Oral immunotherapy (OIT) for food allergies

What OIT is and what it is not

OIT gradually desensitizes your body to a food. Each day you eat a precise dose of the allergen mixed into a food you tolerate, and every couple of weeks the dose is raised in our clinic. Early doses are often a tiny fraction of a single peanut or a few drops of milk. Over time, the amount it takes to cause a reaction, called your threshold, goes up.

The main goal is to become “bite-proof,” meaning protected if you accidentally eat a small amount of the food. Some patients go on to eat the food freely in normal servings, while others stay on a fixed daily dose. Results vary from person to person, and OIT does not mean the allergy is gone.

Because desensitization depends on regular exposure, daily dosing usually continues long term. Stopping or skipping doses for several days can lower your protection.

Foods we treat

Our Food Allergy Center serves families from across Dallas–Fort Worth and offers OIT for the most common food allergies. If you are allergic to more than one food, multi-food OIT can treat several allergens in the same program when it is safe to do so.

Each food is assessed on its own. Some foods tend to cause more side effects during build-up than others, and some people who react to one tree nut can safely eat others, which testing and food challenges help sort out.

• Peanut
• Tree nuts such as cashew, walnut, almond and pecan
• Milk
• Egg
• Wheat
• Sesame

May be a good fit if…

• You or your child has a confirmed allergy to peanut, tree nuts, milk, egg, wheat or sesame
• Fear of an accidental bite affects school, travel or eating out
• Your family can commit to daily dosing and clinic visits about every 2 weeks during build-up
• You want to start early with an infant or toddler who has a diagnosed food allergy
• You have more than one food allergy and are interested in multi-food treatment

Early OIT for babies and toddlers

A very young child’s immune system appears to be more adaptable, and starting OIT early may lead to better results. We can begin OIT in children as young as about 9 months once a food allergy has been confirmed. Babies and toddlers usually take their dose stirred into a familiar food they already tolerate, such as a fruit puree, and parents are coached on how to measure and give it.

Older children, teens and adults are candidates too. Teens heading toward sleepovers, road trips and college often find that being bite-proof makes daily life feel far more manageable. In older patients, a history of severe reactions or asthma that is hard to control may change how we approach treatment.

Dosing at home: the ground rules

Most of OIT happens at home, so we spend real time teaching your family how to dose safely. The rules can feel strict at first, but they soon become part of the family routine. These habits keep the risk of reactions down:

• Take your dose at about the same time each day, with or after a meal or snack.
• Avoid exercise, hot showers and hot baths for about 2 hours after each dose.
• Call us before dosing if there is a fever, a stomach bug or an asthma flare; we may lower or hold the dose.
• Tell us about poor sleep, heavy stress or menstrual periods, which can lower your threshold for a time.
• Carry two epinephrine auto-injectors at all times, and make sure caregivers know how to use them.
• Keep avoiding the food outside your daily dose until your allergist says otherwise.

Support at every stage

OIT is a long-term partnership. Every up-dose happens in the clinic, where you stay for about 60 minutes of observation, and you can reach our team with questions between visits. Up-dose visits are also a chance to talk about how home dosing is going and fix anything that is not working.

We also help with the practical side, including school and daycare plans, dosing while traveling, and what to do if a dose is missed. Families come to us from all over DFW, and our team speaks English, Spanish and Arabic.

As your child grows, we help them take on more of their own dosing and safety habits. Teens learn to carry their epinephrine, spot early symptoms and speak up for themselves at school, camp and restaurants.

What to expect, step by step

1. Evaluation visit

   Your allergist reviews past reactions and testing, explains the benefits and risks of OIT, and makes sure it fits your family’s goals.

2. Oral food challenge

   Many patients begin with a supervised food challenge to confirm the allergy and find a safe starting dose.

3. First dosing day

   You take the first small doses in the clinic under observation, then go home with a measured daily dose.

4. Build-up visits

   About every 2 weeks, the dose is raised in the clinic and followed by roughly an hour of observation. Between visits, you dose daily at home.

5. Maintenance

   Once you reach your target dose, you keep eating it every day and visit less often. Your allergist will discuss whether eating the food more freely is an option.

Before your visit

• Bring records of past reactions and any earlier allergy testing.
• Make sure asthma is well controlled before starting, since uncontrolled asthma is a reason to wait.
• Bring both epinephrine auto-injectors to every visit.
• On up-dose days, plan for a visit of a couple of hours and bring quiet activities.
• Call to reschedule an up-dose if you or your child is sick.

Safety

Side effects are common during build-up and are usually mild, such as an itchy mouth, stomach ache or nausea. More significant allergic reactions can happen, so epinephrine must always be on hand. Eosinophilic esophagitis, an inflammation of the food pipe, is uncommon but possible. We adjust or pause doses when needed and review every symptom with you.