ACAAI: Advice to Allergists Regarding Private Practice OIT

Baby OIT

An article published in the September Issue of Annals of Allergy, Asthma & Immunology is intended to provide advice to allergists that are considering offering private practice oral immunotherapy (PPOIT), but the article also serves as a primer for those that are considering engaging OIT for themselves or their children.

Oral Immunotherapy refers to a process whereby a food allergen is administered slowly over time in small but steadily increasing doses until the patient is desensitized to it. PPOIT is simply OIT provided by a private practice allergist.

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While the article provides insight to both the provider and the prospective patient, the following table is especially of interest to those considering engaging OIT for themselves or their children:

Factors Impacting Shared Decision Making for OIT


Strongly consider recommending food oral immunotherapy:

  • Positive oral food challenge (OFC) to peanut/tree nut/seed
  • Positive OFC to milk, egg, wheat >7 years old
  • Proximate history (<2 years) of IgE-mediated reaction with positive IgE or skin prick test (+sIgE/SPT)
  • Remote history (>2 years) of IgE-mediated reaction with strongly +sIgE/SPT

Carefully weigh the option of food oral immunotherapy:

  • Positive OFC to milk, egg, wheat <8 years old—discuss the possibility and tempo of spontaneous resolution
  • Never eaten—sIgE/SPT both strongly positive—discuss the possibility of false-positive testing and risks of oral food challenge
  • Never eaten—sIgE/SPT 1 or both weakly positive—oral food challenge is essential

Relative contraindication to food oral immunotherapy:

  • History of nonadherence
  • Parental conflict about OIT
  • Eosinophilic esophagitis
  • Non-EoE eosinophilic gastroenteropathy
  • Incompletely controlled comorbid atopic disease

The full article is freely available from the American College of Allergy, Asthma & Immunology and we recommend it for all families considering OIT, especially those that may be unfamiliar with the therapy.

Source: Oral immunotherapy for food allergy – Annals of Allergy, Asthma & Immunology
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