Annotated Bibliography

AAAAI. "Allergy Statistics." American Academy of Allergy, Asthma & Immunology.

Accessed 7 Jan. 2018.

This brief article released by the American Academy of Allergy, Asthma, and
Immunology details statistic and trends in different allergens and populations. The document is
organized by different allergic disease and within each section the it describes the percentage and
estimated number of those affected by the specific disease. Additionally, the information focuses
on the increasing prevalence of food allergies in America for the last two decades. Worldwide
sentization rates to common allergens, such as pollen, dust, and peanuts, have increased to a
threshold of forty to fifty percent. Food allergies affect eight percent so the children under
eighteen in the United States. Majority of the statistics concentrate on food allergies and seasonal
allergies; both which effect large portions of the population. Overall, allergic diseases, including
food allergies, asthma, and outdoor allergies, are rising in prevalence and severity, as more
people are diagnosed and more being hospitalized in the past twenty years.
The document is well organized by allergic diseases, and the statistics are both detailed
and well described. The population observed is well described in the statistic; both the year and
affected group are given in each description. The data is provided by a large, well known
organization; the American Academy of Allergy, Asthma & Immunology is a groups of allergy
researchers and physicians who work to inform the public on the topic of allergies. The data they
compile derives from different scholarly studies, making this document credible. All the data is
credited using footnotes, and these sources are reliable, as they are provided from well known
researchers. Overall, the document was useful in finding specific statistics, and observing the
general trend of allergic diseases. However, it provides little information on specific studies, and
does not analyze the prevalence of allergies in different demographic groups.

AAFA. "Allergy Facts and Figures." Asthma and Allergy Foundation of America.
Accessed 6 Jan. 2018.

This is a brief article written by the Asthma and Allergy Foundation of America that
complies different statistics and trends on allergic diseases. The document complies statistics
from several scholarly studies done over the past twenty years. The statistics mainly focus on the
growing prevalence of allergies in the United States population, mainly in children under
eighteen. Allergies are the sixth leading chronic disease in the United States, despite it lower
fatality rate. Additionally, many of the statistics focus on the trends in different food allergies,
specifically peanuts and milk. Majority of the statistic indicate an exponential increase in food
allergies in the last two decades and all allergic disease are becoming more prevalent in the
United States, specifically in children, as 4.2 million children are affected in the United States
alone. In addition to data on food allergies and outdoor allergies, the sheet includes statistics on
asthma and eczema, both which commonly accompany other allergic conditions.
The document is organized by different allergic diseases and different allergens. The
statistics are accurate, as cross referencing with other articles produce similar trends and data.
The data is accurately credited using footnotes, and all of the articles cited are written by well
known researchers, organizations, and authors. Therefore all the statistics are accurate and up to
date, as majority of the statistics are from the last decade. The Asthma and Allergy Foundation of
America is a credible organization consisting of physicians, researchers, and health care workers
nationwide; therefore the data is well organized and concise. Overall, the article was helpful in
identifying general trends and prevalence of the allergy epidemic. However, the article failed to
give data from the last two years, 2016 to 2017, which would further illuminate the growing
prevalence in allergies.

Albin S., and A. Nowak-Węgrzyn. “Oral Immunotherapy for Food Allergy: MEchanisms and
Role in MAnagement.”​ Clinical & Experimental Allergy​, vol.45, 2015, pp.368–383.

This scholarly journal details the role of oral immunotherapy in allergy treatment and the
theorized mechanism of the treatment. Many clinical trials implementing oral immunotherapy as
a treatment for allergies have varying degrees of success; however, in the majority of them, over
fifty percent of the patients achieve higher levels of desensitization. Researchers view
desensitization as the future allergy treatment; however, the level of desentization varies among
all children, as some patients are forced to drop out due to more serious reactions. Therefore,
more research must be conducted in order to determine its overall effectiveness. Oral
immunotherapy is a process for achieving enough desentization to prevent a reaction if the
antigen is accidentally consumed. However, it is not reaching a high enough desentization
threshold to be considered a per enact cure. Therefore, oral immunotherapy has been applied to
the most common antigens in children under the age of eighteen, including peanuts, eggs, and
milk. In order to increase the effectiveness of oral immunotherapy, other forms of treatment,
such as sublingual immunotherapy and anti-immunoglobulin-E drugs, have been used in
combination with oral immunotherapy.
The article is credible as it was published in a well, known scholarly journal, and the
authors are well known researchers with professional degrees in their respective fields.
Additionally, the article was written in the past five years, making the information recent and
credible. Oral immunotherapy research is constantly updated with more clinical trials; therefore
the data must be up to date. The document is well organized by different clinical trials, and
provides a chart with majority of the published trials in the last twenty years. It details the
procedures used and the percentage of those desensitized, which allows for in depth analysis and
comparisons with other trials. Overall, the article was useful in observing the commonalities
between different clinical trials, but it failed to go in depth on specific procedures or exact
biological pathways. It provides a good starting point for researching more in depth studies on
oral immunotherapy.

