At AAPRI, we’re excited to offer oral immunotherapy (OIT) for people with certain types of food allergy. The goal of OIT is to not only provide greater protection against accidentally eating the allergen, but to make it possible to consume the food without any reaction. Is OIT right for you or your child with food allergy? In this article, we talk with Dr. Vikram Malik, AAPRI’s food allergy specialist about OIT testing and what AAPRI’s OIT protocol entails.
Q. Dr. Malik, what exactly is oral immunotherapy (OIT)?
Vikram Malik (VM): Up until recently the only option for people with food allergy was to avoid the food, carry an epi-pen, and hope to outgrow the allergy. Now we can do oral immunotherapy, which is very cutting-edge—and no other practice in Rhode Island offers this treatment for food allergy.
It works in a similar way to sublingual allergy drops, only we are introducing the actual food protein in measured amounts to allow the patient to slowly build up immunity in a safe, controlled environment. Our OIT desensitization protocol at AAPRI is very structured to gradually increase a patient’s tolerance to the allergen so they can actually eat the food—such as a peanut butter sandwich.
Q. How does OIT increase a person’s tolerance to the food allergen?
VM: Basically, I start off by giving very tiny doses of the allergen to the patient. I may give them 10 doses of the allergen at the first appointment during which the patient is with me for 4 to 6 hours. It takes this long because after each dose there is a waiting period where I observe them to make sure they aren’t having any reaction. With each dose, I increase the amount of the allergen, which helps the patient to gradually build up tolerance.
By the end of the first session the last dose the patient tolerated is the dose I instruct them to take at home once a day until they come see me again the following week. At each weekly follow-up appointment, I just up the dose one level, which takes about an hour and 15 minutes. The whole OIT protocol takes about 6 months to complete.
Q. What kind of testing do you do for OIT?
VM: An initial evaluation may include blood and/or skin testing. Depending on how their blood work and skin test looks, and depending on their reaction history—if it’s low risk—I can do what’s called an oral food challenge.
During this test, which takes about 2 hours, the patient will consume the food in question in 3 or 4 incremental doses every 15 minutes. I then watch them for another hour to make sure they’re not having any reaction. The reason we do it this way is because it’s not safe for them to introduce that food at home if they have a positive allergy test.
Q. So if a person is able to get through the oral food challenge without a reaction, they are not truly allergic?
VM: Correct. A patient who is not able to get through the oral food challenge without a reaction, and who has positive skin and/or blood testing, is considered to have a true food allergy and is most likely a good candidate for OIT.
Q. How safe and effective is OIT?
VM: OIT must be done under the direct supervision of a trained physician. But it is not completely risk-free. Upon completion of the 6-month protocol, the patient will continue taking their daily dose to maintain that level of desensitization. Depending on their progress after a few months, the maintenance dose may be reduced to twice a week or stopped completely. At that point, the person is considered to have achieved sustained unresponsiveness to the allergen.
For patients who have successfully completed the OIT protocol, I recommend that they come in to do a follow-up oral food challenge to confirm that they are still unresponsive to the allergen.
Find out if OIT is right for you
Do you have a food allergy? Contact us to schedule a consultation with Dr. Malik to learn more about OIT and if it can help you better manage your food allergy.
