Oral immunotherapy (OIT) is a process by which your allergist will try to raise the threshold that triggers a reaction to a particular food. The primary goal of OIT is to improve safety. If OIT is successful, then patients will be able to tolerate foods that previously triggered reactions. In some cases, the child may be able to tolerate a full serving of the food, while in others, they may only develop enough tolerance to allow them to tolerate the food in small amounts. Currently, this process is most commonly used for patients who are allergic to peanut. Oral immunotherapy for other food allergens (tree nuts, egg and milk) is currently being investigated and in the future, treatment protocols may be available.
Patients who undergo OIT will typically begin with a desensitization on the initial day. The patient will receive several very small doses of peanut in the office. These doses are only a fraction of a peanut (between 1/125,000 and 1/150,000 of a peanut). These doses rarely trigger reactions, even in patients who are highly sensitive to peanuts. The goal is to establish a safe starting dose for peanut oral immunotherapy. The first day is time consuming and can take up to 5 hours. Once a safe dose is established, the child will receive the same dose once daily at home. The patient will return to one of our designated allergy offices every 1-2 weeks to increase the dose (this is referred to as an updose visit). The patient will be monitored IN the office for 1 hour during each updose visit. If successful, patients are often eating several peanuts per day after approximately 6 months.
The complete duration of peanut OIT may vary between patients. Typically, the build up phase lasts at least 6 months. Then, patients will continue to consume peanut on a daily basis. After several years, the frequency may be reduced to several days per week. It does appear that treatment will need to be lifelong for most patients.
Yes. The most common side effects are gastrointestinal and typically appears as an upset stomach, nausea or vomiting. Other common side effects include oral itching or a few sporadic hives. More severe reactions, such as anaphylaxis, can occur. Lastly, Eosinophilic Esophagitis (an inflammatory reaction in the esophagus) has been reported in patients receiving peanut OIT.
This is a complex question. The answer depends on your child's past history of reactions, their desire to consume peanut safely in the future, and the parents desire for their child to consume peanut safely. If you are considering peanut OIT, you will want to schedule a visit with your allergist first to discuss the treatment in detail.
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