Andorf S. et al​. “Anti-IgE Treatment with Oral Immunotherapy in Multifood Allergic

Participants: a Double-blind, Randomized, Controlled Trial. The Lancet
Gastroenterology & Hepatology, ​2017.

This is a published, scholarly article that assess the effectiveness of the application of
anti-immunoglobulin treatments in addition to oral immunotherapy in patients with multiple
immunoglobulin-E mediated food allergies. The study observes the effectiveness of
anti-immunoglobulin-E, such as omalizumab, also known as xolair, in patients with multiple
food allergies. Anti-immunoglobulin-E treatments are often paired with oral immunotherapy or
sublingual immunotherapy; in order to limit the amount of immunoglobulin-E present in the
immune system when immunotherapy dosages are applied. By injecting omalizumab into the
patient’s bloodstream, some of the immunoglobulin-E, binds to the drug; therefore reducing the
amount of immunoglobulin-E able to bind to mast cells and the antigens. In dosing periods for
immunotherapy, the decrease in the amount of immunoglobulin-E prevents severe reactions
when updosing, which allows the patient to tolerate a greater amount of antigen. Overall, this
method has varying amounts of success, but presents more potential for immunotherapy.
The article is credible, as the research was conducted at Stanford University, a well
known college with an established department of allergy research. The paper was written by
multiple, well known researcher, including Nadeau and Chinthrajah, and was published in the
past year, making the information recent and accurate. The article clearly defines its procedure,
findings, and conclusion; therefore, it was useful in establishing omalizumab’s role in oral
immunotherapy. The information is clearly and concisely stated, making the article easier to
understand. However, the author assumes that the audience knows the fundamentals of oral
immunotherapy, and does not explain oral immunotherapy in depth. It focuses solely on the
dosing stage of oral immunotherapy; therefore significant amounts of background research must
be done on oral immunotherapy. Additionally, no graphs or charts are provided, which would
have been a more efficient method of organizing the procedure and the data from the clinical
trial.

Baker, James R. “Food Allergy Research: Where Are We Now And What’s Next?” ​Food Allergy
Research and Education,​ 16 Dec. 2015

This is a webinar that was posted on the Food Allergy Research and Education
organization’s website, and it was given by Dr. Baker, the CEO of the FARE and an avid
researcher. The webinar and accompanying presentation provide information about alternative
and upcoming treatments, the stages the immune system goes through, current methods of
diagnosis, and lists of people involved in the allergy research community. The increased
exposure to antigens as a infant decreases the chances of allergy development and creates
tolerance. The treatments currently used include epinephrine and antihistamines, and food
challenges are the most common final test for allergy diagnosis. Oral immunotherapy is a
treatment in development with significant side effects, but effective results in the clinical trials.
Some other treatments in early development include therapies that rely on the immune synapse
and blocking the receptor the proteins in the pathway, which prevent the reaction from occurring.
However, this form of therapy is not in use, but is in consideration for the future.
The presentation is credible, as it was given by FARE, a world renown organization, and
the speaker, Dr. Baker, is a reputable professor in the field of allergy medicine. The diagrams in
the presentation were vital in comprehending the many different pathways discussed by the
speaker, as all the involved receptors, proteins, markers and cytokines were labeled and
categorized. Allergy research constantly expands, and the presentation organized and thoroughly
described the development of allergies, current treatments, future treatments, and the goal for
said treatments. Overall, the information is recent, ensuring that all developments in the field
were included. However, the speaker assumes that one is involved and knowledgeable about the
most recent findings of the allergy community, therefore some of the concepts are esoteric.The
webinar focuses on adolescent centric studies and vitalizes the need for a cure in children, which
aligns with many of the immunotherapy studies from other researchers. Many of the resources,
researchers, and specific works are referenced to, which allows allows a branching of ideas.

Burks Wesley A., and Mike Kulis. “Oral Immunotherapy for Food Allergy: Clinical and
Preclinical Studies.” ​Advanced Drug Delivery Reviews, ​vol.65, 2013, pp.774-781.

This scholarly journal details clinical and preclinical trials that applied oral
immunotherapy on those with immunoglobulin-E food allergies. The journal is divided by
antigen, specifically milk, peanut, and egg; each section describes the effectiveness of oral
immunotherapy, basic procedures, and predicted biochemical mechanisms for each antigen. All
groups that that used immunotherapy had patients that reached the targeted level of
desentization, which was 5000 mg in most experiments. In addition to analyzing different
clinical studies, the article differentiates desensitization and tolerance. Tolerance is the ability to
consume any amount of the allergen completely with no reaction, while desensitization is
defined as an increase in the amount of allergen consumed. Researchers are attempting to
achieve a high level of desensitization that results in tolerance.
The article was detailed and extensive, as it closely analyzed selected clinical trials.
Therefore, it succeeded in providing in depth observations and commentary on the different
procedures and results. Additionally, the article provided specific data to support its claim,
making the authors more credible. All of the data used is properly cited, and originates from well
known universities, such as Johns Hopkins and Duke. The paper was also published in a
well-known, credible medical journal. The article provided detailed explanations and
connections between different forms of oral immunotherapy. However it assumes that the reader
has background knowledge on oral immunotherapy and basic immunology. Thus, the article is
only effective in later stages of research.

