What is OIT?

OIT stands for “Oral immunotherapy” or oral desensitization for food allergies. OIT is a medical treatment guided by a board-certified allergist with a payoff of lifetime freedom from food fear and stress.  The immune system is re-trained to tolerate food proteins/allergens through regular eating of small amounts of food.

OIT has been studied in clinical trials for well over a decade and traces back even to medieval times when kings would ingest tiny bits of arsenic to protect themselves from being poisoned. Allergy shots are a form of immunotherapy and desensitization called SCIT or subcutaneous immunotherapy. Allergy shots have been used for over 100 years (since 1911) with a strong track record of safely desensitizing people from environmental allergies.

OIT has an 85+% success rate in clinical trials. Patients must have a documented Ige-mediated food allergy. Two contraindications are previous EOE or uncontrolled asthma (asthma must be brought under control before OIT begins. The allergist must also be sure you can take the protocol as seriously as it needs. A call to the office can clarify a specific protocol they use and insurance/costs. 84% of patients also have had insurance coverage for this treatment.

The key to understanding OIT is that there is low level of allergen an allergic person can safely eat without a reaction. It’s invisible to the body. Then it’s raised slightly and the body still doesn’t react. The “threshold of tolerance” is gradually increased over time. The immune and digestive systems adapt, as they are meant to do.

In Private Practice OIT (PPOIT), the first day of treatment is a build-up day, starting with a minute amount of allergen ( i.e.1/40,000th of a peanut) totaling up to a tiny amount that day with a few doses spaced out. You are sent home and take less than, or equal to, the “safe dose” once or twice daily, depending on the specific protocol used by your PPOIT specialist. You return to office in 1-2 weeks to increase the dose under their watchful eye. Usually it’s a minimum of 12-14 at-home doses. However, many physicians are flexible with spacing out appointments to 3-4 weeks for travel and/or financial reasons. Since we are naturally desensitizing the body, going slowly is often a benefit.

After each dose there is a 1-2 hour observation period with no core body temperature elevation while the body digests and metabolizes the peanut. In maintenance, many take their daily dose about an hour before bed. Dosing just becomes part of your life much like brushing your teeth. Regular dosing ensures your body stays desensitized. Visible proof of protection occurs with each successful dose.

The increase process can take 6-12 months with 15-25 appointments. Depending on the PPOIT Provider’s protocol, there may be a food challenge at the end of the maintenance phase of treatment.  This food challenge is usually 3x the amount of the daily maintenance dose.  For instance, if the patient is on 8 peanuts/day maintenance dose, the food challenge will be approximately 24 peanuts.  If the patient passes the food challenges, they are deemed “tolerant” and free to incorporate the ingredient into their daily diet.  If they do not pass, they continue their maintenance doses.

For many, the dosing will continue for life. Perhaps not daily, but regularly like 3-5 times a week in a normal diet.

There have been clinical studies to see if a daily dose of 1 peanut is enough to retain desensitization and tolerance to a particular ingredient.  Most of this work is conducted outside of the United States and we are eager to see their results.

In other positive news, it appears that OIT also brings along positive epigenetic / DNA results. In a NY Times article: “Research in Nadeau’s lab has found that treating allergies actually changes the genes by epigenetics (a chemical modification of the genes that does not affect the actual DNA sequence), so desensitizing children may reduce the likelihood that they will pass on the disease to their children. One day, perhaps, fatal anaphylaxis may become a sorrow associated with an earlier age, like dying of appendicitis or polio.”

This supports what Dr. Wesley Burks said originally in 2009, “There is a molecular change in the blood… and the allergy just goes away.”

There are 100+ board-certified PPOIT allergists through the world offering OIT to patients for peanut, milk, egg, wheat, tree nuts and other allergens. Our Facebook support groups have thousands of old posts to read–it can be your own private “OIT Google”!

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