Oral Immunotherapy

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.

 

Frequently asked questions about OIT

Until recently, the only treatment for food allergy was strict avoidance of the offending food(s). However, 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. The success rate has been even more impressive in younger children.  A 2021 Canadian study reported that 98% of preschool age children were able to eat the equivalent of four peanuts after one year on OIT. This is in line with our own experience. And a number of 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 have occurred  at home as well even with a previously tolerated dose, and parents must be familiar with their anaphylaxis plan and be prepared to treat in the case of an unexpected reaction.

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. A number of studies have shown that OIT is safe and effective in pre-school  age children and suggest that OIT might reverse the allergic process.

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.

Oit For Anaphylactic Food Allergies
Milk OIT
Michael has his first drink of milk.
Analia with little sister for a tree nut OIT visit
Five year old Anthony at an OIT visit.
Ethan is on sesame OIT.
Gia is eating 14 peanuts and Michael can now drink milk.
Brother and sister on OIT
Marissa is eating 10 peanuts. Steven can eat 10 cashews and can now eat sesame.
Natalie visits us for a sesame updose.

Oral Immunotherapy Testimonials

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.

Yang Huang

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.

Oral Immunotherapy for Food Allergy

Michelle M

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!

Debbie L
My daughter was first diagnosed with food allergies as she was transitioning to solid foods. She has multiple food allergies and as a parent I have been concerned about her safety ever since her diagnosis. It was a stroke of luck that I discovered Dr. Ho and the work he is doing with OIT. Since then , I have had peace of mind knowing that she has a level of protection offered from her OIT treatment that has been overseen Dr. Ho. I don’t know any other doctors that offer this life changing treatment program. It’s a long process but the results are well worth it to know that my daughter is protected from the most severe life threatening reactions from exposure to a food allergen.
Dr. Ho is extremely knowledgeable in his field of work and is a kind and caring physician with all his patients. The nurses are also very friendly and work well with kids. I highly recommend Dr. Ho to anyone with a child who has food allergies. The treatment he offers via OIT can be life saving.
Three year old Finn can now eat peanut butter.

Amber Stiles

My family had been seeing Dr. Ho for a decade now. We started with our first as a baby with some mild food allergies she eventually outgrew. My second had a peanut allergy that required oral immunotherapy (OIT). It’s been a year and a half and she’s now eating 10 peanuts or 2 teaspoons of peanut butter a day! This treatment is hard to find for young children. I’m so thankful to have found Dr. Ho. His care and patience has been life changing. We also do allergy shots here, and the staff has always been wonderful with my children.

Yetty H

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.

Karl has a peanut and tree nut updose with Dad.

Jennifer Hyman

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.

Paula Mika 

We began seeing Dr. Ho in July 2019 after my then 5 year old daughter reacted to eating a dessert containing walnuts. After allergy testing was conducted, he introduced us to the idea of OIT and has been guiding us through our journey for cashews and walnuts ever since. He and his staff are friendly and accommodating.

Susan Klings 

All the doctors of this practice have been great! I used to take my daughter to another allergist who would tell me to look on my own for OIT. I took her to the Allergy Group. Now they have started her on OIT.  Also, when my daughter may have been exposed to COVID19, they arranged for a contact free pickup so OIT would not be interrupted.