Oral immunotherapy for the treatment of food allergies
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:
- To protect from reactions on an accidental basis
- To reintegrate the food in the normal diet
- 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 University Hospital Centre of Sainte-Justine (CHU Sainte-Justine) is now happy to offer a new service treating food allergies with oral immunotherapy outside of a research context.
For additional information, please consult the document in detail (published 2016, French version).
François Graham MD, MSc, FRCPC and Philippe Bégin MD, PhD, FRCPC
(translation: Andrew Moore, MD, FRCPC)