Editor’s Note: Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical or mental health condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.
The precise moment you discover your child has food allergies is something that remains with you forever. From that moment forward, a new life begins with allergy awareness, allergy safety, and allergy advocacy as part of your family’s lifestyle. If your child has a food allergy, you are not alone. According to the Centers for Disease Control and Prevention, “Food allergies are a growing food safety and public health concern that affect an estimated 8% of children in the United States. That’s 1 in 13 children, or about two students per classroom.” The eight most common food groups that cause the most serious allergic reactions in the United States include milk, eggs, fish, shellfish, wheat, soy, peanuts, and tree nuts.
Food allergies are something everyone should be aware of. And parents of kids with food allergies are helping to bring greater awareness. For example, Denise Woodard, founder of Partake Foods, decided to start her own food business when her daughter was diagnosed with multiple food allergies. My dear friend Priscilla Hernandez, whose child Zacky has severe food allergies, has taken up advocating for her son by working on California state legislation to make schools safer in relation to food allergies with The Zacky Bill (AB 2640 Food Allergy Resource Guide).
Food allergies … affect an estimated 8% of children in the United States. That’s 1 in 13 children, or about two students per classroom.
We salute these parents making a difference, but for those whose child has just been diagnosed with a food allergy, it can be extremely overwhelming. And there are many treatment options to consider. Of course, avoidance of the allergen altogether is a viable and valuable option for families dealing with food allergies. However, there is an alternative form of therapy known as oral immunotherapy (OIT), which can provide some families with hope on managing the food allergen(s) long term.
To find out more about what oral immunotherapy entails, I interviewed Dr. Tammy Peng, assistant professor of pediatrics at the UCLA David Geffen School of Medicine. She is a board-certified doctor in pediatrics and allergy and immunology at UCLA. Dr. Peng has provided us with a comprehensive explanation of OIT to inform families on this potential treatment for food allergies. Education is the most powerful tool we can have to support children who have food allergies.
What Happens Once Your Child is Diagnosed with a Food Allergy?
The role of the pediatric allergist is to guide you through the next steps in your child’s life, which now involves awareness of food allergies. This “standard of care” will involve food allergy avoidance measures with having epinephrine (EpiPen) precautions as well as training on how to use epinephrine auto-injectors. In addition, Dr. Peng explained she also takes time to teach “families on how to avoid their food allergens and [provides] resources on how to read labels and navigate avoiding foods. It also involves teaching families how to recognize severe allergic reactions or anaphylaxis, which would warrant treatment with epinephrine.”
Dr. Peng did preface by saying that in general, she may not initially discuss oral immunotherapy when a child is first diagnosed with a food allergy because families may be too overwhelmed at that moment to process the information about this alternative therapy option. In the beginning, you are just learning how to help your child continue to thrive despite having a food allergy.
What is Oral Immunotherapy (OIT)?
Dr. Peng explained oral immunotherapy (OIT) as a “treatment option for patients with food allergies.” Essentially, OIT “is a therapy that involves feeding people with food allergies the food that they are allergic to in small, increasing amounts to help desensitize their immune system to the food allergen.”
To facilitate OIT, patients with food allergies go regularly to an allergist’s clinic and are given increasing amounts of a food allergy during “up-dosing” visits while the allergist is present to observe and support the child’s reaction—if any—to the food allergen. However, the bulk of OIT is done at home in between the clinic visits when the families continue to give the child the approved daily dose of their food allergen. According to Dr. Peng, the goal is for “families [to] reach a maintenance dose and phase of the therapy [so that] the daily dosing will stay at a fixed amount and will occur every day at home indefinitely.” It is important to note that OIT is a daily commitment to be taken seriously.
Dr. Peng said OIT is not a cure for food allergies. Instead, she described it as a “safety cushion” so that if there were ever to be an accidental exposure to a food allergen, “no severe reactions or anaphylaxis [would] occur.” It is believed that giving a patient “small, increasing exposures to the food allergen will help the immune system ‘get used to’ the food allergen so that an extreme immune response does not occur.” You can think of it as an additional “insurance” method to give families more peace of mind and security when navigating the world knowing your child has a food allergy.
OIT is not a cure for food allergies … it’s [more of] a ‘safety cushion’ so that if there were ever an accidental exposure to a food allergen, no severe reactions or anaphylaxis [would] occur.
Lastly, Dr. Peng shared that OIT is currently not considered “the standard of care” treatment for food allergies. Because of this, the process of how OIT is administered is not standardized and, therefore, results in allergists approaching this process differently. Some allergists may not offer it at all.
What Factors Make a Child a Good Candidate for OIT?
There are many factors involved in determining whether or not a patient is a “good candidate” for OIT, which also include factoring in the needs of the patient’s family. “The most important aspect is whether or not your child and your family are interested and motivated to do the very hard work involved with oral immunotherapy,” Dr. Peng stressed.
She is aware that it is a huge undertaking to commit to daily administering of a food allergen to your child at home with frequent visits to the allergy clinic in between. Having the full support of the family and child is paramount to having a successful OIT experience. She also wants families to know it is not the only option for food allergy treatment.
On the medical side, age and other associated medical conditions like asthma, eczema, or environmental allergies are factored in to determine if a patient is a good candidate for OIT.
When Would You Not Suggest OIT for a Child with Food Allergies?
Dr. Peng said she would not suggest OIT for a child with a food allergy if they have poorly controlled asthma or if they have a history of eosinophilic esophagitis (EoE). EoE “is a condition where allergy cells called eosinophils find their way to the throat or esophagus and cause symptoms like gagging or abdominal pain.”
It is important to note that EoE can also be a potential consequence of OIT, although Dr. Peng said it occurs in less than 10% of patients receiving OIT. Another barrier, according to Dr. Peng, is “if a child [or their family] is not interested or willing to participate in OIT; this can be a significant barrier to [its] success.”
What Words of Advice Do You Have for Parents Considering or Undergoing OIT?
Dr. Peng said OIT is a “labor of love.” She shared, “While I support and guide patients and their families on this journey, I recognize that much of the hard work is happening outside of the clinic. It is incredible to see children with food allergies and their families achieve goals that others may take for granted like attending school, going to family events or parties, or enjoying a meal at a restaurant without fear of a severe reaction lurking around the corner.”
“OIT requires a lot of work, diligence, and faith,” said Hernandez, whose son, Zacky, is allergic to peanuts, tree nuts, shellfish, legumes, sesame, and avocado. “Feeding your child the allergen puts immense stress on the caregiver since it is so counterintuitive.“
Caroline, mother of daughter Luna, who is allergic to cashews and pistachios, said something similar about their experience with OIT: “Oral immunotherapy is a daily commitment of love for your child who has allergies. It is not easy and can cause anxiety to give your child the known allergen. We put daily alarms on our phones to remind us to feed her these tree nuts because you must always be diligent with the dosage.”
Dr. Peng hopes families who do decide to pursue OIT do so without any external or internal pressures and consider the huge commitment and risks involved as well as the potential significant benefits for their child with a food allergy.