Oral immunotherapy (OIT)

What food allergies can you treat with OIT?

 

Our OIT program covers allergies for peanut, tree-nuts, eggs, milk, soy, wheat, sesame and sunflower. Our OIT program is offered at all 5 locations: Maplewood, Burnsville, Woodbury, West St. Paul and Duluth.

What is the goal of OIT?

The goal of OIT is unique for each patient depending on history, testing, and family preference. Many choose OIT so that over time they can freely eat food that previously threatened their health. Patients that “graduate” our OIT program will continue to keep taking one serving of that food every day to keep up their resistance.

How Does OIT Work?

The OIT process can be broken down into four phases:

  1. Initial dosing: Seven to 13 doses are given in a single day (occurs during a four-six hour time period under physician supervision).

  2. Build up dosing: The dose is increased incrementally every 1-2 weeks under observation until the maintenance dose is reached, usually over a period of about 8 months.

  3. Maintenance dosing: Doses are taken daily for years depending on the physician’s recommendation.

  4. Along with taking the maintenance doses, patients get long-term resistance and the ability to eat the foods that previously threatened your health.

Here is a video that explains OIT in greater depth:

How do I know if I or my child is a candidate for this treatment?

OIT is worth considering for anyone suffering from food allergies. We’ll be able to determine if OIT is a good choice for you or your child in our first consult. Keep in mind that this is at minimum at 8-month commitment where you’ll be visiting our clinic weekly to increase doses.

 

What is the risk of OIT?

Whenever you’re dealing with allergy immunotherapy, there is a risk of reaction. We’ll be introducing and increasing doses of food allergens over the period of treatment. If there ever is a serious reaction to the food, our staff is available 24/7 to address any concerns.

How long does the process take? 

Most of our patients finish the OIT process around 8 months. Most hiccups in the process come from delaying a visit due to sickness.

 

My child is highly allergic, are they still a candidate?

Yes, we have successfully desensitized people with sIgE levels greater than 100. We have taken patients from having a severe anaphylactic reaction from a spec of the food to eating a handful of the allergenic food without any problems. 

What is the age range to start OIT?

Our clinic offers OIT starting at 6 months of age through adulthood. At the 2019 American Academy of Allergy, Asthma and Immunology annual conference in San Francisco, a doctor presented data on infants he had been successfully desensitizing with OIT. The data showed that not only was the risk of OIT in infants very low, but also there is a greater chance in infants than any other age of actually ‘turning off’ rather than suppressing the food allergy. Because of this potentially life altering treatment, Dr. McMahon spent a lot of his time and resources studying this area. In 2020, Dr. McMahon was the first one in MN to offer infant OIT, starting OIT in patients as young as 6 months of age. Dr. McMahon completed a 3 year residency in pediatrics and has trained his staff in recognizing any potential signs of an allergic reaction in non-verbal children. In 2021 in one of the main Allergy journals JACI Clinical Practice there was an article titled ‘Food-Induced Anaphylaxis in Infants: Can New Evidence Assist with Implementation of Food Allergy Prevention and Treatment?’ It gives a nice summary of what we have seen regarding the successes of Infant OIT. It ends with the following statement: ‘For treatment, OIT in infants and preschoolers holds exceptional promise due to better safety and efficiency, with additional advantages such as prevention of long-term psychosocial consequences such as anxiety, bullying, and poor quality of life. The future for interventions in infants that focus on regular, long-term ingestion rather than avoidance is brighter than it has ever been based on recent evidence.’

 

What is the waitlist for the program?

We know how crucial and life-changing oral immunotherapy can be in a person’s life, that is why we make it a top-priority to block off many times in our providers daily schedules to only see OIT consults. By doing this, we are able to cut down our waitlist immensely and get patients enrolled in our program much sooner than other clinics. Typically, we can get patients enrolled in our L.I.F.E. program within 2-4 weeks.

Can I do multiple food allergies at once?:

Yes, if necessary we can often do up to 3 foods at one time. We have many people undergoing OIT for example to eggs, peanuts and cow's milk. The risk of adverse reactions is not much higher and some studies show it may not even be any higher. We have had a few patients have minor reactions such as a small hive on the face and we have opted to then stop one of the foods or else only increase one food per week. Tree nut OIT often is needed with multiple tree nuts and again we can do 3 of them at once. Pistachio and Cashew as well as Pecan and Walnut cross-react so we normally only need to desensitize to one of these foods. If someone is allergic to all of the tree nuts we can do for example OIT to almond and pecan (cross protection for walnut) and pistachio (cross protection for cashew). Then after that is complete we can do OIT again for brazil nut, macadamia nut and hazelnut.  

If my child is allergic to multiple foods will completing OIT for one food help treat other food allergies?
Each food OIT program is food specific. Completing one program does not treat other food allergies. Ask your provider for more specific information for treating multiple food allergies.

Is our program the same as other OIT programs in Minnesota?:

Currently, there are 2 forms of immunotherapy for foods: Oral immunotherapy (OIT) and Sublingual Immunotherapy (SLIT).  SLIT uses a microscopic amount of the food that is kept under the tongue and then is spit-out or swallowed. The problem about this therapy is that the doses are often so small at the end that there is no real benefit. Many people have undergone this treatment and still have reactions to the foods. Therefore, we do NOT offer this program for foods. Some groups show their data that this therapy 'desensitizes' a child to for example milk or egg, but most children will 'outgrow' the egg or milk allergy on their own over time. OIT however starts with a microscopic amount and slowly increases to the point that a patient can consume enough of the food to protect them against accidental ingestions. 

 

When comparing other OIT programs, all of the OIT programs follow a very similar guideline and often we communicate to share advances or suggestions. Some programs have unique names like our L.I.F.E. program but they are all basically the same program. 

Dr. McMahon Facebook Live Q&A on Oral Immunortherapy: