Oral immunotherapy aims to lessen sensitivity in kids with severe peanut allergies

When it comes to kids and food allergies, a “simple slip up” can quickly become life threatening. Oral immunotherapy, or OIT, is helping to ease the threat of peanut allergies by increasing the threshold that triggers a reaction.

Managing severe reactions in kids with food allergies

According to the CDC, about 8% of kids have a food allergy.  

“Food allergy is on the rise,” said Dr. Wei Zhao, professor and chief of allergy and immunology at CHoR. “Severe food allergy carries the risk of life-threatening reaction upon accidental ingestion. It also has great impact on family lifestyle and social interaction with other children.”

There’s no proven treatment for food allergies. The goal is to avoid foods that cause symptoms, but this isn’t always as easy as it sounds. Kids with allergies have to be diligent about knowing the ingredients in their foods. This is something that comes with age and maturity but is tricky to test due to the serious consequences. Birthday parties, playdates and even the daily routine of going to school can be nerve-racking.

Severe allergic reactions, or anaphylaxis, require quick administration of epinephrine to improve breathing, increase heart rate and blood pressure, and reduce hives and swelling around the face. It’s essential that people with known allergies carry an epinephrine auto-injector, often referred to by the brand name EpiPen, with them at all times.

A promising approach to managing peanut allergies

OIT is a relatively new approach for desensitizing kids who are highly allergic to peanuts. Though it’s not a cure for the food allergy, it can reduce the severity of allergic reactions from inadvertent exposure. The first peanut allergy OIT product, Palforzia, was approved by the FDA in 2020. Soon after this approval, our allergy and immunology providers began offering it at CHoR.

Palforzia was initially approved for children ages 4-17 years with a confirmed peanut allergy diagnosis. Last year, FDA revised the approval down to 1 year of age.

“After medical evaluation by our providers, patients with a peanut allergy go through the initial dose escalation process followed by a bi-weekly up dosing regimen until maintenance is reached,” explained Zhao. “This process has proven to significantly decrease a child’s sensitivity to peanuts and risk of anaphylaxis after accidental exposure.”

Increasing doses of the peanut protein must first be administered in the clinic so our medical team can monitor for reaction. If the dose is tolerated well, daily doses can then be given at home until it’s time for the next dosage increase. Side effects of OIT are usually mild and include oral or throat itching, abdominal pain or a few hives. That said, it’s important to still keep a close eye on your child after home doses and be prepared to identify and address a potentially more serious reaction.

What does the future hold for OIT?

Currently, Palforzia – specifically for peanuts – is the only FDA approved OIT for food allergy. OIT for other foods are being investigated. There is also potential for a multiallergen OIT.

We don’t expect it will allow for eating without caution, but it does provide some latitude in the event of exposure. As with most medical conditions and treatments, if and how well OIT works will vary for each individual.

Think OIT might be helpful for your child? A check-in with their pediatrician is the best first step.

From seasonal symptoms to food allergies and more – find out how we can help your child at CHoR.