What is Oral Immunotherapy and is it right for me?
The following quotes are excerpts taken from episode 5 of the Free-From Podcast, “Pros and Cons of Oral Immunotherapy.”
In this episode, Sofia Gillespie, Editor in Chief of Free-From Magazine and Free-From Podcast host, speaks with both Jodi Shroba, APRN, CPNP, and Meg Nohe, food allergy mom and CMO at Allergy Amulet.
What is Oral Immunotherapy?
“Oral Immunotherapy (OIT) is a form of desensitization. So, in other words, we’re exposing the body to very small increasing quantities of what they’re allergic to, and we’re making the body to be less reactive” (4:27) says Jodi Shroba, a pediatric nurse practitioner at Children’s Mercy Hospital who specializes in allergies and asthma. The goal of OIT is to raise the threshold that may trigger an allergic reaction within an individual’s body, and therefore provide them with protection against the allergen in case it is accidentally consumed.
How long has OIT been around?
“OIT has been around for a while in different forms,” says Sofia Gillespie, Education Coordinator and Editor in Chief of Free-From Magazine. “In January 2020, the FDA approved the first standardized OIT treatment, which is for peanut desensitization (6:17).”
This is great news, since peanut allergies are the #1 most common food allergy among children, and the second most common among adults. OIT can be helpful for both children and adults, but is currently recommended for those aged between 4 and 24 years old. The FDA-approved OIT treatment for peanut allergy (Palforzia®) is currently recommended for children between the ages of 4 and 17 years old.
Generally speaking, other than the time it takes to administer OIT every day, most of the usual daily routines can continue. However, one of the drawbacks of OIT is that immediately following a dose, the child taking it should not be active or doing anything that raises their heart rate for the next 2 hours, since doing so can increase the probability of having a bad allergic reaction.
“They don’t want people doing things that may speed up the digestion,” says Shroba, “So during that 2 hour period, you’re supposed to refrain from heavy activities, sports, hot showers… things that would raise your heart rate that in turn would maybe speed up some of that absorption that occurs during digestion (15:05).”
While an increasingly helpful treatment for many people against their food allergies, it is important to note that OIT isn’t a cure. “Because [of that], we don’t have an end date per se that you can stop this,” says Shroba. “However, they do see some people ‘outgrow their allergy’ while on OIT therapy (16:28).”
Factors to Consider Before Starting OIT
Shroba says that “OIT is not for everybody, it really is a lifestyle commitment (18:26).” With that in mind, there are a few questions you might want to ponder before taking the leap with your child into OIT treatment:
Will your child eat the food they are allergic to without too much fuss?
Do you and your child’s schedule allow for you to come in every 2 weeks for an additional dose during the first 6 months?
Do you have transportation to the clinic in which OIT is administered?
Is your child’s lifestyle too active to observe the 2 hour rest period after administering the daily OIT dose?
Is every caretaker in your family on board with consistently giving the daily shot?
Do you fully understand the benefits and risks associated with OIT?
In Conclusion…
OIT can be just one treatment option out of many management techniques for those suffering from food allergies. It may give them an increased sense of normalcy as they go about their daily lives, and less anxiety when ordering food at a restaurant.
Not having to be as concerned about a potential allergen in a menu item can definitely be one helpful benefit from OIT. In case a small amount of an allergen is unknowingly eaten, someone undergoing OIT might not have to worry about rushing off to the ER or using an epinephrine auto-injector immediately following exposure. This decrease in needed emergency services can greatly reduce the stress and worry of a caregiver for their child as they go to school and hang out with friends.
If you are interested in beginning this treatment, reach out to an allergist near you to discuss your options.