Historically, food allergy has been managed with strict avoidance. Fortunately, over the past decade, increasing evidence suggests that food allergy may be treated by desensitizing the immune system to a specific food. The technique used to do this is food oral immunotherapy (OIT).
During food OIT, a patient receives very small, increasing amounts of their allergic food in the allergy clinic. Typically doses of food are increased (“up-dosed”) in the allergy clinic and then a daily “maintenance” dose is taken at home between the up-dose visits.
Once a determined amount of food protein is reached, then a patient typically remains on daily maintenance doses of that food at home indefinitely. Depending on the amount of food protein reached, a patient may be less vulnerable to accidental ingestion of that specific food. In some cases, a patient might be able to intentionally eat small amounts of that food.
The world of food OIT research is rapidly growing and there is new information in this field of allergy to consider every day. There is debate about who are the best candidates to undergo food OIT, how high of a dose is optimal, which foods to treat with, and whether only commercially available OIT regimens should be used or if clinic-prepared OIT regimens are acceptable.
Our providers are eager to help families tackle food allergy and we are enthusiastic about food OIT implementation in our office. However, there are risks of food OIT that need to be considered, including the risk of an allergic reaction or increased allergic inflammation. Patient safety and wellbeing is our top priority and we believe a careful discussion with patients and parents regarding risks and benefits is important prior to starting food OIT. In some cases, we may recommend against food OIT if we have concern about its safety or efficacy.