Oral Immunotherapy Can Transform the Life of Your Food Allergic Child.
Oral Immunotherapy (OIT) can provide a long-term solution for peanut, milk, egg, tree nut and wheat allergic patients. It usually takes less than 6 months, and at the end of the program, most patients with these food allergies are free to consume the foods whenever they want.
Who can be treated?
If the patient has a confirmed food allergy based on a recent history and a significantly positive food allergy blood test or skin test, he or she is eligible for OIT. If their diagnosis is less certain, that is, there has been some problem or a positive test in the past, but no recent reaction, additional testing is done to confirm the food allergy. Confirmatory testing by blood test and skin test may be sufficient but, often an oral food challenge or OFC is performed. This is the gold standard for food allergy testing and involves carefully giving increasing amounts of the suspect food while carefully watching for signs of a reaction. If there are any symptoms, for example itchy mouth or some hives, the OFC is positive confirmation of the food allergy. If a meal-sized portion (e.g 8 ounces of milk or a whole egg) is eaten with no problem, the food allergy has been disproved. All patients with confirmed food allergies are eligible for treatment.
How is the treatment implemented?
Prior to beginning OIT, parent(s) and child attend at least two office visits to be sure that all other allergy-related problems have been identified and controlled. At these visits, OIT is explained and both the parents and the patient are encouraged to ask questions and address any worries or concerns. Some patients may only have one visit before beginning OIT, but all patients must be seen within the month before beginning OIT treatment. They also have the option to speak or meet with other parents of children who have completed the treatment.
It is important for children to understand the value of the treatment by showing them how the doses are mixed, seeing the big board with photos of happy program graduates, helping them realize that once the treatment is successful they can attend birthday parties, camp outs and do more things with their friends without being worried about an allergic reaction. Every child is different so the treatment is individualized.
The protocol for treatment starts with a powdered form of food diluted in water mixed with Kool-Aid flavoring that is then administered orally with a syringe. For liquid foods such as milk, no powder is used. The next step is to progress to a powder form of the food and final stage is solid food, such as a whole peanut, egg or organic whole milk.
Flavors can be varied when Kool-Aid is used to mix treatment; for instance, grape for peanuts; cherry for egg; orange for tree nuts. The allergenic food can be mixed into other foods or drinks to help mask the flavor, if necessary. Peanut flavor is the hardest taste to disguise. Milk and egg are much easier. The food cannot be cooked or baked as baking alters the protein in the food allergen making it less stimulating. Finding what tastes good to the child is the best way to keep them interested in the process and makes the parent’s job much easier.
The treatment begins with a long day during which 15-20 doses, starting with very tiny amounts of food (e.g. 1/50,000 of a peanut) are given. The first day ends if there are any reactions at all or if the patient reaches the target for the day. The parents are then provided with a supply of the highest tolerated dose to given at home twice a day. After a week, they return to the office to be challenged with the next higher dose. This process continues until the patient is taking the target dose (e.g., 8 ounces of milk, 12 peanuts, one whole egg white).
Patients are allowed to progress at their own pace. One week for each dose increase. Typically, the overall timeline is 20-23 weeks. The number of dose increases varies with the food allergy: Egg has 19 dose increases after the first day, Milk 23, Peanut and Tree Nuts 21, Wheat 20. If a child has an adverse reaction, the dose is reduced by taking a step back in the process. For example, decrease the dosage from two peanuts to only one.
The average length of time a food treatment takes for the patient to reach his/her target is about 13 weeks on average. However, some may take longer. Average number of weeks to reach target for the various food allergens are:
- Egg: shortest 16 weeks; average 23 weeks
- Milk: short 13 weeks; average 32 weeks
- Peanut: short 15 weeks; average 26 weeks
- Wheat: short 17 weeks, average 20 weeks
- Cashew: short 20 weeks, average 22 weeks
Once the target is reached, treatment is continued once a day for at least three years.
More than 80% of our patients who have been treated with OIT can now safely consume foods that once threatened their health. To learn more about how to change your child’s life with Oral Immunotherapy (OIT), visit us today!