We have an active oral immunotherapy program for children with anaphylactic food allergies. OIT has been shown to be effective and is an alternative to simple food avoidance. Very small amounts of the food are given daily and increased every other week until the child can eat the food without a reaction. We are currently treating children with peanut, tree nut, milk, egg and sesame allergies.
Until recently, the only treatment for food allergy was strict avoidance of the offending food(s). However, over the years research studies have shown that it is possible to treat food allergies with oral immunotherapy.
Oral immunotherapy, or OIT, is a proactive treatment for food allergy that trains the immune system to tolerate a food and allows the patient to eat the food without an allergic reaction.
Every patient will first be evaluated to be sure they are candidates for oral immunotherapy. This will consist of skin and sometimes blood tests and a history that indicates a risk for anaphylaxis.
At the first OIT visit, the patient is given a very small amount of the food and observed in the office for an hour to be sure it is tolerated. This dose is then given daily at home and increased every two weeks at an “updose” visit in our office.
Within 12 months or less the patient will usually tolerate the equivalent of one or two peanuts or tree nuts. The amount will differ for other food allergens such as egg or milk. Skin and blood tests will then be repeated to determine if the food sensitivity has decreased. If so, the escalation process can continue up to a full serving size.
The goal is to decrease the patient’s sensitivity to the food to the point that it can be eaten without a reaction. OIT can reduce the risk of reactions due to cross-contamination by 95 percent. Some patient will eventually be able to consume the food in normal serving amounts without any reaction, but need to remain on a daily maintenance dose so that the desensitization is not lost. It is not yet known whether OIT can be a cure, but studies are ongoing. OIT may be more effective the in younger children where the possibility of a cure may be real.
Most of the studies have been done with peanut, but OIT can also be done for tree nuts, milk, egg, wheat and sesame. If the patient has more than one food allergy two or more foods can be treated at a time.
Peanut, milk and egg OIT have been shown to desensitize 70 to 80% of patients. In a recent study with a commercial peanut product in patients 4 to 17 years of age, 75% of patients could eat two peanuts by the end of a year. Numerous studies have reported success with patients being able to eat full serving amounts of the food. Desensitization, however, is different from a cure, and requires continuing a maintenance dose to be effective.
Reactions during OIT can occur but they are mostly mild, consisting of stomach upset or mild hives in our experience. However, more serious reactions including anaphylaxis can potentially occur.
Any updose is always performed in the office with observation for at least an hour. All medications are readily available to treat any reaction. Reactions could occur at home as well, and parents must be familiar with their anaphylaxis plan.
Our updosing schedule is intentionally very gradual and is meant to minimize the chances of a reaction while achieving the same end result over time as more rapid regimens.
A very small percent of patients have been reported to develop eosinophilic esophagitis (EoE), an allergic condition of the esophagus that causes heartburn, vomiting or difficulty swallowing, but it is not clear that this was caused by OIT. This risk may be minimized by drinking fluids after the food dose.
Avoidance of the food allergen is still the standard of care. Most allergists do not perform OIT although there may be more adoption of the treatment now that the FDA has approved a commercial peanut OIT product.
The downside of not doing anything, however, is that peanut and nut allergies tend to worsen spontaneously over time, so that a mild to moderate allergy may become severe.
Another benefit of OIT that should not be overlooked is that patients and families report a significantly improved quality of life after treatment. We will always discuss the pros and cons of OIT with the family.
Mark from Toms River
Our young son is being treated by Dr. Ho with OIT for peanut allergy. Our son looks forward to his appointments and we always leave feeling confident and informed. Dr. Ho’s staff is warm and courteous. Although the risk of an allergic reaction is never far from our minds, our fears are mitigated by Dr. Ho’s proactive, personalized therapy.
Dr. Ho is one of a kind. He’s the reason why my daughter, who used to be anaphylactic to peanuts/tree nuts, can now consume these allergens without any major concern. We went to see him when she was just 11 months old and he informed us of the option to start her on oral immunotherapy treatments, which essentially involves slowly giving increasing doses of the allergen.
I know many other allergists are not interested in pursuing this option due to a lack of familiarity or risk of liability. He is very detail oriented, proactive, and has a true interest in his patients. We have since moved out of state and can’t find an allergist who even comes close to him.
My son has been seeing Dr. Ho since we discovered he was allergic to milk at the age of one. My daughter is five and has been seeing Dr. Ho since she was 10 months old, and we discovered through blood work that she was allergic to peanuts. We started her at 2 years old doing peanut OIT with Dr. Ho, and at 4 years old, she ate 10 peanut M&Ms!! Dr. Ho moved at a comfortable pace and we never felt like she was in any type of danger. She will now start kindergarten not needing to sit at the peanut table.
We just started my son, now 8 years old, doing milk OIT. We are moving at a very gradual pace with him, and are super confident in Dr. Ho’s abilities to get us the results we want for him. Dr. Ho has been nothing short of superb in this process with our two children. He always has time to listen and answer the million questions I come into the office with. I can’t say enough good things about him and his staff, and would highly recommend him to anyone!
We found out that our child had peanut and tree nut allergy when our child was about 18 months. Dr. Ho is very knowledgeable. He explained everything and educated us on how to read food labels. This was new to us as parents with a child who has food allergy. He did skin tests on our child and compared the skin test results with the blood test results from the lab. Based on the result of both tests, he recommended food challenges on certain nuts. After doing the food challenges for two years, Dr. Ho recommended that we start with Oral Immunotherapy (OIT) in 2018. The result has been really positive. Today we still continue with OIT treatment. We are very happy with Dr. Ho and his amazing staff. The front desk staff are very nice and respectful. The nurses are amazing with children. This is true with the Holmdel office and Manalapan office staff.
We have been taking our son to Dr. Ho for about 2 years now to treat his tree nut allergy. We have been ever so slowly introducing micro doses of tree nuts to my son in a controlled environment at the doctor’s office and then continuing at home in between visits. Oral Immunotherapy (OIT) has made it possible for my son to ingest small amounts of his allergen without a reaction! I am no longer worried about him eating foods that were made in the same facility that handles tree nuts. We are very happy with his progress and hope to build up his immunity even further.
Dr. Ho has been my son’s doctor since he turned 1 and he’s now 6! Many food allergy visits and I’m glad he pushed us to start OIT for our son. We visit every two weeks and increase his peanut dose. The anxiety of my son having cross contamination has gone down for peanut. We still have many other food allergies but we will continue to keep at this OIT so we can all live a life with less anxiety.