Immunomodulation for Plant-Based Food Allergy, With María José Torres Jaén, MD, PhD

At the 2026 American Academy of Allergy, Asthma & Immunology (AAAAI) annual meeting in Philadelphia, María José Torres Jaén, from Hospital Regional Universitario de Málaga in Spain, presented emerging work on immunomodulation for plant-based food allergy.

The presentation focused on allergy driven by lipid transfer proteins, known as Lipid Transfer Protein Allergy. These proteins are highly stable plant allergens that resist digestion and can trigger systemic reactions, including anaphylaxis. Because lipid transfer proteins are present in multiple plant foods, patients often demonstrate sensitization to several fruits, vegetables, or nuts simultaneously.1

Torres emphasized that accurate diagnosis requires distinguishing sensitization from true clinical allergy. In practice, this may involve a combination of skin testing, controlled food challenge procedures, and laboratory tools such as the basophil activation test.

During the session, Torres highlighted 3 lines of research exploring immunomodulatory strategies.

Sublingual Immunotherapy with Peach Allergen

The first strategy involves sublingual immunotherapy targeting peach lipid transfer protein allergens. This approach is currently being evaluated in a phase 3 clinical trial, according to Torres.

Earlier studies of sublingual immunotherapy using peach allergen have demonstrated improvements in immune tolerance among sensitized patients.2 Torres highlighted an additional potential benefit observed in current research: immunotherapy directed at peach allergens may also influence tolerance to other foods containing related lipid transfer proteins.

According to Torres, patients treated with peach-based immunotherapy have shown improved tolerance not only to peach but also to other plant foods.

“Using the SLIT with peach, we were also able to modify the tolerance to peanut,” she said. “This [is] extremely important because with one immunotherapy, you can modify the tolerance to other fruit[s].”

Nanostructure-Based Immunotherapy in Preclinical Development

The second research area involves nanostructure-based immunotherapy currently in preclinical development, following animal model studies.

Researchers engineered nanostructures containing peptide fragments derived from peach allergens and evaluated their effects in experimental models of food allergy. Torres noted that the findings demonstrated both short-term desensitization and longer-lasting immune tolerance.

Tolerance persisted even after treatment discontinuation. In animal studies, the immune protection remained for ≥ five weeks after immunotherapy stopped, suggesting the approach may induce durable immunologic changes rather than temporary desensitization.

The research has progressed to safety studies, which represent a preparatory step before potential phase 1 human trials.

Prebiotic Modulation of Food Allergy

A third line of investigation explores whether prebiotic supplementation can modify allergic responses through the gut–immune axis. Torres described a human study evaluating pectin-based prebiotics derived from apple and citrus.

In the study, patients with confirmed peach allergy received pectin supplementation for 2 months. Torres reported that approximately 30% of participants who initially reacted to peach during provocation testing became tolerant after treatment.

Based on these findings, researchers are planning a phase 2 clinical trial to further evaluate the strategy.

Expanding Research in Food Allergy

Although the session focused on plant-based allergens, Torres emphasized that additional research is needed across a wider spectrum of food allergies. Future trials will be important for common allergens such as milk, egg, fish, and seafood, which frequently affect children and can significantly impact diet and quality of life.

“[Food allergy] is increasing in number and in severity,” Torres said. “We need to have [an] appropriate way of diagnosing. That is why the in vitro tests are so important. Laboratory tests, such as activation test, [are] extremely important for diagnosis…we need to try to find immunomodulatory treatment.”

Torres has no reported disclosures.

References

1. Skypala IJ, Asero R, Barber D, et al. Non-specific lipid-transfer proteins: Allergen structure and function, cross-reactivity, sensitization, and epidemiology. Clin Transl Allergy. 2021;11(3):e12010. Published 2021 May 18. doi:10.1002/clt2.12010

2. Bagos G, Gómez F, Salas M, et al. Evaluation of peach tolerance after one year of sublingual immunotherapy with LTP (Pru p 3) in allergic patients sensitises to food by LTPs. Clin Transl Allergy. 2015;5(Suppl 3):O14. Published 2015 Mar 30. doi:10.1186/2045-7022-5-S3-O14