Oral Immunotherapy (OIT) for Food Allergy

Which Food Allergies can be treated?

Currently, we treat individuals for the following food allergies, as well as some that are not listed. Please contact our office to review your needs. We can also treat more than one food allergy simultaneously.

• Eggs
• Green pea
• Milk
• Peanuts
• Sesame
• Soy
• Tree nuts
• Wheat

How long does the process take?

The first day of treatment is a build-up day, starting with a minute amount of allergen ( i.e.1/10,000th of a peanut) totaling up to a tiny amount that day with a few doses spaced out. You are sent home and take less or equal to than the “safe dose” once or twice daily. You return to office in 1-2 weeks to increase the dose under their watchful eye. Usually it’s a minimum of 12-14 at-home doses.

After each dose there is a 1-2 hour observation period with no core body temperature elevation while the body digests and metabolizes the peanut. Regular dosing ensures your body stays desensitized and you get visible proof of protection every time you easily ingest the allergen.

The treatment process can take 6-12 months with 15-25 “updoses” reaching a daily serving of the allergen being eaten with no symptoms.

When are maintenance doses reached?

After a period of time, usually 6 months to 12 months at this dose, there is a final “challenge” of about double or triple what the daily amount is (i.e a 24-peanut challenge when eating 10-12/day). This challenge simulates “unlimited” eating and that the patient is “fully desensitized” to their allergen. From that point, you go into maintenance where X amount per day is eaten to keep the body recognizing the allergen.

For many, the dosing will continue for life. Perhaps not daily, but regularly like 3-5 times a week in a normal diet.

Food Allergies

A food allergy is an exaggerated immune response triggered by eggs, peanuts, milk, or some other specific food.

• Download the Anaphylaxis Emergency Action Plan from the American Academy of Allergy Asthma & Immunology
• Download What You Should Know About Food Allergies from the American Academy of Allergy Asthma & Immunology

Causes

Normally, your body’s immune system defends against potentially harmful substances, such as bacteria, viruses, and toxins. In some people, an immune response is triggered by a substance that is generally harmless, such as a specific food.

The cause of food allergies is related to your body making a type of allergy-producing substance called immunoglobulin E (IgE) antibodies to a particular food.

Although many people have a food intolerance, food allergies are less common. In a true food allergy, the immune system produces antibodies and histamine in response to the specific food.

Any food can cause an allergic reaction, but a few foods are the main culprits. In children, the most common food allergies are to:

• Eggs
• Milk
• Peanuts
• Sesame
• Shellfish (shrimp, crab, lobster, snails, clams)
• Soy
• Tree nuts
• Wheat

A food allergy frequently starts in childhood, but it can begin at any age. Fortunately, many children will outgrow their allergy to milk, egg, wheat, and soy by the time they are 5 years old if they avoid the offending foods when they are young. Allergies to peanuts, tree nuts, and shellfish tend to be lifelong.

In older children and adults, the most common food allergies are:

• Fish
• Peanuts
• Shellfish
• Tree nuts

Food additives—such as dyes, thickeners, and preservatives—may rarely cause an allergic or intolerance reaction.

An oral allergy syndrome may occur after eating certain fresh fruits and vegetables. The allergens in these foods are similar to certain pollens. Examples are melon/ragweed pollen and apple/tree pollen.

Many Americans believe they have food allergies, while in reality fewer than 1% have true allergies. Most people’s symptoms are caused by intolerances to foods such as:

• Corn products
• Cow’s milk and dairy products (See: Lactose intolerance)
• Wheat and other gluten-containing grains (See: Celiac disease)

Symptoms

Symptoms usually begin immediately, within 2 hours after eating. Rarely, the symptoms may begin hours after eating the offending food.

If you develop symptoms shortly after eating a specific food, you may have a food allergy. Key symptoms include hives, hoarse voice, and wheezing.

Other symptoms that may occur include:

• Abdominal pain
• Diarrhea
• Difficulty swallowing
• Itching of the mouth, throat, eyes, skin, or any area
• Light-headedness or fainting
• Nasal congestion
• Nausea
• Runny nose
• Swelling (angioedema), especially of the eyelids, face, lips, and tongue
• Shortness of breath
• Stomach cramps
• Vomiting

Symptoms of oral allergy syndrome:

• Itchy lips, tongue, and throat
• Swollen lips (sometimes)

Exams and Tests

In severe reactions, you may have low blood pressure and blocked airways.

A blood or skin test can be done to identify elevated antibody levels (particularly IgE) and confirm that you have an allergy.

With elimination diets, you avoid the suspected food until your symptoms disappear. Then the foods are reintroduced to see if you develop an allergic reaction.

In provocation (challenge) testing, you are exposed to a suspected allergen under controlled circumstances. This may be done in the diet or by breathing in the suspected allergen. This type of test may provoke severe allergic reactions. Challenge testing should only be done by a doctor.

Never try to deliberately cause a reaction or reintroduce a food on your own. These tests should only be performed under the guidance of a health care provider—especially if your first reaction was severe.

Treatment

If you suspect you or your child has a food allergy, consult an allergy specialist.

If you have symptoms on only one area of the body (for example, a hive on the chin after eating the specific food), you may not need any treatment. The symptoms will likely go away in a brief time. Antihistamines may relieve the discomfort. Soothing skin creams may provide some relief.

Consult your doctor if you think you have had an allergic reaction to food, even if it is only a local reaction.

Anyone diagnosed with a food allergy should carry (and know how to use) injectable epinephrine at all times. If you develop any type of serious or whole-body reaction (even hives) after eating the offending food, inject the epinephrine. Then go to the nearest hospital or emergency facility, preferably by ambulance. Seek immediate medical attention after injecting epinephrine for a food reaction.

Outlook (Prognosis)

Avoid offending foods, which may mean restricting your diet. Carefully read all package ingredients and ask detailed questions when eating away from home. In addition to avoidance, discuss potential treatment options including OIT and SLIT to treat food allergy with one of our providers.

Possible Complications

Anaphylaxis is a severe, whole-body allergic reaction that is life-threatening. Although people with oral allergy syndrome rarely have an anaphylactic reaction, they should ask their doctor whether they need to carry injectable epinephrine.

Food allergies can trigger or worsen asthma, eczema, or other disorders.

When to Contact a Medical Professional

• Call your local emergency number, such as 911, if you have any serious or whole-body reactions (particularly wheezing or difficulty breathing) after eating a food.
• If your doctor prescribed epinephrine for severe reactions, inject it as soon as possible, even BEFORE calling 911. The sooner you inject the epinephrine, the better.
• Anyone who has had an allergic reaction to a food should be evaluated by an allergy specialist.

More Information

Visit the American Academy of Allergy Asthma & Immunology’s website: www.aaaai.org