## 3 Immunotherapy for Food Allergies
\begin{table}
\begin{tabular}{|p{42.7 pt}|p{42.7 pt}|p{42.7 pt}|p{42.7 pt}|p{42.7 pt}|p{42.7 pt}|p{42.7 pt}|} \hline
**Pairures 2003** & Pro prospective, (50) & \(N=16\) & SOTI & _Maintenance_: 120 mL. milk at least & 10716 tolerant & SPT \(\Downarrow\)\(\bullet\) \\
[50] & group study with & \(-\)16 years & \(-\)16 years & adjunct therapy & \(-\)3-time/week & 3/16 introduced schedule & \(\mathrm{leg}\Downarrow\) \\
[50] & reformate group & & fresh cow’s milk & _Enduplet challenge_: No & 3/16 withdrew & \(\mathrm{leg}\Downarrow\) \\ \hline
**Pairures 2007** & Pro prospective, (48) & \(N=14\) & SLIT, then SOTI & _Maintenance_: 130 mL. milk at least & 10714 tolerant & SPT \(\Downarrow\)\(\bullet\) \\
[48] & open study with & 3-16 years & adjunct therapy & 2-3 times a week & 1/14 partially tolerant & \(\mathrm{leg}\Downarrow\) \\  & reference group & & fresh cow’s milk & _Enduplet challenge_: No & 1/14 failed & \(\mathrm{leg}\Uparrow\) \\  & & & & & 2/14 withdrew & \\ \hline
**Meglo 2004** [55] & Pro prospective, (50) & \(N=21\) & SOTI & _Maintenance_: 200 mL. milk per day for & 1521 tolerant & SPT \\
**\& **\& **\& **\& **\& **\& 0/15 asymptomatic & EPST \(\uparrow\) \\  & **\& & & & & \\  & & & & & & \\  & & & & & & \\  & & & & & & \\  & & & & & & \\  & & & & & & \\  & & & & & & \\ \hline
**Nariety 2009** [57] & Pro prospective, (50) & \(N=15\) & Tolent children increased & _Maintenance_: median dose 7000 mg milk & **41.78-weeks** & EPST \(\uparrow\) \\ Follow up of [43] & open study & 6-16 years, & dose of fluid ponded milk & protein (\(\pm\)200 mL. milk) & 6/16 tolerant & \(\mathrm{leg}\Downarrow\) \\  & & & & & & \\  & & & & & & \\  & & & & & & \\  & & & & & & \\  & & & & & & \\  & & & & & \\  & & & & & & \\ \hline
**[PERSON] 2012** [59] & Pro prospective, (50) & \(N=10\) & SOTI & _Maintenance_: 200 mg cow’s milk & **41.78-24** & SPT \(\uparrow\) \\  & open study & Syears (\(-\)17) & adjuster therapy & protein (60 mL.) & 9/10 tolerant & \(\mathrm{leg}\Downarrow\) \\  & & & & & & \\  & & & & & & \\  & & & & & \\  & & & & & & \\  & & & & & \\  & & & & & \\ \hline \end{tabular}
\end{table} 
Table 2: _Cont._Not all of the studies assessed actual tolerance to cow's milk or egg at the end of the intervention. Some used a double blinded, placebo controlled food challenge, the recognized \"gold standard\" for diagnosis of food allergy and some of the trials used open oral food challenges. The end point challenges varied in terms of the type of food used for challenge, with some testing the raw cow's milk or egg and some testing cooked egg for the case of egg immunotherapy. The volume of cow's milk or egg given in the final challenge varied. Many children who underwent immune therapy were able to reach tolerance to cow's milk or egg in these studies however overall there was a high incidence of adverse reactions and a risk of loss of clinical desensitization after small periods off therapy [38]. [PERSON] _et al._ reported loss of tolerance in as little as one week off SOTI [38]. The longest follow up period after the oral immunotherapy reported was three years for egg allergy [46] and four years for cow's milk allergy [56]. There are no safety data available testing the efficacy of oral immunotherapy beyond this length of time. Many of the human intervention studies investigating clinical outcomes of individuals undergoing oral immunotherapy to cow's milk and egg have used skin pick testing as a marker of IgE levels or have measured serum specific IgE / IgG4 levels against the specific allergens to look for changes in the immune system towards tolerance (Tables 1 and 2). Only the more recent studies have begun to investigate changes at the cellular level [38, 46, 49, 53]. Production of cytokines (IL10, TGFB and IFN\(\gamma\)) by T-cells influences the production of protective antibody responses by B cells including secretion of allergen-specific IgG4 and IgA and later inhibition of IgE.