Branum, Amy M., and Susan L. Lukacs. "Food Allergy among U.S. Children: Trends in
Prevalence and.." Food Allergy Among U.S.Children: Trends in Prevalence and
Hospitalizations​, 2008, pp. 1-8

This is a government document released by the US Department of Health and Human

Services that reviews data and trends of food allergies present in children under the age 18. It
focuses on the strong correlation between the presence of food allergies and the presence of
eczema, asthma, skin allergies, and respiratory allergies, as children with food allergies are about
4 times as likely to have one of the other conditions. Additionally, the percentage of children
diagnosed with food allergies in the United States increased by 18% in the last 10 years. The
percentage of children with allergies seem to differ among racial groups, but not among sex.
Therefore, the amount of food allergy related hospitalizations increased dramatically due to both
increased numbers of allergies and awareness.
The graphs within the document are well organized, clear, precise, and accurate
represents the data and trends. Although it lacks trends among different allergens, the article does
give specific data on the prevalence of allergies in certain demographic groups and different time
periods, which has become a nation-wide concern in the last twenty years.The data was collected
by the National Center of Health Statistics; therefore, it is credible and well representing.
Additionally, the data collection methods, procedures, and testing groups are detailed in the
article, ensuring the study is transparent. This data provides background information on the
demographics and environmental factor that are responsible for the allergy trend, as well as other
diseases that correlate with the allergy epidemic. However, the article is about 10 years old, thus
the trends are a little outdated, but overall it is useful in identifying the broad, overarching trends.

Cabrera, Carmen M., and José M. Urra. “Food Allergy and the Oral Immunotherapy Approach.”
Archivum Immunologiae et Therapiae Experimentalis​, vol. 63, no. 1, Feb. 2015, pp.
31–39, doi:10.1007/s00005-014-0304-z.

This scholarly article describes the mechanism and application of oral immunotherapy for
food allergies. In developing countries, food allergies have become a serious form of chronic
illness. The main method of food allergy management is currently avoidance, but oral
immunotherapy builds oral desensitization. The biochemical mechanism is still unknown, but
researchers predict that the level of FoxP3+ cells and increases in the IgG4 antibodies are the
underlying cause for the increase in desentization. Clinical trials from the past indicate that oral
immunotherapy does not favor any demographic, including age, ethnicity, or gender. However,
some trial correlate oral immunotherapy at an early age and overall all success in desentization.
Thus, researchers plan to attempt more trials for younger children.
Overall, this article assisted in assessing the current condition of oral immunotherapy and
the conditions that must be met in order to approve oral immunotherapy as a clinical treatment.
The paper is well organized by the different aspects of the treatment, including the hypothesized
mechanism of oral immunotherapy, the hypothesized pathway of allergy development, and the
factors of oral tolerance. It includes labeled diagrams of the biochemical pathways, allowing for
visualization; therefore making the concepts easier to understand. Additionally, the article
properly credits its sources, and majority of these sources are reliable and from well known
journals, such as the Journal of Allergy and Clinical Immunology. This article furthered
understanding on the current status of oral immunotherapy research, and highlights aspects that
must be further researched.

FARE. “Food Allergy Facts and Statistics for the U.S.” ​Food Allergy​, Food Allergy Research
and Education.

This is a fact sheet released by the Food Allergy Research and Education focusing on the
prevalence of food allergies in the United States. In the last twenty years, many more children
are affected with allergies, and the count continues to rise. The most common allergen among
children is milk; however, many children outgrow this allergy. Therefore, peanut allergies tend
to be more prevalent among all age groups. In addition to an increasing prevalence, allergies are
becoming more costly to families who are affected. The estimated cost of food allergies
nation-wide is 25 billion dollars annually, and the family is burdened both financially and
emotionally, as the stress from managing allergies is high. With the prevalence rising,
researchers are analyzing the probability of a child developing other allergic diseases in addition
to food allergies. Children with food allergies are twice as likely to develop other allergic
conditions, such as asthma or eczema. With this in mind, it is imperative to develop a safe and
effective treatment to combat this epidemic.
 The fact sheet was well organized, and good for identifying general trends in allergy
prevalence. It’s targeted audience is the general public, so it does not use esoteric and research
specific language, rather it utilizes common terms. The sheet does not provide in depth analysis
or inferences from the data, but it does provide shocking and accurate statistics regarding
allergies. The facts are accurate, as the organization, FARE, is a well known organization
consisting of health professionals, researchers, and patients devoted to the allergy field. The data
is cited in the sheet using footnote; therefore, all the data can be cross referenced, many which
are from Therefore, the fact sheet serves its purpose of providing interesting statistic, but does
not provide any in depth connections or ideas.

