited data: appears to have reduced efficacy compared to other modalities | Frequent office visits during up-dosing; administered by injection | Administered by injection |
AE, adverse event; AIT, allergen-specific immunotherapy; EoE, eosinophilic esophagitis; EPIT, epicutaneous immunotherapy; LAMP, lysosomal-associated membrane protein; OIT, oral immunotherapy; SCIT, subcutaneous immunotherapy; SLIT, sublingual immunotherapy.
*Very limited data in humans.