Providing a modern and comprehensive approach to food allergy management.
The Food Allergy Center of St. Louis, a division of Allergy, Asthma & Sinus Care Center, has been offering food allergy “OIT” or oral immunotherapy/food desensitization to treat food allergies since 2016, when our first patient (the daughter of one of our providers) was desensitized to peanut when she was 9 years-old. Since then, more than 60 patients have successfully completed OIT to foods with more than 60 additional patients currently going through active treatment.
At the end of the active treatment phase, the vast majority of food allergic patients are able to safely consume the food without having reactions.
What is OIT?
Oral Immunotherapy (OIT) is the process of desensitizing someone to a food to which they are allergic by giving very tiny doses of that food and slowly increasing the amount of the dose over time. It is a way to get a person who has life-threatening food allergy to be able to consume the food without having a reaction. This is not necessarily a “cure” for food allergies, and people need to consume the food on a daily basis to prevent reactions in most cases. They should also continue to have access to their epinephrine autoinjectors. However, promising studies suggest many children (especially younger children) may not have to consume the food daily after several years on maintenance therapy to be protected.
OIT consists of three phases:
Modified rush desensitization (“Day 1”)- Patients are in the office for 5-6 hours and start with minuscule amounts of the offending food with increasing doses and are discharged with a small daily dose of the food which is consumed daily at home.
Build up dosing (“dose escalation” or “up-dosing”) phase- Over approximately 6 months, the amount of the food consumed is increased, usually every 1-2 weeks, under medical supervision in the office. Patients usually need to budget an hour of time for these visits.
Maintenance phase- After approximately 6 months, patients are challenged with a large serving of the food of concern (ex. 24 peanuts or 8 ounces of milk) and observed for 2 hours. If they pass the challenge, the will continue to consume the food daily at home.
OIT is also very effective with over 85% of patients able to successfully go through OIT.
What are the goals of OIT?
The primary goal of OIT is to prevent an episode of anaphylaxis (severe life-threatening allergic reaction) with an accidental ingestion of an allergen such as peanut. However, most individuals who go through OIT will eventually be able to consume the allergenic food and incorporate it into their diet.
What are the risks/side effects associated with OIT?
The most common side effects are some itchy mouth/throat and abdominal pain/discomfort. The main and most serious risk when going through the OIT process is having a serious allergic reaction or anaphylaxis. While this is a significant concern, a large study on OIT found that only 95 doses of epinephrine were used for over 240,000 OIT doses, which is a risk of 0.04%, and for most families, the benefits far outweigh the risks.
There is also a 3-5% risk of developing an inflammatory condition of the esophagus called eosinophilic esophagitis or “EoE”. If EoE develops, stopping or slowing down the OIT process generally resolves this condition.
How young can OIT be initiated?
The youngest patient in our practice to complete OIT started at 5 months of age and is doing very well. In fact, the younger the patient, the better the outcome in the vast majority of patients. A 2017 study published in the Journal of Allergy and Clinical Immunology (“Early oral immunotherapy in peanut-allergic preschool children is safe and highly effective”) by Vickery et al., concluded that “E-OIT [early-OIT] had an acceptable safety profile and was highly successful in rapidly suppressing allergic immune responses and achieving safe dietary reintroduction.”
Is OIT a new treatment for food allergies?
OIT has been offered by board certified allergists across the country for over 10 years, but there are reports of OIT being done successfully from over 100 years ago.
Where can I obtain more information on OIT?
If you are interested in learning more about food allergy treatment options, please call our office at 314-849-8700 to schedule an initial consultation with one of our providers. Most insurances cover this treatment. After you have scheduled your consultation, please go to http://www.aascare.com/patient-info/your-first-visit/ to download forms to fill out and bring to the initial visit. Please note, at least one week before your appointment, we need the following:
1. Most recent food allergy lab tests
2. Any allergy (food and environmental) skin test results
A couple of our patients and our practice were featured on KMOV Channel 4 regarding OIT in May 2018
You can also read more about OIT at http://www.aascare.com/treatment-for-food-allergies-what-is-oral-immunotherapy-or-oit/
Please note that your first consultation visit regarding OIT will be primarily focused on discussing food allergy and OIT, and follow up visits may be required to optimize asthma and other allergic conditions to safely go through OIT.
We look forward to partnering with you and your family to improve health outcomes!