Food Allergy Immunotherapy (OIT)
Oral Immunotherapy to food was first described in 1908 in the Lancet - ‘a case of egg poisoning’ - by a physician practicing in Harley street (pre NHS). This report (open access on link above) is extremely informative and reflects the process of OIT rather well, where even very allergic patients can enjoy a rise in threshold of the allergen to which they are allergic.
The field of OIT to foods has enjoyed a massive leap forward thanks to the rigorous large international studies (Palisade & Artemis) that underpin the licensing of a peanut OIT product.
Thanks to these studies, we now understand the best regimens and products to use for successful OIT as well as the likely risks associated and side effect profiles.
Peanut OIT is now available in London at our www.thefoodallergyimmunotherapycentre.com - we will soon expand the program of foods covered, please register your interest on our website.
There is little provision of OIT to foods in the UK, outside of clinical research. It can however be argued that the medical supervision of incremental baked egg and milk products in allergic children, which is more common practice in many NHS UK clinics, often using ladders, also represents a form of immunotherapy/desensitisation.
Please be aware of the following principles when considering an OIT program:
OIT is not curative i.e. for most allergens, ongoing therapy is required to ensure tolerance.
It is controversial as to whether OIT to baked egg and milk ‘hurries up’ the the process of developing natural tolerance to all egg and milk, but it has been asociated with an increase in QOL in those eating these baked foods (unsuprisingly).
OIT seeks to raise the threshold at which a reaction would occur, aiming to render your child ‘bite proof’ i.e. protected from accidental every day exposures.
OIT is allergen-specific and only protects only against the allergen that is eaten (perhaps with the exception of cashew and walnut, where protection may also be enjoyed to pistachio and pecan nut, respectively).
Side effects on OIT are common and usually affect the GI system
More severe allergic side effects can occur, sometimes unpredictably i.e. after months of tolerance. This can arise due to co-factors such as exercise, infections, medication use.
Emergency medication will therefore always be required on your preson will undergoing OIT.
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Please feel free to discuss advances in the filed and the potentail for OIT for your child when consulting with Prof du Toit. Prof Du Toit has been an investigator on many of these trials and is actively involved in research testing other treatment modalities e.g. Viaskin trials. Here are some links around the topic that will hopefully be of interest.