Hussey Freeland, Deborah M. et al. “Oral Immunotherapy for Food Allergy.” ​30 Seminars in
Immunology​, vol.36, 2017

This scholarly journal holistically summarizes current research on oral immunotherapy.

Researchers are attempting to confirm the biochemical pathway of allergies, and the effect of
oral immunotherapy of said pathways that build desensitization. The hypothesized mechanism
for oral immunotherapy success derives from the increase in Treg cells, the slightly higher
concentration of IgG4 antibody, and the higher frequency of the FOXP3 gene. Although the
specific mechanism is not confirmed, oral immunotherapy does induce higher levels of
desensitization, but have not yet reached a threshold of permanent, complete tolerance.
Tolerance, defined as the ability to consume any amount of the allergen without a reaction, has
not been achieved in any clinical trial; therefore, different procedures and forms of oral
immunotherapy are being observed in order to reach this goal. Overall, more further research
must be conduct to illuminate the biochemical pathway, but the treatment is still not ready for
clinical use.
This articles shed light on the biochemical pathway of immunoglobulin-E mediated food
allergies and the biological mechanics of oral immunotherapy. Many diagrams, pictures, and
captions were included, so the concepts were easier to visualize and understand. The descriptions
were detailed and included many acronyms and abbreviations that were not specified, which
caused some initial confusion. However, those with background knowledge in more advanced
immunology and allergy research would have little to no problem with the article’s clarity.
The information is accurate and precise, as the article was published in a well known research
journal and the author works at the famed Stanford University, one of the leading center of oral
immunotherapy research. Overall, the journal provided another perspective on oral
immunotherapy that deviated from the classical clinical trial; therefore it proved to be useful.

JHM. "Allergies and the Immune System." Johns Hopkins Medicine, Johns Hopkins University.

This short article on Johns Hopkins Medicine’s website holistically summarizes allergies
and the immune system. It adequately explains the biochemical pathway of allergies, and
includes a brief list of common symptoms, including wheezing, hives, and inflammation.
Allergies result from a normally non-harmful substance enters in the immune system and
provokes an immune response. White blood cells produce an unique antibody known as
immunoglobulin-E, which is the main component in the biochemical pathway. Patients with
allergies have higher levels of immunoglobulin-E, but higher levels of immunoglobulin-E do not
correlate to more severe reactions. Additionally, allergy treatment is limited to avoidance, but
new treatments, such as oral immunotherapy, are in the research and clinical trial stages. With
further research, this therapy may reach clinical standards.
This brief article targeted the general public, specifically those with allergies or those
with an allergic family member. The article summarizes the information concisely and clearly;
however, the concepts are simplified so even those with no background knowledge can
understand the basics. Therefore, some more specific details and terminology are left out.
Despite its simplicity, the information is accurate when cross referenced, and the provider is a
well known hospital and research site. Johns Hopkins is well known for it medical department
and allergy research center; therefore the information is provided by experts in the field. Overall,
the article is good for background knowledge and basic understand in order to understand more
complex concepts. However, further reading must be done in order to uncover more complex
ideas, including the biochemical pathway of histamines.

Jones, Stacie M., and Amy M. Scurlock. An Update on Immunotherapy for Food Allergy.”
Current Opinion in Allergy and Clinical Immunology,​ vol.10.6, 2010, pp.587–593.

This review observes the current status of immunology in food allergy research. Common
immunologies used for allergy treatment included oral, sublingual, and ​epicutaneous​. Oral
immunotherapy is a potential treatment for food allergies, while ​epicutaneous is considered a
treatment for allergic rhinitis, also known as seasonal allergies or hay fever. Sublingual
immunotherapy generally treats inhalant allergies through the use of a serum containing the
protein or allergen. Oral immunotherapy source is the food itself, while epicutaneous applies the
antigen to the skin. The goal of such therapies are to build tolerance to a threshold where the
patient is no longer affected by their allergy symptoms. Although there are non-antigen specific
treatments, allergen specific treatments appear to be more effective and efficient.
This article was clear and concise; it briefly summarized various forms of allergy
immunotherapy. It describes the three most common in depth, while briefly mentioning any
other methods. This article is a good starting point for research immunotherapy, as it does not
delve in depth on each topic. Therefore, some background research on immunology is required,
but no knowledge on immunotherapy is necessary as it is explained in the article. With this
article other more specific research articles can be more comprehensible.

Keet, Corinne A. et al. “The Safety and Efficacy of Sublingual and Oral Immunotherapy for
Milk Allergy.” ​The Journal of Allergy and Clinical Immunology, vol.​129.2, 2012, pp.
448–455.

