Oral Immunotherapy To Foods
Immunotherapy is a method to reduce the sensitivity and risk of reaction to specific allergens. It has been widely used for treating hay fever, pet and house dust mite allergies, and it is now available for particular food allergens. The aim is to improve the quality of life for children and their families.
If you are interested in OIT (Oral Immunotherapy Treatment), Professor Du Toit recommends that you visit The Food Allergy Immunotherapy Centre (TFAIC) in London, where he is one of the founding team. Our TFAIC is committed to providing patient-centred and responsive care backed up by the highest safety standards and supported by the most experienced clinicians.
Currently, TFAIC offers OIT for:
Sesame OIT
Cashew OIT
Wheat OIT
Walnut OIT
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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 (freely available on the link above) is highly informative. It reflects the process of OIT rather well, where even very allergic patients can enjoy a rise in the threshold of the allergen to which they are allergic.
Standard care for managing food allergies has focused on avoiding allergen and facilitating the treatment of adverse reactions after allergen exposure.
An increase in the development of immunotherapy treatments for food allergy has driven our knowledge forward. Initial studies mainly focused on school-age children in whom food allergies are likely to be persistent. However, increasing evidence indicates that delivering immunotherapy for food allergies to preschool-age children may provide higher success rates. Conversely, the natural resolution of food allergies occurs primarily in these younger age groups, resulting in challenges in selecting patients who will ultimately benefit from these treatments.
Both immunotherapy and natural history studies reveal the inherent plasticity of the immune system in early life, which may be more amenable to intervention, but this raises a delicate yet unknown balance between the optimal timing of intervention versus waiting for natural resolution of the food allergy.
The field of OIT to foods has enjoyed a massive leap forward thanks to the rigorous extensive international studies (Palisade & Artemis) that underpin the licensing of a peanut OIT product. These studies show us the best regimens and products for successful OIT and the associated risks and side effect profiles.
The medical supervision of incremental baked egg and milk products in allergic children is common practice in many NHS UK clinics, often using ladders, also represents a form of immunotherapy/desensitisation.
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 process of developing natural tolerance to all egg and dairy, but it has been associated with an increase in QOL in those eating these baked foods (unsurprisingly).
OIT seeks to raise the threshold at which a reaction would occur, rendering your child ‘bite-proof’ i.e. protected from accidental everyday exposures.
OIT is allergen-specific and protects only against the allergen that is eaten.
Mild 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, and medication use… Emergency medication will, therefore, always be required on your person while undergoing OIT.
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Please feel free to discuss advances in the field and the potential 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.