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Kids and adults with severe food allergies may worry daily about life-threatening exposure. While the standard of care continues to be to avoid their food allergen and carry epinephrine, new treatment aims to prevent severe reactions in the event of accidental exposures.

Oral immunotherapy (OIT) is a promising new treatment for severely allergic patients that attempts to retrain their immune systems. The idea is to introduce tiny amounts of the food allergen over time, with the aim to desensitize patients to the offending food.

Because OIT is a relatively recent treatment that’s still undergoing clinical trials, patients often have questions about it. Let’s briefly review OIT so that you have a better sense of how it works and whether it’s a potential treatment option for you.


What is Oral Immunotherapy?

Oral immunotherapy, also called OIT, is quite new. While there is no cure for food allergies, OIT is aimed at reducing the risk of severe allergic reactions with accidental exposures.

OIT achieves this goal by slowly introducing amounts of the allergen into the patient’s body. Over time, the patient will receive increasing doses, which builds up tolerance. Ultimately, this may reduce the severity of allergic reactions.

How Effective is OIT

OIT has proven effective in clinical trials, though results differ according to the food allergen.

Recent studies have shown that peanut, egg and milk OIT have boosted tolerance in about 60-80% of patients. While this success rate is promising, it’s not clear whether other food allergens show similar results. Published studies have ranged considerably in efficacy, varying from 30%-90%.

In addition, the effectiveness of OIT over time is the subject of further study. It’s unclear how long tolerance lasts and whether accidental exposure to food allergens later in life can still be life-threatening.

What to Expect With OIT

Remember that OIT should be performed under the medical supervision of a board-certified allergist. The treatment must be highly controlled in order to reduce the risk of a severe allergic reaction.

To get started, you’ll receive a tiny amount of the allergen in the office. For example, if you have a peanut allergy, you’ll be given a dose of micro-dosed peanut powder. At home, you’ll also take a daily dose of the allergen.

Every two weeks, the dose will increase under your allergist’s supervision. Each time, you’ll also be required to stay for a period of observation. You’ll continue this regimen of one to two week updoses for up to 9-12 months.

In highly successful cases, OIT patients may be able to consume small amounts of the allergen in their diet without any adverse reaction.

Important note: Patients receiving OIT must continue to follow allergy precautions such as carrying epinephrine autoinjectors and reading food labels.

Side Effects and Risks of OIT

Those receiving OIT may have an allergic reaction to the treatment or from accidental food exposure. Side effects may include:

  • Anaphylaxis, which can be life-threatening. In this case, patients will need to administer epinephrine and seek urgent medical attention.
  • Eosinophilic esophagitis, which may cause difficulty swallowing, sensation of food sticking in the chest, vomiting and abdominal pain.
  • Gastrointestinal symptoms, including abdominal pain, vomiting and cramping.
  • A rash, hives or throat itchiness.

According to recent studies, negative side effects are fairly common in OIT patients. In a recent clinical trial, 95% of patients experienced adverse side effects, including about 50% with gastrointestinal symptoms and 14% who needed to use epinephrine.

Oral Immunotherapy vs. Avoidance

There’s no “one size fits all” treatment for patients with food allergies. While some patients may benefit from OIT, others may prefer the traditional avoidance method. Your decision may also be determined by what food allergy you have and the severity of your reactions.

Those with severe allergies may benefit from OIT therapy, as it can build tolerance and help families be less anxious about life-threatening allergic reactions.

However, OIT is also a big commitment that involves both daily doses and appointments every two weeks to increase dosage. OIT typically takes a year to see results, so this type of care plan can be quite disruptive and requires taking time off from school or work.

Avoidance is a tried-and-true method for those with food allergies. Essentially, you work to avoid the allergen, carry an epinephrine autoinjector to stop any severe reaction and seek medical attention as needed.

While the avoidance method doesn’t have the benefit of improving tolerance, it’s doesn’t require a daily commitment or put you at risk of side effects.

Choosing between OIT and avoidance is a personal decision that should be made with the specialized opinion of your allergist. Some families may stick to avoidance so their child doesn’t face disruptions at school, while others may decide on OIT in order to try building allergen tolerance.

Outlook of OIT

At Carolina Asthma & Allergy Center, we currently offer the cutting-edge treatment of OIT in limited cases. We believe OIT is the future for severely allergic kids and adults, who could most benefit from increasing their allergen tolerance.

If you’re interested in learning more about OIT, contact our team of board-certified experts. Together we can help determine whether it’s a potential treatment option for you.


How much does oral immunotherapy cost?

Oral immunotherapy costs can vary greatly. Because it involves daily doses and allergist appointments every two weeks, it’s more expensive than the traditional avoidance method. We always recommend checking with your insurance carrier to ensure the accurate cost.

What age can you start oral immunotherapy?

Early results with young children and oral immunotherapy are promising. We currently start oral immunotherapy at four years of age up to fifteen years old.

Is oral immunotherapy a cure for food allergies?

Oral immunotherapy is not a cure for food allergies. Instead, it works to build tolerance so that there’s less likelihood of a life-threatening reaction. If OIT is successful, it can lead to less severe reactions and reduced anxiety about food allergies.