Oral Immunotherapy (OIT) for Food Allergies at VATC
- leifdapharmaceutic
- Sep 23
- 6 min read
Updated: Nov 4
Food allergies can be a significant concern for many individuals and families; however, recent advancements in treatment options, particularly oral immunotherapy (OIT), offer hope for those affected. Dr. Klaiber heads the OIT provider group at VATC and has personally overseen the desensitization of over 500 pediatric patients with severe food allergies. Experience is the most important factor families should consider when choosing an OIT provider. In the Richmond area, no one has more experience than Dr. Klaiber.
The results of Dr. Klaiber's desensitization protocols have been published in the Journal of Allergy and Immunology (JACI), and he has presented his work at national and international conferences. These protocols are based on the latest data from the leading academic centers specializing in food allergy across the United States. Starting with very low doses of the target food, patients slowly build up the amount they are eating on a daily basis over several months. By the time they reach maintenance, the majority of our patients can tolerate at least 2000mg of the target food (approximately 10 peanuts). Almost any food allergen can be targeted. The incremental build over time promotes both safety and efficacy. A significant percentage of patients who start at an early age are able to start free eating their food allergen after achieving maintenance.
The IMPACT trial was a 5 academic center, randomized, placebo-controlled trial which showed that the major factor influencing the long-term outcomes of patients on OIT was the age at which patients start therapy. Younger children seem to have a more malleable immune response and can achieve long-term desensitization with the potential for free eating at an increased rate.
What is Oral Immunotherapy?
Oral immunotherapy involves the gradual introduction of small amounts of an allergenic food into a person's diet. Over time, the amount is increased. This process helps the immune system become accustomed to the food, reducing the likelihood of a severe allergic reaction.
The treatment typically starts with a very small dose of the allergen. Patients consume this dose under medical supervision. As they tolerate the initial dose, the amount is gradually increased over several months.
How Does Oral Immunotherapy Work?
OIT is not new. The first publication describing successful OIT appeared in the Lancet during 1908 (see link below). However, we now understand the pathophysiologic mechanisms underlying the therapeutic efficacy of OIT in much greater detail. When the immune system sees an allergen over and over again, cells called T regulatory cells are stimulated to become activated. These cells divide and put the brakes on the overactive immune response which leads to food allergy. At the bottom of this page, you will find links to other scientific publications which describe the biological underpinnings of OIT.
Initial Dose: The treatment begins with a very small amount of the allergen. This is usually done in a clinical setting to monitor for any immediate reactions.
Build-Up Phase: After the initial dose is tolerated, the patient gradually increases the amount of the allergen over several weeks. This phase can take anywhere from a few weeks to several months.
Maintenance Phase: Once the patient reaches a target dose, they enter the maintenance phase. This involves consuming the allergen regularly to maintain tolerance. The aforementioned IMPACT trial studied children who had been on maintenance for 2 years.
Benefits of Oral Immunotherapy
Oral immunotherapy offers several benefits for individuals with food allergies. Here are some key advantages:
Increased Tolerance: The primary goal of OIT is to increase tolerance to the allergenic food. This means that individuals can consume small amounts without experiencing severe reactions.
Improved Quality of Life: With increased tolerance, individuals can enjoy a wider variety of foods. This can lead to a more enjoyable dining experience and reduce anxiety around food. Studies have shown decreases in the Generalized Anxiety Scores among children with food allergies and their caregivers after undergoing OIT. From riding on a plane to eating lunch in a crowded cafeteria, no one should have to worry about an accidental exposure to a tiny amount of food allergen leading to a severe reaction.
Reduced Risk of Severe Reactions: By building tolerance, OIT can help reduce the risk of severe allergic reactions. This is particularly important for individuals who may accidentally consume the allergenic food.
Long-Term Benefits: Some studies suggest that the benefits of OIT can last even after treatment has stopped. This means that individuals may maintain their tolerance for years. Studies indicate that the earlier in life OIT is initiated, the greater the chance it will induce long-term tolerance. (see the link to the IMPACT Trial below)
What to Expect During Treatment
If you or your child is considering oral immunotherapy, it is essential to know what to expect during the treatment process. Here are some key points to keep in mind:
Initial Consultation: Before starting OIT, a thorough evaluation is necessary. This includes a detailed medical history, allergy testing, and discussions about the treatment plan.
