Paul Detjen M.D. Deborah Pockross M.D.
Kenilworth Medical - Adult and Pediatric Asthma and Allergy
534 Green Bay Road, Kenilworth, IL 60043
There have emerged new technologies over the past 10-15 years to address the world wide
near epidemic of food allergy. In general, the concept is similar to immunotherapy for airborne
allergens; that is, administering small but increasing amounts of allergen to the patient, trying
to get to a level that changes the patient’s immune system, similar to vaccination, and makes
patients less allergic or nonallergic, while not causing too high a risk of systemic allergic
reactions. Allergists have always walked that line as part of their injected and oral
immunotherapy treatment plans, in practice for over 100 years.
There was strong push to shelve immunotherapy for food allergy in the 1990s after severe
reactions from injected peanut in clinical trials. There has been a reemergence through the
introduction of non-injected technologies (patch, sublingual, oral) to address food allergies
which have a lower rate of systemic reactions.
Procedures perhaps soon available for food allergy include a peanut food patch, now working
its way through the FDA approval process, phase III, several other foods in the pipeline. The
doses are relatively low (e.g. less than 1/1,000
of a peanut), systemic reactions relatively
rare, efficacy not yet established. Higher doses than the patch would be sublingual (SLIT)
which still has a very good safety rating, and although oral itch reactions can happen, systemic
reactions are unusual. Doses are in the mg ranges. The success of SLIT may be to safely
decrease the chances of a severe reaction from an accidental exposure or cross
contamination. It is also used as an initial therapy prior to OIT.
Oral immunotherapy for food (OIT) has been investigated at academic and private practice
centers for more than a decade. Private practice OIT generally uses higher amounts of food
protein than academic trial “OIT”. These doses are used in order to induce a higher and more
prolonged tolerance to the food. There are a number of private practice protocols used
currently with different starting doses, dosing escalation intervals, final target maintenance
doses, estimated durations of ingestion, etc. Each has its own rate of side effects, systemic
reactions, and success. There is no currently FDA-approved product and no generally
accepted single protocol in the form of guidelines, etc. Private practice allergists have been
administering immunotherapy in various forms for 100 years, and there seems now sufficient
information and experience available from any number of clinical, research and private practice
trials that show reasonably effective and reasonably safe sublingual and OIT protocols as
treatment options for allergists and their food-allergic patients.