Food Allergy Treatment Program (Oral Immunotherapy)
Food allergies affect almost 15 million people in the US. Nearly 8% of school age children have a history of food allergy. The rate of food allergy has been steadily increasing. For example, the incidence of peanut allergy nearly tripled from 1997 to 2007. Food allergies can cause severe life threatening allergic reactions (anaphylaxis). Fear of anaphylaxis can lead to significant anxiety in families living with food allergies. These concerns usually result in a decreased quality of life. Recently, treatment options for decreasing the risk of food allergies have been developed.
Oral Immunotherapy (Desensitization)
The traditional approach to food allergy consists of avoiding the food to which one is allergic, and keeping medications available for emergency use.
Oral immunotherapy involves cautiously eating the food to which one is allergic, while being monitored in a medical facility. Doses of the food are administered by mouth. The initial dose of the food administered is designed to be small enough to not trigger an allergic reaction (sub-threshold dose). The amount of food consumed is slowly increased over time, usually at 2 week intervals. Since this desensitization process occurs in a medical facility, under supervision of our allergist, if an allergic reaction occurs, the symptoms are promptly treated by the allergy staff.
Which food allergies can be treated with Oral Immunotherapy?
Currently, we treat peanut, certain tree nuts, almond, sesame, milk and egg allergy using Oral Immunotherapy. Additional foods will be added to the program soon.
Goals of Treatment
The goal of Oral Immunotherapy is to increase the individual’s ability to consume a food to which one is allergic without triggering an allergic reaction, i.e., increase one’s tolerance to that food. By increasing one’s tolerance, accidental ingestion is much less likely to trigger a worrisome allergic reaction. This creates a safety net in case of accidental exposure. During the buildup phase of the program, patients should continue to avoid that food, other than for their treatment doses. Some patients may eventually be able to incorporate the treatment food into their normal diet.
The amount of peanut, tree nut, almond, sesame, milk or egg consumed daily at the end of the buildup phase of the program depends on many factors including the age of the individual, specific goal of treatment and whether or not that person likes or dislikes the taste of the food. For example regarding peanut, some individuals like the taste of peanut butter and want to consume unlimited amounts of peanut or peanut butter. Other individuals dislike the taste of peanut and their goal is to avoid an allergic reaction caused by accidental ingestion. For some a top dose of 10-15 peanuts daily (or equivalent amount of peanut butter) is a achieved. For those who do not want to consume large amounts of peanut, a smaller daily dose is chosen, such as 3 peanuts or 3 peanut M&M’s daily.
Currently our Tree Nut Oral Immunotherapy program treats cashew nut, pistachio nut, walnut and pecan nut allergies. Our protocol administers either cashew nut flour progressing to whole cashews or walnut meal progressing to walnuts. Since cashew and pistachio are cross-reactive, treating for cashew almost always also protects against pistachio nut allergic reactions. Since walnut and pecan are cross-reactive, treating with walnut almost always protects against pecan nut allergic reactions.
The goal for Milk Oral Immunotherapy is to be able to consume 8 ounces of milk without triggering an allergic reaction.
The goal for Egg Oral Immunotherapy is to be able to consume at least one whole egg without triggering an allergic reaction.
Frequently Asked Questions:
- Q. How old must one be to participate?
A. To participate in the food desensitization program, a child must be mature enough to notify the parent/physician of the onset of symptoms suggestive of an allergic reaction, during the desensitization process, which usually corresponds to about age 4 years.
- Q. What is the success rate?
A. While there may be some people who are unable to complete the desensitization, studies report that the vast majority of individuals are successful.
- Q. What are the most common symptoms during build-up?
A. The most common symptoms are upset stomach, nausea and less frequently vomiting. Itching of the mouth/throat may occur. Severe allergic reactions rarely occur. Some patients are found to have an increased number of cells known as eosinophils in their esophagus (Eosinophilic Esophagitis). It is unknown as to whether this is an incidental finding or caused by the food desensitization.