Update: On January 31, 2020, the Food and Drug Administration approved Palforzia(TM), the first treatment for peanut allergy.
Q: What should a peanut-allergic patient expect when undergoing oral immunotherapy? Is it just for peanut or are other foods available?
Julie Wang, MD: Oral immunotherapy (OIT) is an approach to treating food allergy that involves giving a patient a small, increasing amount of the food allergen to teach the body to be less reactive over time.
Here’s how it works: under an allergist’s supervision, the patient starts with very small doses of the food allergen. The patient continues daily doses at home and returns to the allergist’s office every 1-2 weeks for dose increases until a pre-specified maintenance dose is reached.
Once that maintenance dose is reached, then the patient continues on that maintenance dose indefinitely.
Oral immunotherapy is best used for peanut at this point. We have the most data on peanut allergy OIT in terms of its safety and effectiveness. However, oral immunotherapy is being studied for other food allergens. More research is needed to better understand the safety and effectiveness of OIT to other foods.
As with any therapy, it’s important to consider the benefits of the therapy as well as potential side effects. For peanut allergy oral immunotherapy, most studies show about 80% of patients are able to become desensitized to peanut.
Side effects are possible. Most allergic reactions occur during the buildup phase – however, it is possible for patients to have an allergic reaction to doses during the maintenance phase, even after they have tolerated the maintenance dose for quite a bit of time.
Allergic reactions can vary from mild to severe and some may require treatment with epinephrine. Because of the potential side effects of oral immunotherapy, it’s important for families to embark on this process under the close supervision of an allergist.
Julie Wang, MD, FACAAI, is professor of pediatrics, allergy and immunology at Mount Sinai Hospital in New York City. She is a fellow with the American College of Allergy, Asthma and Immunology (ACAAI) and a member of the ACAAI Food Allergy Committee.
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