Experts: Oral immunotherapy (OIT) for food allergy is not ready for prime time

Analogy between oral immunotherapy (OIT) and subcutaneous immunotherapy (SCIT)

Office-based oral immunotherapy (OIT) for food allergy is safe and effective, according to an allergist group from Texas. The only death caused by OIT occurred during a formal trial at an academic center and was caused by a dosing error. Many more deaths have resulted from accidental exposure. The group experience represent the completed treatment of more than 175 patients.

Similar concerns have been raised in the treatment of allergic rhinitis by subcutaneous immunotherapy (SCIT), a treatment that was introduced more than a century ago and is one of the cornerstones of therapy for the specialty of allergy. In fact, the comparison of SCIT to OIT is quite revealing. Although the benefits of SCIT for airborne allergens are unquestionable, this treatment modality is not lifesaving but rather improves the quality of life.

Experts: Oral immunotherapy (OIT) is not ready for prime time

Oral immunotherapy (OIT) is not ready for prime time, say the leading experts in the field of food allergy.

In oral desensitization to peanut, adverse reactions requiring epinephrine occurred in 43% of patients. Overall, 32% of patients with food allergy were unable to continue.

Further investigation must address the less common but potentially more disabling consequences of OIT, such as eosinophilic esophagitis and other delayed-type reactions.

8 top allergens account for 90 percent of food allergies. Serum IgE levels (sIgE) that predict the likelihood of passing an oral food challenge are shown in the figure. (click to enlarge the image).


Office-based oral immunotherapy for food allergy is safe and effective. The Journal of Allergy and Clinical Immunology, Volume 127, Issue 1 , Pages 290-291, January 2011.

Oral immunotherapy: Ready for prime time? The Journal of Allergy and Clinical Immunology, Volume 127, Issue 1 , Pages 289-290, January 2011.

Reply. The Journal of Allergy and Clinical Immunology, Volume 127, Issue 1 , Pages 291-292, January 2011.

Sublingual and oral immunotherapy for milk allergy. Desensitization was lost in some cases within 1 week off therapy. JACI, 2011.

The place of oral desensitization in the practice of allergy at this time is in flux - see why:

Image source: Roasted peanuts as snack food, Wikipedia, public domain.

1 comment:

  1. There have been ZERO deaths from OIT in studies and/or in private offices. The death you are referring to was by INJECTION--NOT oral ingestion. At National Jewish, an adult patient who had been on placebo accidentally received an injection of the actual peanut protein and they were unable to control the reaction. The study was halted. It was an attempt at desensitization but via injection, NOT OIT.

    Thank goodness several researchers have come out of the studies and joined other private allergist in the quest to help the food allergic community. The rate of reaction portrayed in this article is due to the study protocol of attempting to rush the patients to 50mgs. or more of peanut protein. Private OIT board-certified allergists would never attempt to go so high--usually starting at 1/1000ths of a peanut and stopping at 3mgs. the first day. What is terrifying is that some studies are attempting to "rush" the patients even higher than 50mgs. the first day--using Xolair to rush them to 1000mgs. the first day.

    So when we are stating usage of epi and what sorts of reactions the patients experienced, it would be professionally responsible to provide other details as well.

    I am grateful for the studies but would never be comfortable giving my child a food challenge to prove his allergy before participating in a study. He experience three severe reactions which is why we wanted to prevent another, which is why we chose private OIT that was tapered to his exact medical condition and history.