This research journal assesses the safety and efficacy of oral and sublingual oral
immunotherapy in immunoglobulin-E mediated milk allergies through a clinical trial. The
experiment was conducted with children from six to seventeen years old who had severe milk
allergies over the course of 60 weeks. Before and after the treatment, an oral food challenge and
skin prick test were conducted for each patient in order to compare the level of desentization. In
addition to noting the dosages given to each patient, blood tests were done in order determine the
level of immunoglobulin-E, IgG4, and Treg cells for each dose of antigen. Eight out of ten
children who under when oral immunotherapy achieve the targeted level of desentization of eight
grams and one out of ten for sublingual. Therefore, oral immunotherapy appears to be more
efficient and effective that sublingual. However both methods of desentization resulted in mild
reactions throughout the dosing.
This article detailed a specific study in depth, which helped assess the procedures of oral
immunotherapy and the risks it entails. The article provided the raw data, analytical graphs, and a
flow chart of the procedures, which certifies the validity of the study as they can be cross
referenced with other sources. In addition, the study was conducted at the Johns Hopkins
Hospital and Duke University Medical Center pediatric allergy clinics, both which are well
known for allergy research. Overall, the article does not describe the mechanism or assess the
risk of oral immunotherapy. It solely describes a study, therefore it requires extensive knowledge
on the immune system and oral immunotherapy to understand.

Lack, Gideon, and Alexandra F Santos. “Food Allergy and Anaphylaxis in Pediatrics: Update
2010–2012.” ​Pediatric Allergy Immunology,​ vol. 23, 2012, pp. 698–706.

This review holistically summarizes the improvements and discoveries made in food
allergy and anaphylactic reactions from 2010 to 2012. In these two years, researchers have
uncovered more risk factors that may result in the development of allergies, including home
environment, season of birth, and maternal history. The differences in environment appears to be
a major factor in the development of food allergies, as seen in the disparity between developing
nations and industrialized countries. With the growing amount of technology and experience in
the field, the use of oral food challenges as a diagnostic has increased tremendously. Despite its
risk, the oral food challenge is the most accurate in comparison to a blood test and skin test.
There has been little improvement in management, as no permanent cure or treatment has been
developed. Therefore avoidance remains the optimal treatment.
This review adequately summarized current research on food allergies in pediatrics, and
covered the most crucial topics in the field: developing factors, treatment, and diagnosis. The
article was written by researchers based in the United Kingdom; therefore it may not apply to the
trends and practices in the United States. However, the data is reliable as the researcher has a
professional degree at a well known hospital in United Kingdom. The article was useful in
determining the current knowledge on food allergies, and assessing the future actions. However,
it lacked a chart that would better organize the data provided, and uses esoteric vocabulary and
abbreviations that require background knowledge for understanding.

Mudd, Kim. Personal Interview. 8 Dec. 2017.

This is a personal interview conducted with Ms. Kim Mudd, the senior nurse at Johns
Hopkins Pediatric Department of Allergy Research. She specializes in with clinical trials that
administer oral immunotherapy in children; therefore, she has hands on experience with the
treatment. Although the treatment has a significant amount of risk, oral immunotherapy is a
potential treatment for immunoglobulin-E food allergies, as it achieves higher levels of
desentization in majority of children. Additionally, there are other methods to reduce the risk of
oral immunotherapy, the most common being an immunoglobulin-E binding drug, xolair. The
procedure is still evolving, but with more adjustments the procedures become less labor
intensive, more efficient, and safer for patients.
 This interview was very informative and clarified the procedures of oral immunotherapy.
The interviewee was very detailed in her explanations, but simplified terms when necessary. The
interviewee is credible, as she works at Johns Hopkins Pediatrics as a senior nurse in allergy
research. She has personal experience administering oral immunotherapy and academic expertise
in the field. The interview covers the many aspects that the interviewer aimed to cover. However,
although all the topics discussed are related, the subjects switch frequently and occasionally lead
to tangents. The interview was effective in provide specific concepts, but fails to give a holistic
view of oral immunotherapy. One must have prior knowledge of the topic in order to understand
majority of the interview.

Nowak-Węgrzyn, Anna, and Hugh A. Sampson. “Future Therapies for Food Allergies.” ​The
Journal of Allergy and Clinical Immunology​, vol.127.3, 2011, pp. 558–573.

This research journal holistically described several upcoming treatments for food
allergies. Those with the highest potential for clinical use are oral immunotherapy, sublingual
immunotherapy, and anti-immunoglobulin-E therapies. Oral immunotherapy, specifically, has
shown high potential in clinical trials for eggs, peanuts, and mild. Despite the higher of reactions
and even anaphylaxis, the treatment has yet to cause a fatal reaction and does indeed achieve
higher tolerance. Very few studies have achieved tolerance, but many have reached a level of
desentization that allows the patient to be healthy after accidental consumption. Non-allergen
specific treatments such as anti-immunoglobulin-E therapies show some potential as they
prevent adverse allergic reactions in animal models. However, none of the treatments mentioned
above are ready for clinical practice, due to inconsistency in results and the ever present risk of
reactions.
This journal was useful in assessing oral immunotherapy in comparison to other potential
treatments. Short descriptions and analysis were written for each treatment, which highlight the
pros and cons of each. The journal remains unbiased throughout its assessment, and the
information is accurate because the journal was developed at Duke University and provided by
the US National Library of Medicine through the National Institutes of Health. The article does
not go in depth, nor provides specific data in its analysis, instead it identifies trends and specific
studies. This article provides sufficient background information needed to understand other more
detailed and in depth article about these specific treatments. Therefore, this article should be used
as a starting point for allergy treatment research, as it provides basic knowledge of many
different treatments,

Pajno, Giovanni B. et al. “Oral Immunotherapy for Treatment of Immunoglobulin E-Mediated

Food Allergy: The Transition to Clinical Practice.” ​Pediatric Allergy, Immunology, and
Pulmonology,​ vol.27.2, 2014, pp.42–50.

