Conclusions
Studies have shown that OIT-induced remission of food allergy is
associated with anergy of memory T cells and modest T regulatory cell
activity that may be linked to the anergic T cell state. Type I
interferons have recently emerged as candidate regulators of remission
following OIT and may play a key role in suppression of the Th2 antigen
response through regulatory action on GATA3 and the high affinity IgE
receptor. In contrast, desensitisation without remission/SU is
associated with transient regulatory activity that may be insufficient
to support longer-lasting redirection of the allergic response,
suggesting that a more stable induction of regulatory activity is
required to achieve durable redirection of immune responses towards a
tolerant state. Most studies have examined changes in CD4+ T cells and
understanding of potential upstream factors or other cell types with
pivotal roles in supporting stable remission remains limited. Systems
biology approaches are well suited to provide a broader and much deeper
understanding of OIT mechanisms and may facilitate development of more
targeted and effective treatment approaches. For example, single cell
profiling paired with cutting-edge computational tools holds great
potential to unlock the immunological mechanisms underlying tolerance
within the CD4 T cell compartment and beyond. There is also a need for
larger studies including well-defined clinical outcomes and longitudinal
sampling to enable high quality evidence of the key mechanisms driving
redirection of the immune response in OIT. Such studies can unveil novel
biomarkers of treatment response and associated therapeutic targets that
can be leveraged to develop more effective treatments.