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.
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.