This medical journal assesses oral immunotherapy potential to be a clinical treatment for
immunoglobulin-E mediated food allergies. As of now, the only treatment for allergies is
avoidance and epinephrine when an emergency arises. However, with oral immunotherapy
success in clinical trials, it is transitioning into a viable practice to achieve desentization. In
comparison with other possible treatments, such as sublingual immunotherapy, oral
immunotherapy succeeds more often in achieving the targeted level of desentization over shorter
periods of time overall. Clinical trials have tested different procedures of oral immunotherapy,
such as rush immunotherapy and slow dosing, and weekly dosing, but no difference hae arises
from differences in timing. However, despite the success in desensitization, no patients have
reached the threshold of complete tolerance; thus, more research must be conducted to achieve
such goal. Additionally, despite its success in clinical trials, oral immunotherapy is no ready for
clinical use due to the lack of insight in the mechanism and the frequency of mild reactions
during the dosing periods. More consistent and safe results must be achieved in order to
transition to a clinical treatment.
The article was very helpful in identifying the strengths and weaknesses of oral
immunotherapy, in addition to summarizing what is currently known about oral immunotherapy.
The journal remains unbiased, pointing both flaws and success of the treatment; therefore it is
able to make an accurate conclusion on oral immunotherapy’s status as a treatment. However,
the paper requires though background knowledge in immunotherapy as many abbreviations,
esoteric terminology, and specific pathways are mentioned without explanation. Additionally, to
support its findings, the journal includes a table summarizing all the the published oral
immunotherapy studies and clinical trials. All the studies are cited and can be crossed referenced
to assess validity. The journal itself is accurate as it was published in the Journal of Pediatric
Allergy, Immunology, and Pulmonology, a globally recognized journal. Overall, the article was
useful in determining the current status of oral immuthepty and the improvements that it must
develop in order to be recognized as a clinically efficient treatment.

Silber, Glenn M., Dr. Personal Interview. 4 Jan. 2018.

This was a personal interview done with Dr. Glenn Silber, an allergist at the Allergy and
Asthma Center of Maryland. He has professional experience treating children with food allergies
or asthma. The interview discussed a clinicians view on the safety and effectiveness of oral
immunotherapy. Many clinicians are hesitant about using oral immunotherapy due to its
inconsistencies and high risk, but they believe that the future of allergy treatment lies in
desentization. The desensitization may result from gradual exposure to antigens during infancy
in order to build tolerance early. Additionally, the oral immunotherapy is not ready for clinical
practice because there are children who react very poorly to oral immunotherapy and those that
do not build tolerance despite consist exposure. The supplement of xolair may assist in the
effectiveness of the treatment, and despite the FDA’s black box warning on xolair, the drug has
been approved by many physicians for safe use. Overall, oral immunotherapy is not ready for
clinical use as variable and many of the mechanisms are a mystery.
This interview was very helpful as it provided a different view on oral immunotherapy, as
clinicians voice more concerns about consistency. The interviewee is an allergist who regularly
works with children, who have varying conditions and severity of allergies. His view differed
greatly from a researcher, as he considered the labor involved, the familial responses, and the
patient’s physiological factors. The interviewee has been in the allergy field for more than a
decade, and has extensive knowledge on both the upcoming treatments and the concerns of the
patients. This interview provided a better understanding of the risks and shortcomings entailed
with oral immunotherapy. Thus, it provided an enlightening view on the improvements oral
immunotherapy must achieve in order to become a viable treatment.
Skripak, Justin M. et al. “A Randomized, Double-Blind, Placebo-Controlled Study of Milk Oral
Immunotherapy for Cow’s Milk Allergy.” ​The Journal of Allergy and Clinical
Immunology​ ,vol.​122.6, 2008, pp.1154–1160.
This is a research journal published in the journal of allergy and clinical immunology. It
details a study conducted at Johns Hopkins University Hospital in Baltimore, Maryland and
Duke University Medical Center in Durham, North Carolina. Children from six to twelve years
old with severe immunoglobulin-E mediated milk allergies underwent oral immunotherapy for a
duration of three to four months. Both a skin prick test and an oral food change were conducted
before and after the treatment in order to assess the amount of desensitization built during the
duration for the treatment. Most children did desentize to the allergen by significant margins, and
a median of 5140 mg of the antigen was tolerated. There were little differences in
immunoglobulin-E levels before and after treatment, yet there was an increase in the amount of
IgG4 antibodies after treatment. However, despite the overall success, oral immunotherapy still
poses a risk due to the high frequency of mild reactions during the dosing phases of the
immunotherapy.
This article describes a specific study and provided in depth analysis of the results and
implications. It succeeded in illuminating the potentials of oral immunotherapy by highlighting
the high percentage of children that achieved greater levels of desentization. However, safety and
logistics were considered; therefore, the article remains unbiased. The document well organizes
the information provided, as it thoroughly describes its procedures, findings, and background
research. The procedures are valid and were conducted at two well known allergy research sites,
making the clinical trial reliable and accurate. The article fails to analyze the pros and cons of
oral immunotherapy, but instead studies it shortcomings and successes. Overall, the article is
useful in familiarizing one to the procedures and conduct of oral immunotherapy studies, but
should not be used for learning the concept itself.

