舌下免疫疗法(SLIT)
在治疗早期,逐步将口腔暴露于天然食物蛋白,以诱导调节T细胞,并在随后的治疗中形成针对非过敏性Th1应答的免疫偏差。[14]Sicherer SH, Sampson HA. Food allergy: recent advances in pathophysiology and treatment. Annu Rev Med. 2009;60:261-277.http://www.ncbi.nlm.nih.gov/pubmed/18729729?tool=bestpractice.com在一项研究中,患者口服榛子SLIT能够提高引起过敏反应的平均阈剂量,尽管50%受试患者的症状仅限于口腔过敏并发症。[69]Enrique E, Pineda F, Malek T, et al. Sublingual immunotherapy for hazelnut food allergy: a randomized, double-blind, placebo-controlled study with a standardized hazelnut extract. J Allergy Clin Immunol. 2005;116:1073-1079.http://www.jacionline.org/article/S0091-6749(05)01912-3/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/16275379?tool=bestpractice.com一项双盲安慰剂对照花生SLIT的研究表明,那些接受花生SLIT的患者对花生蛋白的耐受与安慰剂对照组相比要高出20倍。[70]Kim EH, Bird JA, Kulis M, et al. Sublingual immunotherapy for peanut allergy: clinical and immunologic evidence of desensitization. J Allergy Clin Immunol. 2011;127:640-646.http://www.ncbi.nlm.nih.gov/pubmed/21281959?tool=bestpractice.com与安慰剂组比较,治疗组皮肤点刺试验风团直径显著下降,嗜碱粒细胞的反应性下降,而显著的变化是治疗组检测到了花生特异性IgE和IgG4。其他食物的SLIT的效用的相关研究正在进行,它们的应用仍然被认为是研究性的。
口服免疫疗法(OIT)
在为期数月治疗过程中,给予逐渐加量的食物过敏原,以恢复或诱导耐受状态。迄今为止最大的研究是追踪85名花生过敏的儿童;39名儿童接受了治疗,46名接受安慰剂。接受积极治疗的参与者中62%达到了脱敏作用。[71]Anagnostou K, Islam S, King Y, et al. Assessing the efficacy of oral immunotherapy for the desensitisation of peanut allergy in children (STOP II): a phase 2 randomised controlled trial. Lancet. 2014;383:1297-1304.http://www.ncbi.nlm.nih.gov/pubmed/24485709?tool=bestpractice.com另一项研究是包含28名受试者的双盲、安慰剂对照食物试验。16名受试者完成了为期一年的治疗,并能耐受约20颗花生,相比之下,安慰剂组只能耐受大约1颗花生。[72]Varshney P, Jones SM, Scurlock AM, et al. A randomized controlled study of peanut oral immunotherapy: clinical desensitization and modulation of the allergic response. J Allergy Clin Immunol. 2011;127:654-660.http://www.ncbi.nlm.nih.gov/pubmed/21377034?tool=bestpractice.com治疗组皮肤点刺试验风团直径减小,白细胞介(IL)-5和IL-13降低,花生特异性IgG4升高。一项研究发现,合用带花生 OIT 的益生菌可能会促进持续昏迷的加速发展;然而,这还需要更多研究。[73]Tang ML, Ponsonby AL, Orsini F, et al. Administration of a probiotic with peanut oral immunotherapy: a randomized trial. J Allergy Clin Immunol. 2015;135:737-744.http://www.ncbi.nlm.nih.gov/pubmed/25592987?tool=bestpractice.com其他食品包括牛奶和鸡蛋的研究显示特异性口服诱导耐受(SOTI)是有希望成功的。[74]Calvani M, Giorgio V, Miceli Sopo S. Specific oral tolerance induction for food: a systematic review. Eur Ann Allergy Clin Immunol. 2010;42:11-19.http://www.ncbi.nlm.nih.gov/pubmed/20355360?tool=bestpractice.com[75]Brożek JL, Terracciano L, Hsu J, et al. Oral immunotherapy for IgE-mediated cow's milk allergy: a systematic review and meta-analysis. Clin Exp Allergy. 2012;42:363-374.http://www.ncbi.nlm.nih.gov/pubmed/22356141?tool=bestpractice.com[76]Romantsik O, Bruschettini M, Tosca MA, et al. Oral and sublingual immunotherapy for egg allergy. Cochrane Database Syst Rev. 2014;(11):CD010638.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010638.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/25405335?tool=bestpractice.com 然而,还需要通过更多的研究阐明哪种疗法和方案最能改善治疗结局并降低与治疗相关的不良反应。
肽免疫疗法
无数小分子肽被呈递到T细胞抗原决定簇,而不与IgE的交联。在小鼠模型已被证明有效,但应用到人类还是有困难的。[14]Sicherer SH, Sampson HA. Food allergy: recent advances in pathophysiology and treatment. Annu Rev Med. 2009;60:261-277.http://www.ncbi.nlm.nih.gov/pubmed/18729729?tool=bestpractice.com
中草药治疗
持续6周每天服用复方中草药的一项研究表明,在花生过敏的小鼠模型中过敏性的症状被完全阻断。[77]Srivastava KD, Kattan JD, Zou ZM, et al. The Chinese herbal medicine formula FAHF-2 completely blocks anaphylactic reactions in a murine model of peanut allergy. J Allergy Clin Immunol. 2005;115:171-178.http://www.jacionline.org/article/S0091-6749(04)02620-X/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/15637565?tool=bestpractice.com针对人类第一阶段的临床研究已经启动。[14]Sicherer SH, Sampson HA. Food allergy: recent advances in pathophysiology and treatment. Annu Rev Med. 2009;60:261-277.http://www.ncbi.nlm.nih.gov/pubmed/18729729?tool=bestpractice.com
抗-IgE单克隆抗体
一项最初的试验显示对一些患者有治疗作用,在发生过敏前允许摄入更大量的花生。[78]Leung DY, Sampson HA, Yunginger JW, et al. Effect of anti-IgE therapy in patients with peanut allergy. N Engl J Med. 2003;348:986-993.http://www.nejm.org/doi/full/10.1056/NEJMoa022613#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/12637608?tool=bestpractice.com因为方案的安全问题,进一步的研究已经停止。[14]Sicherer SH, Sampson HA. Food allergy: recent advances in pathophysiology and treatment. Annu Rev Med. 2009;60:261-277.http://www.ncbi.nlm.nih.gov/pubmed/18729729?tool=bestpractice.com在牛奶 OIT 的构建和维护阶段注射奥马珠单抗可改善安全性,但是不会影响疗效。[79]Wood RA, Kim JS, Lindblad R, et al. A randomized, double-blind, placebo-controlled study of omalizumab combined with oral immunotherapy for the treatment of cow's milk allergy. J Allergy Clin Immunol. 2016;137:1103-1110.http://www.ncbi.nlm.nih.gov/pubmed/26581915?tool=bestpractice.com
经皮免疫疗法 (EPIT)
EPIT 法通过皮肤斑贴使皮肤长时间接触过敏原。目前进行的试验正在研究 EPIT 对治疗各类食物过敏的有效性。