Oral Immunotherapy for Food Allergy

1. Oral Immunotherapy for Food Allergy Oral immunotherapy for food allergy has gotten a lot of attention recently. It has been something that has intrigued patients, parents of food allergic children as well and allergists as a potential future therapy. Currently, the standard of care for patients with food allergy is strict avoidance of the trigger food(s). Oral immunotherapy, or OIT, requires patients to start consuming a tiny amount and subsequently consume a larger and larger amount of the food to which they are allergic until their bodies become desensitized to it. Oral immunotherapy patients generally start consuming the biggest serving they can tolerate without a reaction (which is sometimes a dose as little as 1/10,000th of an egg) and slowly build up from there over the course of months. Once they reach their target dose (generally what would be considered a normal portion size such as a peanut butter sandwich), patients must eat the food on a daily basis to keep their bodies from regaining the allergy. This is called the state of desensitization. While oral immunotherapy has shown promise in clinical trials, it remains experimental. Some researchers have criticized those in clinical practice for making OIT available too soon, before more rigorous studies have been completed to assess its safety and effectiveness. This is definitely a controversial topic in our field today, but I always think it is a good thing when 2 groups of very smart physicians challenge each other and really think about how we will progress as a specialty to help our patients in the safest and most beneficial way. I have many patients and friends ask me my personal opinion on OIT. I think that OIT for the treatment of food allergies is promising. Many studies have showed that OIT can desensitize the majority of patients who undergo it. My main hope is that there will be more data in the future regarding if OIT can induce a state of tolerance. Tolerance is different than desensitization. When you are in the state of desensitization, you need to eat that amount of food protein on a daily basis to keep being in the state of desensitization. Tolerance is when you can eat the food whenever you feel like it. If you go a few days, or months without eating the food, the next time you choose to eat it you will be fine. With desensitization, if you skip a few days of eating the food, it is possible you would have an allergic reaction to the food the next time you eat that food. I definitely believe that OIT is promising, but so far it is not clear to me if it would actually “cure” food allergy versus keeping you in a desensitized state where daily consumption is necessary. There are risks to OIT. There are allergic reactions that can occur when you are going through the process of oral immunotherapy. The research studies will continue, and the debate will go on regarding OIT, which in the end will benefit the food allergic patient. If you have any questions regarding research on food allergy, whether it is OIT or other modalities, please ask one of the board-certified allergists at Allergy and Asthma Associates of Southern California!