AAIQ   The Association of Allergists and Immunologists of Québec

Oral immunotherapy for the treatment of food allergies


Résumé

Oral immunotherapy (OIT) is a form of immunotherapy designed to treat food allergies. Contrary to subcutaneous immunotherapy (injections) or sublingual (oral administration of a liquid suspension of tablet), OIT consists of the direct ingestion of a food, in precisely measured amounts following a set calendar. This therapy starts at very small doses, below the threshold of reaction of the patient, and slowly increases until a normal portion of the food is ingested. Once at this maintenance dose, the patient must continue to ingest the food on a regular basis in order to maintain protection.

The 3 potential benefits of oral immunotherapy are:

  1. To protect from reactions on an accidental basis
  2. To reintegrate the food in the normal diet
  3. To definitively resolve the allergy (sustained tolerance)

The success rates for the 2 former objectives are approximately 80% in certain studies and can exceed 90% in private clinics, possibly because of the greater flexibility of protocols. Sustained tolerance (the 3rd objective), which is defined by persistent tolerance to the food in question after a prolonged discontinuation of daily doses, may be possible after several years of treatment in certain patients.

In a recent survey in the United States, 13% of allergists were reported to practice oral immunotherapy. The exact percentage of allergists practicing oral immunotherapy in Québec and elsewhere in Canada is unkown, but the availability is currently limited because of lack of access to the technical skillset and human resources, both of which are required to offer this treatment in a secure and structured manner.

For additional information, please consult the document in detail (published 2016, French version).

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François Graham MD, MSc, FRCPC and Philippe Bégin MD, PhD, FRCPC

(translation: Andrew Moore, MD, FRCPC)

In detail