Oral Immunotherapy

Austin Family Allergy & Asthma is one of only a handful of allergy practices in the country that offers food allergy desensitization, called Oral Immunotherapy (“OIT”). This is a gradual process by which the patient can safely eat the food they are allergic to. It is best explained as a series of Q&A:

Q: So, what exactly is OIT?
A: Let’s say you are allergic to peanut protein (but you could apply this to any food we offer in our OIT program). We give you peanut protein in extremely trace amounts and gradually increase the dose until you get to “maintenance.” This process involves numerous office visits where the dose is escalated under a careful, supervised setting. It is counter-intuitive, but it works. Slowly, over time, your body will become “desensitized” to peanuts.

The initial visit takes almost a full day. The goal of that visit is to get you to safely start drinking a diluted peanut flour containing solution. The doses are increased every 20-30 minutes under close monitoring and supervision. Following this initial visit, you will be required to have a daily dose of the peanut containing solution at home (we will provide you with it).

Then, every 1-2 weeks, we start increasing the dose. These increases, called “updosing” visits can ONLY be done in the office under our supervision, NEVER at home. Updosing visits take about 1 ½ hours.

Q: How long does it take to get to maintenance?

A: It’s a commitment – about 6 months, with multiple visits, usually weekly or biweekly, as discussed above. Each patient’s situation is different, and sometimes doses may need to be delayed or repeated. Reasons for delaying or repeating a dose would be reactions to the doses, viral infections, or asthma symptoms. The usual maintenance dose for peanut allergy is 8-12 peanuts per day and 1 cup (8 ounces) for milk allergy.

Q: After that, I’m cured of my food allergy?!
A: No! And while it may be tempting to think this, it is critical to realize that OIT is not a disease cure or reversal. Rather, we are temporarily making your immune system desensitized to the specific allergen that you are allergic to. In order to maintain this state of desensitization, you MUST continue to eat this food daily for the rest of your life. But herein lies the greatest benefit of OIT: you don’t have to worry about accidentally eating the allergic food and having anaphylaxis!

Q: Is it safe? Are there any long-term effects?
A: Generally speaking, under careful supervision by our Board-Certified Allergists, Dr. Lieberman and Dr. Parekh and their nursing staff, it is safe. However, OIT certainly carries the risk of anaphylaxis and should not be performed by anyone other than a Board-Certified Allergist with extensive training and experience in food allergy and anaphylaxis. A few children have developed eosinophilic esophagitis (an allergic reaction in the esophagus) during the course of therapy and have required discontinuation of OIT.

Q: Can you desensitize me to any food?
A: At this time, we are only offering OIT for milk and peanut allergy. We hope to offer OIT for additional foods in the future.

Q: What are the restrictions while on OIT?

A: Exercise must be avoided for 2 hours after each and every dose. Children must also be observed for at least 1 hour after the dose, therefore, we strongly recommend you give the dose in the morning or just after school, and NOT at nighttime. The daily doses must be given 21-27 hours apart and it is extremely important to not skip or miss any doses.

Q: Is there a minimum age requirement?
A: While there isn’t a specific minimum age, OIT is best suited for school-age children and older. If the patient is a child, she/he must be mature enough to understand what we are attempting to do, and to not consume the allergic food except as specified under the program.

Q: Is this covered by insurance?

A: Yes, office visits and food challenges are usually covered by most insurances. Please see Insurances Accepted for insurance plans that we accept.

Q: How do I begin?
A: If you are interested and feel you or your child are a candidate for OIT, schedule an evaluation with Dr. Lieberman or Dr. Parekh.