Understanding (OIT) Oral Immunotherapy

Understanding oral immunotherapy starts here: a detailed look at how this cutting-edge treatment can desensitize you to food allergens, like peanuts, milk, eggs, wheat, tree-nuts, sesame, etc., and what that journey involves. From the breakthrough science behind it to the practical steps of managing daily doses—learn the essentials without the medical jargon.

Young Teenager after completing Oral Immunotherapy

Key Takeaways

Oral Immunotherapy (OIT) is a treatment for food allergies where patients are gradually exposed to increasing amounts of an allergen, aiming to build tolerance and reduce allergic reactions. While effective for various food allergies, so far the FDA has approved OIT for peanut allergies.

The OIT process involves three phases: initial dose escalation, build-up, and maintenance, with the intention of increasing the body’s tolerance to allergens and decreasing the risk of severe allergic reactions. This applies to all foods, including the peanut OIT.

OIT can have significant benefits but also carries risks and potential side effects, such as allergic reactions, anaphylaxis risk, and possibility of eosinophilic esophagitis (EoE). The OIT helps patients reach the state of desensitization and tolerance over time.

How Oral Immunotherapy works? (OIT)

Oral Immunotherapy (OIT) is a revolutionary approach for addressing food allergies. It involves gradually introducing small amounts of the allergen into a patient’s daily diet in order to desensitize them and increase their tolerance. This process, closely monitored by medical professionals, aims to reduce the severity of allergic reactions.

During OIT treatment sessions, patients are given increasingly larger doses of the allergen. This carefully controlled method helps individuals build up resistance and has proven to be an effective form of food allergy treatment, often considered one of the best available options for managing food allergies successfully.

The Science Behind OIT

The science behind oral immunotherapy (OIT) is both fascinating and life-changing. The treatment involves gradually exposing the body to small amounts of an allergen, which helps reduce allergic reactions over time. This process known as desensitization strengthens the body’s ability to tolerate food allergens.

We have been providing the OIT for peanuts and other common foods for many years. The FDA has approved products for peanut OIT and hopefully will approve many more foods.

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young girl holding a peanut m&m after undergoing food OIT

Types of Food Allergies Treated with OIT

OIT has a wide range of applications and can be used to treat common and uncommon food allergies such as peanuts, tree nuts, milk, eggs, wheat, sesame, soy, and many more. In cases involving infants and young children with confirmed allergies, the OIT can be started at a younger age.

When dealing with multiple food allergies in children and adults, it’s important for our team to collaborate closely with parents/caregivers before deciding on which allergen/s should be addressed first during treatment using OIT. We can combine multiple foods during the same cycle of OIT.

The Journey from Peanut Allergy to Tolerance

The approach to achieving tolerance for peanut and other food allergies through oral immunotherapy (OIT) is a meticulous and well-planned process. In the first starting day appointment, which typically takes 4-6 hours, the allergic patient will receive gradual doses of increasing amounts of food protein.

This method focuses on gradually building up exposure in order to enhance tolerance levels over time. The child must consume daily measured amounts of food protein during this up dosing phase until reaching a maintenance level where they continue consuming an allotted amount consistently or as directed by our team in order to sustain their developed tolerance against peanuts.

Phases of Peanut and other Food OIT Treatment

Peanut OIT and other food treatment involves three stages: initial dose escalation, build-up, and maintenance. The first stage is also referred to as ‘rapid desensitization’ or ‘rush immunotherapy’, where a small amount of the food allergen is given to the child for about 4-6 hours.

After completing the initial dose escalation, up-dosing begins in which the quantity of the food allergen gradually increases every one to two weeks until reaching the desired maintenance dose. These steps are personalized, planned and performed by our team to ensure safe and effective treatment.

Managing Multiple Food Allergies with OIT

OIT has the ability to manage multiple food allergies at once, not just a single one. This is made possible by creating personalized treatment plans for each specific allergen.

From milk and eggs to peanuts, tree nuts, wheat, soy, sesame and baked goods containing these ingredients, OIT can be applied for various types of food allergies. There are many factors that we consider before deciding single vs. multi-food OIT and foods that can be combined. This gets designed based on safety, risks, and the commitment level of the family.

Combining Treatments for Different Food Allergens

When dealing with multiple food allergies, it is important to have a strategic plan for incorporating treatments for each allergen. This may involve adjusting dosages and timelines according to the individual patient’s needs and progress. It is possible to distribute doses evenly among four to six different food allergens.

Maintaining open communication with our team throughout the treatment process is crucial in order to promptly address any concerns that may arise. By doing so, patients can ensure their safety during treatment and increase their chances of successfully managing their multiple food allergies.

Weighing the Pros and Cons of OIT

While there are numerous benefits to utilizing OIT, it is important to carefully weigh both its strengths and limitations. One of the main advantages is that OIT has demonstrated a high success rate in achieving maintenance dosing within a span of six to twelve months. The reported rates for desensitization through OIT continue to increase and now over 90 percent, suggesting that a majority of patients could potentially achieve desensitization through this treatment method.

