This letter is to introduce a new treatment we offer for our food allergy patients.
The treatment is called Oral Immunotherapy (OIT). OIT is fundamentally a graded food challenge supplemented over time by subthreshold doses to achieve a desensitized state dependent on persistent ingestion of a food allergen. We will offer this treatment with the following food allergens: Milk, Egg, Peanut and Wheat. In future, we aim to treat other food allergens as well, particularly tree nuts. This is a very exciting treatment for our food allergic population. We hope this will help our community reduce allergic reactions leading to ER visits and hospitalizations. In addition, it will help parents manage their child’s food allergy safely and reduce fear in both parent and child of accidental exposure.
At the present time, there is no adequate marker to differentiate cure (i.e. sustained unresponsiveness) versus successful treatment, so patients should anticipate that, for most, this will be a lifelong process and is a commitment.
Specific dosing varies from food to food, but the general concept includes an initial escalation day of serial, increasing, low doses of the food, followed by a buildup phase wherein a single higher dose is administered in the clinic followed by a 45 minute observation period, then the same dose is taken daily at home until the next visit 1-2 weeks later. This continues until a maintenance dose of the food is safely consumed which is generally a meal equivalent of the culprit food. There will be some circumstances where a “bite proof dose” will be the target, for highly allergic individuals. This will reduce severe reactions due to accidental exposures.
The majority of children undergoing OIT can tolerate the dose escalations well. However, Immediate IgE mediated allergic reactions are expected and may occur. The children are carefully monitored during these dose escalations and reactions will be quickly reversed and/or managed. Identifying an avoidable risk factor and reducing the next doses, should then allow resumptions of scheduled dosing. Immediate or delayed gastrointestinal problems can slow down the escalation process considerably and is the most common side effect.
This treatment can be billed to insurance and should be covered with most plans, although there is expected to be some costs to the patient.
OIT is the future for food allergy treatment. We truly believe this is a life changing treatment and are very excited to offer it to our community. We are constantly striving to provide the most compassionate and up-to-date care in allergy, asthma and immunology and continue to increase our treatment options as new possibilities arise in this specialty.
Thank you for your kind attention and please contact us anytime with further questions at (208)377-4000.
Neetu Talreja, MD
Charles N. Webb, MD
Brianne Ayers, PAC