Oral Immunotherapy: Controversial Treatment Shows Promise for Food Allergies

An article in the Feb. 15, 2016, issue of The Wall Street Journal outlined how oral immunotherapy – a treatment used for environmental allergies — is showing success in treating patients with food allergies, primarily to peanuts. The controversial treatment involves increasing ingested doses of peanuts (or other offending food) until the allergic patient no longer suffers an allergic reaction. One patient identified in the article ate the equivalence of 46 peanuts in one sitting and is now considered “peanut tolerant.” The desensitization means he no longer carries epinephrine and can eat peanuts without symptoms.
The treatment occurs in a controlled manner, with the offending nuts dosed in powdered protein form at dedicated medical clinics with clinician oversight. In other words, this treatment should not be conducted at home, in the absence of medical supervision.
The treatment seems to fly in the face of conventional medical wisdom where nut-allergic patients are told by their doctors to avoid the food and any other edible that may have been contaminated by nuts during processing/packaging. At facilities where oral immunotherapy for food allergies is offered, children are dosed with carefully measured nut protein (usually mixed with yogurt, pudding or applesauce), with those doses increasing gradually until desensitization occurs).
So far, the New England Food Allergy Treatment Center – a leading facility engaging in oral immunotherapy for food allergies – has seen overwhelmingly positive results. As the center’s founder and medical director noted in the WSJ article, of the roughly 750 to 760 patients treated, so far, the facility has experienced a 90-92% success rate. Most of the center’s patients are children who came to the center seeking help with peanut allergies; however, the center also has also treated patients with milk, egg or tree-nut allergies.
Oral immunotherapy, often called OIT, isn’t approved by the U.S. Food and Drug Administration or endorsed by any professional organization of allergists. Some of the country’s leading allergists say that, despite promising evidence, more research and regulatory approval are needed before the process should be recommended as a treatment for food allergies. Studies have shown about 80-85% of patients who undergo oral immunotherapy are successfully desensitized to their allergen; however, questions remain about its long-term effectiveness, and there are concerns some patients could have adverse reactions, these allergists say.
The therapy is a frequent topic of debate at medical conferences and in academic journals. Many academic institutions offer oral immunotherapy for food allergies, but only as part of ongoing clinical trials.

Source: The Wall Street Journal. “A Controversial Treatment for Peanut Allergies.” February 15, 2016. News brief content edited for length.