Streiber, Melanie Thernstrom. “I Can Eat It.” ​Stanford Medicine​, 20 Oct. 2017,
stanmed.stanford.edu/2014fall/i-can-eat-it.html.

This is an article published in Stanford University’s medical magazine. It describes the

research and experiences of Kari Nadeau, a pioneer in the oral immunotherapy treatment. Food
allergies can be deadly, impeding children from living their daily lives in fear that they might die
from a reaction. An upcoming treatment for desensitizing allergies is oral immunotherapy, which
is feeding small dosages of an antigen and increasing the dosage slowly until immunity is build.
However, oral immunotherapy is not widely used due to the limited research and the risk of
deadly reaction. Nadeau ran a clinical trial using such treatment, and ended with positive results:
not deadly reactions and almost complete desensitization. But without constant intake of the
allergen, the allergy has a chance of coming back. Nadeau is currently doing research on a
FOXP3 gene, which codes for Treg cells, cells that regulate the immune system.
The article is credible; it comes from Stanford University’s medical department, which is
well known around the world. The article is explains the basic process of the mechanisms and
describes the impact on the lives of those involved in the project. However, the article was only
an introduction the topic and written in a fashion so the public can understand the research. It
fails to explain the biological mechanisms or the results of the clinical trials in depth. The article
provided a very brief, overview of the potential of oral immunotherapy in treating food allergies,
but failed to give information on the actual procedures. Despite this, the article was useful in
discovering a topic of research, and peaking interest in alternative methods of allergy treatment.

Stewart, Gregory John. “Allergies and Autoimmune Diseases.” ​The Immune System​, Chelsea
House, 2009, pp. 82–99.

This book holistically covers the workings of the immune system. Specifically one
chapter describes allergies in more depth. Allergies are the an immune response and
inflammatory response to an antigen that should normally be unharmful. This immune response
derives from the binding of an IgE, a specific type of antibody that binds to mast cells and
granulate white blood cells. IgE form when an antigen is first exposed to a B cell; the reason for
the creation is unknown and still a topic of research. When an antigen binds to an IgE, the IgE
now has the capability to bind to these immune cells, which triggers the release of histamines
and other granules. Histamines is the main cause of an inflammatory response, which can lead to
anaphylactic shock in severe cases. Anaphylactic shock is the common cause of death when
dealing with allergies. Today, people prescribe epinephrine, which blocks all inflammatory
responses for emergencies, and antihistamines to minimize symptoms.
Overall, the book was useful in providing the background information needed to
understand more complicated articles. Allergy research is built on the foundation of
immunology. Without a strong understanding of immunology, understanding the research
journals and papers is nearly impossible. The book is well organized by topic with clear
diagrams of the mechanisms in which the IgEs bind and the response they induce. In other
words, the book is an overarching guide on the immune system, which acts as a stepping stone in
comprehending higher level, more specific papers. The source proved to be very useful, as it
created a strong background knowledge on the biological response known as an allergy.

Varshney, Pooja et al. “A Randomized Controlled Study of Peanut Oral Immunotherapy (OIT):
Clinical Desensitization and Modulation of the Allergic Response.” ​The Journal of
Allergy and Clinical Immunology, ​vol.​127.3, 2011, pp.654–660.

This research journal details a peanut oral immunotherapy clinical trial conducted at
Allergy and Immunology clinics at Arkansas Children's Hospital and Duke University Medical
Center. The study consisted of children from one to sixteen with severe peanut allergies, and the
patients underwent oral immunotherapy for twenty one months. Each patient received an initial
dose of 0.1mg of peanut, and if the patient consumed the dosage without a severe reaction, the a
larger dose was given. Escalation of doses were solely conducted in the clinics, but in order to
maintain the desenixation built. Patients were required to take maintenance doses at home. To
ensure safety, both epinephrine and antihistamines were in the patient’s homes, and patients
logged any reactions or discomforts in a log book. Overall, sixteen of the twenty seven children
reached the threshold of 5000 mg of peanuts. However more research must be conducted as three
patients required epinephrine and the overall mechanism remains a mystery.
This journal assisted in comprehending the procedures and method of oral
immunotherapy clinical trials. The article provided raw data and analysis of said data, which
allowed for comparisons between several similar clinical trials. The graphs and charts detailing
the procedures, data, and trends concisely and clearly summarized the findings and allow for
future comparisons. The article outlines the experiments procedures, which align with many
other similar peanut oral immunotherapy experiments. Therefore the results can be compared
and contrasted. The data and clinical trial are valid, as the results were published in a well known
journal, The Journal of Allergy and Clinical Immunology. The authors are well known
researchers in the feild, and the clinics where the trials were held are known for allergy research.
Overall, the research journal was useful because the data and findings can be compared with
similar studies. However, comprehension requires extensive background knowledge on food
allergies and immunology.