Success Rates and Effectiveness

A thorough examination of the success rates and effectiveness of OIT reveals how significantly desensitization can improve one’s quality of life. For example, children and families are able to enjoy the freedom of travel and eating out without stress is freeing and life changing.

Achieving higher levels of tolerance through this therapy - for instance going from 1mg to 2,000mg of food protein - has been found to greatly reduce the risk of experiencing a severe allergic reaction upon accidental exposure. In fact, continuous treatment may even result in Improvement beyond what was initially achieved during the early stages, ultimately benefitting individuals to reach free eating and tolerance. There are no more struggles with symptoms related to their food allergies.

Potential Side Effects and Complications of Food OIT

It is crucial to stay up-to-date on the potential side effects and complications associated with OIT. For instance, there is a possibility of an allergic reaction such as anaphylaxis that could require epinephrine during food oral immunotherapy, with a reported occurrence rate of 7-10%. This risk should be considered when deciding whether or not to undergo this treatment method. Approximately 2-3% of Individuals undergoing OIT may also experience eosinophilic esophagitis (EoE), which can cause hypersensitivity in the esophagus. Other potential adverse reactions include abdominal pain, nausea and vomiting.

Preparing for Oral Immunotherapy: Tips for Success

Proper preparation is crucial when considering the potential benefits and risks of oral immunotherapy (OIT). This includes familiarizing oneself with the treatment process, managing daily routines effectively, and making necessary lifestyle adjustments.

To ensure patients are following their recommended dosing regimen for OIT, there are several methods that can be utilized. These include keeping a documented schedule, maintaining an organized dosage schedule within close reach at all times. Additionally, engaging in calm activities for two hours after each dose can help prevent any adverse reactions or discomfort. Eating prior to taking an OIT dose can minimize GI symptoms. We invest a lot of time on education with each family to maximize the success of OIT.

Managing Daily Routines and Lifestyle Changes

It is crucial to make adjustments to daily routines and incorporate lifestyle changes in order for OIT treatment to be successful. Patients must avoid activities that increase body temperature or heart rate 30 minutes before and 2 hours after dosing, including intense physical activity, hot showers, and certain medications like ibuprofen. It is also important for them to consume a meal with complex carbohydrates prior to up-dosing.

Vigilance plays a critical role in monitoring for potential side effects of the treatment, while open communication with our NYFA team is essential in addressing any concerns or issues promptly. These strategies help facilitate the management of daily OIT dosing and greatly contribute towards achieving success in the overall treatment process.

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Young girl completing the Oral Food Challenge

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Frequently Asked Questions

Who is a candidate for oral immunotherapy?

Individuals with food allergies who are dedicated to undergoing oral immunotherapy (OIT) can be considered suitable candidates, regardless of the severity of their allergy.

Those who experience severe and potentially life-threatening reactions to certain foods would see the greatest benefits from OIT.

What is an example of oral immunotherapy?

One form of oral immunotherapy is used in the maintenance phase for treating a peanut allergy. This involves consuming a precise amount of peanuts daily to gradually build up tolerance. It is crucial to follow our guidance throughout this process, as stopping or altering the treatment can lead to increased risk of reactions and potentially reverse progress made against the allergy.

Is oral immunotherapy FDA approved?

The FDA has approved a peanut product for oral immunotherapy treatment, reducing the impact of allergic reactions in individuals who have a medically confirmed diagnosis of peanut allergy. It is nice to have DFA approved products to do the process of food OIT, but it is not necessary to start and complete OIT for other foods.

What does OIT mean for allergies?

Oral immunotherapy, also known as OIT, is a gradual increase in the amount of an allergenic food given to someone with allergies. The goal is to build up their tolerance and decrease the chance of having a reaction. This method helps individuals become less sensitive or get desensitized to specific foods they are allergic to.

Can OIT treat multiple food allergies?

OIT has the capability to address multiple food allergies concurrently through individualized treatment strategies for each specific allergen. This means that all of a person’s known food allergies can be targeted and managed individually or simultaneously with customized plans.

Who can perform Oral Immunotherapy?

Oral immunotherapy must be done by food allergy experts, like the NYFA team with resources to plan and execute OIT with safety and best outcomes. Dr. Atul Shah and his team at NY Food Allergy & Wellness have 3 offices. Locations on Long Island: Centereach and Shirley. Manhattan: 110 E 60th Street. Please visit https://www.center4asthmaallergy.com/ for locations on long island. And visit https://www.nyfoodallergy.com/ for our Manhattan location.

Where can I learn more about Oral Immunotherapy?

You can learn more about the Oral Food Challenge, as well as all of the food allergy treatment options by watching success stories on our YouTube channels. NY Food Allergy & Wellness and Center4Asthma&Allergy.