Monitoring: The initial doses are typically administered in a clinical setting. Medical professionals will monitor for any adverse reactions. This is crucial for ensuring safety during the early stages of treatment.
Gradual Increase: The build-up phase involves gradually increasing the dose of the allergen. This process requires patience and commitment. It is essential to follow the prescribed schedule closely.
Regular Follow-Ups: Regular follow-up appointments are necessary to monitor progress and adjust the treatment plan as needed. These appointments help ensure that the patient is tolerating the treatment well.
Potential Side Effects: Some individuals may experience mild side effects during treatment, such as stomach discomfort or skin reactions. These are usually manageable and can be addressed by the healthcare team. Anaphylaxis and eosinophilic esophagitis have also been rarely noted during OIT.
Who is a Candidate for Oral Immunotherapy?
Not everyone with a food allergy is a suitable candidate for oral immunotherapy. Here are some factors that healthcare providers consider:
Age: OIT is often more effective in children, but adults can also benefit. The age of the patient can influence the treatment approach.
Type of Allergy: OIT is most commonly used for allergies to peanuts, tree nuts, milk, and eggs. Other food allergies may also be considered on an individual basis.
Severity of Allergy: Individuals with a history of severe allergic reactions may be more closely monitored during treatment. The severity of the allergy can impact the treatment plan.
Commitment to Treatment: OIT requires a commitment to regular dosing and follow-up appointments. Patients and their families must be willing to adhere to the treatment schedule.
The Role of Healthcare Providers
Healthcare providers play a crucial role in the success of oral immunotherapy. Here are some ways they support patients:
Education: Providers educate patients and families about the treatment process, potential side effects, and the importance of adherence.
Monitoring: Regular check-ups allow healthcare providers to monitor progress and make necessary adjustments to the treatment plan.
Support: Emotional support is essential during the treatment process. Providers can help address concerns and provide reassurance.
Real-Life Success Stories
Many individuals have experienced positive outcomes from oral immunotherapy. We have performed OIT on over 500 pediatric patients with anaphylactic food allergies. Many of the patients who have gone through our protocol are currently able to free eat the foods they were previously allergic to. When considering an OIT program it is important to ask how many patients your provider has treated and for peer-reviewed publications to show that their protocols work.
Challenges and Considerations
While oral immunotherapy offers many benefits, it is not without challenges. Here are some considerations to keep in mind:
Time Commitment: The treatment process can take several months, requiring regular visits to the healthcare provider. This commitment may be challenging for some families.
Potential Side Effects: While most side effects are mild, some individuals may experience more significant reactions. It is essential to be prepared for this possibility.
Not a Cure: OIT is not a cure for food allergies. It aims to increase tolerance, but some individuals, especially those starting over 5-6 years old, may still need to avoid large amounts of the allergenic food.
Cost: The cost of OIT can vary depending on the healthcare provider and location. It is essential to discuss financial considerations with your provider.
Final Thoughts
Oral immunotherapy represents a significant advancement in the management of food allergies. It offers hope for increased tolerance and improved quality of life for those affected. While the treatment process requires commitment and patience, the potential benefits are worth considering.
If you or a loved one is struggling with food allergies, it may be time to explore the possibilities of oral immunotherapy. Consult with a healthcare provider to discuss whether this treatment option is right for you.
By understanding oral immunotherapy and its benefits, you can take proactive steps toward managing food allergies and enjoying a more fulfilling life.
Peer reviewed publications
Oral tolerance to dietary antigens and Foxp3+regulatory T cells.
Oral immunotherapy in children with allergic diseases: past, present and future.
Oral immunotherapy directs systemic transcriptomic changes in children with hen's egg allergy.
Efficacy and safety of oral immunotherapy in children aged 1-3 years with peanut allergy (the Immune Tolerance Network IMPACT trial): a randomised placebo-controlled study. Lancet.