What is oral immunotherapy, and is it right for your child?

What oral immunotherapy does and doesn't do

Oral immunotherapy (OIT) is a structured programme of gradually increasing doses of a food allergen (most often peanut, milk, egg, or tree nut) given to a child in a clinical setting over a period of months. The aim is to raise the threshold at which the immune system reacts.

OIT is not a cure. After completing a programme, most children still have some degree of peanut (or other food) allergy. What changes is the amount of the allergen that triggers a reaction. A child who previously reacted to trace contamination may, after OIT, be able to tolerate the equivalent of several peanuts before reacting. This substantially reduces the risk of a serious reaction from accidental exposure.

Who is it suitable for?

OIT is not for every child with a food allergy. Children need a thorough assessment before starting, including recent allergy testing and a review of overall health. The programme is generally not appropriate for children with uncontrolled asthma, certain immune conditions, or other factors that increase the risk of reactions.

The decision to proceed is made carefully, in conversation with the family, after reviewing all the relevant information.

What the programme involves

A typical OIT programme begins with a baseline visit to establish the child's current reaction threshold. Dose increases (up dosing) take place in a clinic/hospital setting, with trained clinical staff and emergency equipment immediately available. Between clinic visits, children take a daily maintenance dose at home at the level already safely reached in hospital.

The programme usually takes between 12 and 18 months, though this varies.

Carrying emergency medication

Throughout the programme and after it, children with food allergy should continue to carry prescribed emergency medication, including an adrenaline auto-injector where indicated. OIT reduces risk; it does not eliminate it.