Is your baby allergic to any food? Are you constantly worried that even a small amount of peanuts, milk, or eggs will cause a rash and make it difficult to breathe? Even when you go to a party or event, you worry about what your baby will eat. Today, we are going to talk about a special treatment that can be a solution to this fear and anxiety.
Simply put, what is Oral Immunotherapy (OIT)?
Oral Immunotherapy, or OIT for short, is a treatment for food allergies. Imagine that your body mistakenly identifies a protein in the food that causes the allergy (we call it an `allergen`) as an enemy. So the body starts a big fight to protect you from that ``enemy.`` That fight is what we see as an allergic reaction.
OIT treatment involves giving you a very small amount of the food you are allergic to, under the supervision of an allergist. Then, over time, the amount is gradually increased in a very careful and planned manner. It's like talking to an angry person and making them feel better. The main goal of this is to gradually get your immune system used to the 'enemy' (allergen) and make it understand that it is not dangerous. We call this process `desensitization'. The goal is to get you to a point where, even if you accidentally eat a small amount of that food, you will not have a severe enough reaction to be life-threatening.
What should I do before starting this treatment?
Before starting OIT treatment, your doctor will tell you to do certain things.
- Skin and blood tests for allergies: These tests are needed to confirm whether you really have a food allergy and to measure the success of treatment. In particular, they can measure the level of antibodies in the blood called `(IgE)` and see how much it has decreased after treatment.
- Good control of asthma and eczema: If you have respiratory diseases like asthma or other allergic conditions, it is essential to keep them well controlled. Otherwise, you are at higher risk of having a severe reaction during OIT treatment.
- Preparing the necessary food and measuring equipment: You will need to purchase the food you need to eat daily for the treatment (e.g., peanut powder - such as `Palforzia®`) and the equipment needed to measure it accurately.
- Get an epinephrine auto-injector: This is what you may have heard of called an EpiPen® or Auvi-Q®. This is a life-saving emergency injection that can be given in the event of a severe allergic reaction. Your doctor will give you a prescription for this. You cannot start OIT treatment without it.
How does the treatment take place?
OIT treatment consists of two main phases: the escalation phase and the maintenance phase. If you develop an allergic reaction at any time during this period, your doctor may refer you back to the last dose you successfully took or discuss another option.
Phase One: Updosing Phase
This is what happens at this stage:
1. The first appointment takes place in the doctor's office. On that day, you will be given a very small amount of the food you are allergic to (perhaps a small amount that you can hold on the tip of your little finger).
2. The doctor will then observe you for a few hours to see if there is any reaction.
3. After you go home, you should take the same dose at the same time every day .
4. You should see your doctor again every two weeks . Then, under the doctor's supervision, the dosage will be increased a little more. This will continue for several months.
Phase Two: Maintaining the level to which the body has become accustomed (Maintenance Phase)
Once you reach a certain target dose (this is determined by your doctor), the maintenance phase begins. In this phase, you will take the last dose you successfully reached every day for at least six months . After six months, your doctor will do blood tests again to see if the antibodies to the allergen have decreased. After that, you may be asked to take the dose a few days a week instead of every day.
What are the things to follow during treatment?
There are a few rules for OIT treatment to be successful. Following these can reduce the risk of allergies.
Do not, under any circumstances, attempt this at home without medical supervision. This can be very dangerous.
| Point to be observed | Description and reason |
|---|---|
| Keeping an EpiPen® nearby | Always keep an unexpired EpiPen® and other allergy medications handy, especially when taking a dose. |
| Do not take on an empty stomach. | Eat some food before taking the dose. Taking the dose on an empty stomach is more likely to cause a reaction. |
| Exercise and hot water | Avoid strenuous exercise, running around, and hot baths for two hours before and after taking the dose. These increase blood circulation in the body and increase the risk of allergies. |
| Painkillers (Ibuprofen) | Avoid taking pain relievers such as ibuprofen (Advil®, Motrin®) 3-4 hours before and after taking your dose. |
| Illnesses | Do not take the dose if you have a fever, cough, or vomiting. You are more likely to have a reaction when you are sick. Be sure to talk to your doctor before skipping a dose. |
What to do if you have an allergy?
Your doctor will give you clear instructions about this. A severe allergic reaction (anaphylaxis) is an emergency. If you experience one or more of the following symptoms, use your EpiPen® immediately and go to the nearest hospital emergency department (ETU).
- Swelling of the face, lips, tongue, or throat
- Difficulty breathing or chest tightness
- Multiple large hives all over the body
- Vomiting
- Numbness in the hands, feet, or lips
- Weakness, dizziness, or fainting
- Feeling afraid that something big is going to happen
What are the benefits and risks of this treatment?
Benefits
The main advantage of this is that it is "bite proof" . That is, even if a small amount of the allergic food is eaten by mistake, it will not cause a severe reaction. This greatly reduces the fear and anxiety of the parents and the child. The quality of life increases significantly. There are cases where some young children, after completing OIT treatment, can eat previously allergic foods without any fear.
Risks
The main risk is the severe allergic reaction called ``anaphylaxis'' that we talked about earlier. That is why this treatment must be done under the supervision of a doctor.
In addition, there is a risk of developing a condition called `(eosinophilic esophagitis)`. This is when the throat and esophagus become swollen. If you experience vomiting or a feeling of food getting stuck in your throat, you should tell your doctor immediately. A young child may refuse to eat. But the good news is that this condition usually goes away once OIT treatment is stopped.
OIT is a treatment that requires a lot of commitment and time. And it is not suitable for everyone. Therefore, before deciding whether this treatment is right for your child or you, it is very important to talk to your doctor about it and ask all the questions you have.
Take-Home Message
- Oral Immunotherapy (OIT) is a method of treating food allergies. It involves gradually increasing the amount of the allergenic food, starting with a very small amount, to accustom the body to it.
- The main goal of this treatment is to prevent a severe reaction from occurring even if the allergenic food is accidentally eaten.
- This should be done entirely under medical supervision and should never be attempted at home alone.
- It is very important to follow the rules during treatment, such as keeping an EpiPen® with you, taking the dose on time, and avoiding exercise.
- Although OIT treatment is a journey that requires a lot of commitment, if successful, it can be a great help in overcoming the fear and anxiety caused by food allergies and living a more relaxed life.
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