Food Oral Immunotherapy
(OIT) Food Oral Immunotherapy
Food Oral Immunotherapy, or OIT, is the process of desensitizing a patient by ingesting increasing incremental amounts of an allergenic food in a monitored medical setting. The immune system is retrained to no longer react to the allergenic food. Food OIT has been studied in trials for over a decade and the concept of immunotherapy for environmental allergens has been in clinical practice for over a century.
Who is a good candidate for oral immunotherapy?
OIT has been successful in a wide range of ages and foods. Other allergic diseases such as asthma must be well controlled prior to starting desensitization. OIT is contraindicated in patients with eosinophilic esophagitis.
What is the process for oral immunotherapy?
There is an initial visit 2-3 weeks prior to onset of desensitization to review the protocol in detail and ensure that all other allergic diseases are well controlled. The first day of treatment is a build-up day, starting with a very small amount of allergen (i.e. 1/125,000th of a peanut) with increasing doses given every 20 minutes for several hours. The last tolerated dose is then ingested daily at home until the next incremental increase in the office in at least 7 day intervals. The food dose continues to increase with the goal of being able to freely eat the formerly allergenic food as desired at the end of the several month process. There typically is a food challenge at the end of the build-up phase to show that the patient can tolerate ingesting the usual serving size of the food while in the desensitized state.
Frequently asked questions
What is the goal of this process?
The number one goal is safety; to allow the patient to ingest the allergenic food and foods that contain the allergenic food without worrying about it.
How long will the entire process take?
The first day procedure will take about 5 hours. If there are no problems during the escalation phase, the patient will be eating a full serving of the allergenic food in about 5 months.
Should routine allergy medications be stopped before the first day procedure?
No. Patients should take all rountine medications as they normally would during OIT.
How often can the dose be increased?
There must be a minimum of 7 days between dose increases (7 doses given), but patients may decide to go longer between dose increases if they so choose.
When can foods containing the allergenic food be introduced into the regular diet?
Foods containing the allergenic food may be introduced into the diet at the end of the entire oral immunotherapy escalation process as instructed by your physician.
With once daily dosing, is the time of day that the dose is given important?
Time of day is not important but the amount of time between doses is important. We have achieved a delicate balance that depends on a certain amount of the allergenic protein being in their system at all times. You should try to give the once a day dose at the same time every day (21-27 hours between doses.)
Does my child need to avoid exercise during the oral immunotherapy process?
Exercise should be avoided for at least two hours after dosing and doses should not be given immediately following exercise. Exercise around the time of dosing increases the chance of a reaction. Exercise restriction applies to both escalation and maintenance dosing.
How much of the allergenic food can/must my child eat during the maintenance phase of the oral immunotherapy process?
In most cases the food may be freely added to the diet after reaching the maintenance phase of food OIT treatment.
Against what foods can one be desensitized?
Currently, we can desensitize against peanuts, tree nuts, egg, milk, and additional foods.