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Immune Basis of Allergic Reactions to Food

Lozano-Ojalvo D1, Berin C1*, Tordesillas L2*

1Jaffe Food Allergy Institute, Immunology Institute, Mindich Child Health Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
2Department of Tumor Biology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
*Both authors contributed equally to the manuscript.

J Investig Allergol Clin Immunol 2019; Vol 29(1) : 1-14
doi: 10.18176/jiaci.0355

Food allergies are diseases where the normal tolerance response to oral antigens is altered. Recent advances have begun to uncover mechanisms that mediate sensitization to food allergens and maintenance of the disease. Production of alarmins by epithelial cells triggers a cascade that leads to allergen-specific IgE synthesis. IL-9 has also been shown to play a role in mast cell recruitment and amplification of the allergic response. In recent years, increasing evidence suggests that sensitization to food allergens can be developed via nonoral routes, in particular the skin, thus leading to the “dual exposure hypothesis”. Environmental factors such as diet or microbiota can shape the immune system to promote tolerance or sensitization to food antigens. While the mechanism of primary tolerance to food antigens is quite clear, that leading to permanent tolerance in food-allergic individuals through immunotherapy is still under study. Understanding the mechanisms by which oral tolerance is suppressed and sensitization develops will help to identify new targets to develop combined therapies for the treatment of food allergies.

Key words: Food allergy, Skin sensitization, Oral tolerance, Microbiota, Allergen-specific immunotherapy