Learn More About OIT
What Is Food Allergy Oral Immunotherapy (OIT)?
OIT is an optional treatment for patients with confirmed food allergies. Sometimes the media refers to this as ‘food allergy desensitization’. It involves starting patients on a very small daily dose of the food they are allergic to. The dose is then advanced gradually over the course of 6-12 months.
The first dose and each dose increase is done in our clinic, under our supervision. By feeding patients a gradually increasing amount of allergen (the food to which they are allergic), their immune system is trained to be less reactive when exposed to that food in the future.
After all of the dose increases, the patient reaches a ‘maintenance dose’. For example, a maintenance dose may be:
Eating 3 peanuts per day (for peanut-allergic patients)
Eating a teaspoon of tahini every day (in sesame-allergic patients)
Drinking 10mL of milk everyday (in milk-allergic patients)
After reaching the maintenance dose, patients are re-evaluated on a regular basis to check for improvement in their allergy skin tests and allergy blood work (Food-specific IgE levels). Once these show improvement, an oral food challenge may be offered to see if the patient has been desensitized.
What is the goal of OIT?
Food allergy OIT is not considered a cure, but by continuing to eat a daily maintenance dose, patients achieve protection against accidental exposures to their allergens. Their diet can also be liberalized. For example, patients can feel comfortable to safely consume foods that have ‘may contain’ or ‘cross contamination’ labeling. Patients can feel more comfortable to eat at restaurants, go to ice cream shops, bakeries, birthday parties, and eat out while traveling.
Another goal is to achieve desensitization. This means that either the patient can tolerate a normal serving size of the allergenic food OR their allergic threshold is increased (eg. they previously reacted to a small piece of cashew, and now they can eat 10 cashews without reacting). In day-to-day life, this equates to protection from accidental exposures and less dietary restrictions.
Multiple well-designed scientific studies (randomized controlled trials) have demonstrated that about 85% of patients (especially younger children) will tolerate significant quantities of their allergic food after completing OIT.
Is OIT the standard of care?
Not in Ontario. In Ontario, the standard of care involves strictly avoiding your allergens and carrying epinephrine autoinjectors at all times.
A word of caution...
There are risks associated with food allergy oral immunotherapy, including the risk of allergic reactions or anaphylaxis. In our opinion, OIT should only be done under the supervision of Royal College-certified allergists who have a lot of experience working with children. OIT should only be done in patients with confirmed food allergies who are unlikely to outgrow their allergies. The work-up often involves oral food challenges. We recommend being skeptical of clinics that offer OIT but do not offer food challenges prior to starting OIT.
Who can be referred for OIT?
We are offering oral immunotherapy for patients under 8 years old. Food allergies may include: peanuts, tree nuts, sesame, sunflower, other seeds, other legumes, milk, egg, wheat, soy. Other foods will be considered on a case-by-case basis. Note that initial consults are covered by OHIP. However, at this time, OIT is not covered by OHIP. Our clinic will provide itemized receipts and letters to help patients achieve coverage from private insurance plans.