In this review, we will discuss the immunological mechanisms that maintain lifelong food allergies and are, consequently, those which must be dismantled or reprogrammed to instate a clinically non-reactive state. Importantly, such a state must persist beyond the course of the treatment and exert its protective effects permanently. This may be attained through either an active, non-harmful immune response (immunological tolerance) or a lack of a harmful immune response (e.g., anergy), such that subsequent exposures to the allergen do not elicit a clinical reaction. In principle, any transformative treatment for established food allergy would require the restoration of a homeostatic immunological state. Epinephrine, and other therapeutic options like antihistamines provide acute symptom relief but do not target the underlying pathology of the disease. The standard of care for food allergy is allergen avoidance and the timely administration of epinephrine upon accidental exposure. This challenge is particularly pressing in the case of allergies against peanut, tree nuts, fish, and shellfish which are lifelong in most patients and may elicit severe reactions. One of the greatest remaining challenges is whether patients with established food allergy can return to health. Department of Medicine, McMaster Immunology Research Centre (MIRC), Schroeder Allergy and Immunology Research Institute, McMaster University, Hamilton, ON, CanadaĪ series of landmark studies have provided conclusive evidence that the early administration of food allergens dramatically prevents the emergence of food allergy.Allyssa Phelps *, Kelly Bruton, Emily Grydziuszko, Joshua F.
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