Venes, Donald. ​Taber's Cyclopedic Medical Dictionary​. 23rd ed., F.A. Davis, 2017.

This is an definition and description provided in a medical dictionary. The short

paragraph describes the symptoms and biological mechanisms affiliated with anaphylactic
reactions and shock. Anaphylactic reactions result from an exposure from a normally non
harmful substance known as an antigen. When this specific antigen is exposed to white blood
cells in the immune system, the white blood cells produce antibodies, called immunoglobulin-E.
Immunoglobulin-E signals the immune system, and triggers multi pathways, including
anaphylaxis. Anaphylaxis is a severe reaction, and majority of the symptoms are deadly. The
common symptoms include swelling of respiratory pathways, hives, internal inflammation, and
external inflammation. Thus, this is the most serious and fatal reaction due to an allergy among
adults and children alike.
The source was helpful in simplifying complicated biochemical pathways into easier
explanations. Like all dictionaries, this medical dictionary divides concepts by terms; therefore,
the explanations are clear and concise. Although the explanations were concise, they did not lack
the necessary details or proper terminology. The source is accurate, as the publisher is well
known, and there are multiple editions of this medical dictionary. The dictionary included
pictures, but did not provide diagrams, which made some of the more difficult concepts harder to
visualize. The dictionary was useful in gaining a general understanding of the anaphylactic
pathway, but did not provide an in depth analysis of each part of the system. Overall, the
information was good for general knowledge.

Vickery, Brian P. et al. “Early Oral Immunotherapy in Peanut-Allergic Preschool Children Is

Safe and Highly Effective.” ​The Journal of Allergy and Clinical Immunology, ​vol.139.1,
2017, pp.173–181.
This is a research journal that analyzes a study which tested oral immunotherapy in
children from 9 to 36 months. With detection of allergies occurring earlier in children’s lives, the
initiation of a treatment may occur earlier as well. In this trial, 37 children participated, and there
was a range of race, gender, and age. The children achieved various levels of desensitizations,
and no children were hospitalized in the process. However, about eighty percent of the children
did induce mild reactions. Within the clinical trial, there were three groups: a high dose, low
dose, and a control. 80% of the patients involved did reach the targeted level of desentization.
Immunoglobulin-E,SPT, and IgG4 levels were measured, but the level of desentization and these
levels show no correlations,
 This journal was successful in describing the specific clinical trial. However, it does not
holistically observe oral immunotherapy. Therefore it does not observe the pros and cons of oral
immunotherapy, rather the article focuses on the overall effect on this specific group of patients.
The study was conducted by well known university, such as Johns Hopkins and Duke University,
both which are highly involved in allergy research.

Wood, Robert A. “Food Allergen Immunotherapy: Current Status and Prospects for the Future.”
Journal of Allergy and Clinical Immunology, vol. 137, no. 4, pp. 973–82,
doi:10.1016/j.jaci.2016.01.001.

This is a scholarly article analyzing the prospect of the clinical application of oral
immunotherapy for treating immunoglobulin-E mediated food allergies. The treatment is not
perfected yet, therefore more research must be done and clinics must proceed cautiously. The
final goal for oral immunotherapy is to build a level of desentization, so if a patient accidentally
consumes the antigen, there is no severe reaction. It is unlikely that the treatment will achieve
complete tolerance, meaning they can not eat the allergen freely. In pursuing these trials, safety
is the utmost concern, as the chances of a reactions is likely; however, no fatal reaction has
occurred in any food oral immunotherapy trial. In comparison to other potential treatments, such
as sublingual immunotherapy, oral immunotherapy has a greater success and degree of
desentization; therefore, making it a likely candidate for a clinical treatment, Although there is
risk involved, the controlled environment and medical professionals present when oral
immunotherapy occurs, increases safety.
This scholarly journal was effective in summarizing and highlighting the important
aspects of oral immunotherapy. It discusses oral immunotherapy from a more clinical standpoint,
as it considers the labor and safety risks. The article takes a stance for oral immunotherapy,
therefore it may include some bias, but it acknowledges the risks that accompany the therapy as
well. The author is a well known researcher at John Hopkins University, which is a well known
center for allergy research. Additionally, the article includes a works cite, which includes other
well known organizations and articles; therefore, the article is credible and accurate. The journal
provides in depth analysis of the treatment and data from clinical trials. The article assumes the
reader has high levels of background knowledge, and an understanding of proper terminology.