Facing a Food Allergy? Oral Immunotherapy May Be an Option

Living with a food allergy can be stressful and exhausting. Concerned about accidental exposures to what you’re allergic to, you may find yourself feeling a lot of anxiety – especially in situations involving meals and eating.

However, if you or someone you love is facing a food allergy – there’s great news. While there is no cure for food allergies, an innovative treatment – oral immunotherapy (OIT) – can help desensitize people to foods they are allergic to, reducing the chance that they will have a reaction if they are exposed to it.

To spread the word about OIT and how it can improve quality of life for people with food allergies, allergist/immunologist Robert Zemble, MD, with LVPG Allergy, Asthma and Immunology–1605 N. Cedar Crest, shares the answers to common questions he receives:

OIT is the process of desensitizing a person who has a food allergy.

“This is done by having you eat increasing amounts of the food you are allergic to under the guidance of medical professionals,” Dr. Zemble says. “This process retrains your immune system to no longer react to that food.”

There are two separate end goals of OIT:

• Not experiencing a reaction if you are accidentally exposed to your allergen
• Being able to freely eat meals and foods without needing to look for or ask about your allergen

Your OIT regimen will differ in length and maintenance depending on which of these two goals you are hoping to achieve.

“It’s important for people to know that this isn’t a cure for their food allergy,” Dr. Zemble says. “However, as long as patients continue their maintenance dose, they may be able to start eating the food they are allergic to after time. More importantly, it is a safeguard against accidental exposure and can allow you to be less cautious around food overall.”

OIT is an option for people of all ages with a wide range of food allergies (though it is most successful in children).

“At Lehigh Valley Health Network, we regularly offer OIT for peanut, tree nut, sesame, egg and milk allergies,” Dr. Zemble says. “However, OIT is an option for other food allergies as well, and we are always happy to meet with people to discuss their eligibility.”

If you have other allergic conditions (such as asthma, allergic rhinitis or atopic dermatitis), they will need to be well controlled prior to the start of your OIT. If you have eosinophilic esophagitis, an inflammatory condition that affects the esophagus, you cannot undergo OIT.

The first step in the process is confirming your allergy. This is done by either reviewing your history of allergic reactions and conducting a blood or skin test, or through a food challenge (which involves you eating the food you are thought to be allergic to while being monitored for a reaction).

Once your allergy is confirmed, you will come for another appointment to review the process in detail and then schedule an appointment for your first treatment.

“The first treatment is known as the initial dose escalation,” Dr. Zemble says. “At this appointment, you will start by eating a very small amount of the food you are allergic to and then eat increasing quantities of the food every 20 minutes. The dose will be increased about 10 times.”

After eating your last dose and being monitored for an hour, you will leave and continue to eat that dose at home once a day for at least seven days. At your second appointment, your dose will be increased incrementally (this is known as updosing). Before your next appointment, you will eat your new dose daily.

“The updosing cycle will continue for several months until you reach a predetermined level based on your selected goal for OIT,” Dr. Zemble says. “Based on that goal and your age, your care team will recommend a specific maintenance dose for you to continue taking at home, a personalized follow-up care plan and additional food challenges to test your tolerance level in the future.”

The most common side effects of OIT are mild, including mouth/throat itchiness, abdominal pain and rashes.

However, severe allergic reactions (like anaphylaxis) are possible.

“If you experience a severe reaction while taking your at-home dose, you should follow your typical allergic reaction protocol and contact your care team to let them know as soon as possible,” Dr. Zemble says. “But severe reactions while undergoing OIT are not typical.”

Make an appointment today.

The care team at LVPG Allergy, Asthma and Immunology–1605 N. Cedar Crest has specific expertise in supporting individuals throughout all stages of the OIT process. 

To make an appointment with an oral immunotherapy expert, call 610-820-9000.