Peanut OIT

Food Oral Immunotherapy (OIT) is an evidence-based treatment that helps reduce allergic reactions to food through gradual, controlled exposure. It builds tolerance by regularly administering small but increasing amounts of the allergenic food, eventually reaching a maintenance dose.

This approach has long been used for environmental allergies such as grass pollen, tree pollen, house dust mite, and pet dander. Now, with a growing body of high-quality research, OIT is transforming care for children with food allergies.

Imagine not having to worry about your child having reactions to accidental exposure to their food allergen?

Food allergies can place a heavy emotional and practical burden on families. OIT can provide hope and a proactive pathway forward, helping children:

Feel safer and more confident
Participate more freely in everyday life
Look ahead to a future with fewer allergy limitations

At Compass Kids Clinic, we offer food oral immunotherapy to peanut in children up to 8 years of age. The upper age limit for starting oral food immunotherapy is 8 years due to the increased safety of this approach in younger children, fewer gastrointestinal side effects, and a higher likelihood of achieving remission. Our preference is to commence peanut OIT prior to 3 years of age.

What is food oral immunotherapy?

Food oral immunotherapy is a medically supervised process where increasing amounts of the food allergen are introduced daily into the child’s diet, to reduce their allergic symptoms in case of accidental exposure to that food. The team at Compass Kids Clinic have conducted peanut oral food immunotherapy in over 100 children to date.

What allergies can oral immunotherapy be used for?

The oral desensitisation treatment has been most studied for milk, egg and peanut but there is an increasing body of evidence on using this for sesame, tree nuts, legumes and wheat. We plan to expand our OIT program in the coming years. It is important to note that food oral immunotherapy treatment requires ongoing dosing of the food allergen to maintain its benefit. If not, the risk of reaction returns, because the treatment does not necessarily give full and true ‘tolerance’ or a ‘cure’.

Desensitisation is not something that should be done without the close supervision and follow-up by a paediatric allergy specialist, as it can cause severe allergic reactions.

How effective is food oral immunotherapy?

Numerous studies have been carried out around the world that demonstrate that OIT works well for milk, egg, peanut. Most importantly, the studies for peanut also show an improvement in quality of life. Different studies use different approaches, but most report around 80-90% rate of desensitisation in children.

Peanut oral immunotherapy process

The Oral Immunotherapy process involves gradually increasing the child’s exposure to peanut protein in a controlled medical setting. The process is conducted in a under close supervision, starting with a very small dose of the food protein which is gradually increased over time.

Here is an overview of the peanut desensitisation process:

Evaluation: Before starting treatment, the patient will undergo a thorough evaluation to determine their eligibility for OIT, including an assessment of their food allergy and their overall health status.
Preparation: The patient will be advised to avoid consuming the allergen in question and will be prescribed an emergency treatment, such as an adrenaline auto-injector, in case of an allergic reaction.
Baseline testing: The patient’s baseline level of peanut sensitivity will be determined through skin prick tests and blood tests (IgE test or RAST).
Dietetic appointment: Children's health always benefits from optimal nutrition and the OIT path requires this for success. An appointment with our in-house dietitian, Jillian Dimock, is highly recommended.
Initial dose: The initial dose is always given in clinic and monitored for any adverse reactions for 1-2 hours.
Dose escalation: The dose will be increased gradually over time, typically at 2-4 weekly intervals in the clinic. This will continue until the patient reaches a maintenance dose, which is typically around 2000 mg (2 grams) of peanut protein, equal to 8 whole peanuts or 2 teaspoons of peanut butter for infants and toddler, or 4000mg (4gms), or 4 teaspoons of peanut butter for preschool children. The patient will be monitored closely for any adverse reactions throughout the treatment process. If an adverse reaction occurs, the dose will be adjusted accordingly.
Maintenance dose: Once the patient reaches the maintenance dose, they will continue to consume that amount of peanut protein daily to maintain their tolerance.
Monitoring: A review occurs at 6 months into the maintenance dosing, to assess progress, answer any queries patients may have, and ensure adherence to the golden rules of food oral immunotherapy.
Support: A bespoke 7-days a week OIT text and email support is available throughout the OIT process.
Follow-up: At one year follow-up we perform repeat allergy testing and, if the results have reduced substantially, then we aim to reduce the dosing to three times a week.

How safe is oral food immunotherapy?

Oral food immunotherapy is considered safe when conducted under the close supervision of a specialized allergy clinic. However, like any medical treatment, there is a risk of side effects, adverse reactions and reactions due to accidental exposures, especially in individuals with severe food allergic reactions.

The most common side effects reported include abdominal pain, nausea, vomiting, oral itching, throat itching, and hives. In rare cases, more serious allergic reactions including anaphylaxis and difficulty breathing have been reported.

What are the potential benefits of oral food immunotherapy?

Increased tolerance: The goal of oral food immunotherapy is to increase the patient’s tolerance to the allergenic food, which reduces the risk of a severe allergic reaction.
Improved quality of life: For individuals with food allergies, being able to eat the allergenic food without fear of a reaction can greatly improve their quality of life.
Reduced risk of accidental exposure leading to allergic reactions and emergency medication use: With increased tolerance to the allergenic food, individuals with food allergies may be less reliant on emergency treatment, such as adrenaline auto-injectors, to manage their allergies.
Increased social and psychological well-being: Food allergies can have a significant impact on an individual’s social and psychological well-being. By reducing the fear of a reaction and increasing the patient’s ability to enjoy a wider variety of foods, food oral immunotherapy can improve their overall sense of well-being.

It is important to note that oral food immunotherapy is not a cure for food allergies and that patients must continue to follow their doctor's guidance on food inclusion levels. Additionally, the success of oral food immunotherapy varies from person to person, and the long-term benefits and risks of treatment are still being studied.