Oral Immunotherapy Program
When children have severe allergies to common foods like milk, eggs and nuts, families must remain hypervigilant to keep their children safe. Even the smallest exposure to the allergen can cause an extreme reaction called anaphylaxis, in which the immune system begins to attack itself, causing tissues in the body to swell, the airways to close, and the heart and lungs to fail. Today, patients treated at Children's Hospital of Philadelphia (CHOP) have a new treatment option: oral immunotherapy.
What is oral immunotherapy?
Oral immunotherapy, or OIT, helps desensitize children to the foods they are allergic to by giving them small quantities of the allergen every day at home, and then gradually increasing the amount under medical supervision at the hospital.
In many cases, daily ingestion of the allergen actually helps reduce the child's sensitivity to the food. OIT has been shown to be effective in 60 to 80 percent of research trials. The goal of CHOP's Oral Immunotherapy Program is to make OIT more accessible to a larger population of patients and families.
Currently, CHOP's Food Allergy Center offers oral immunotherapy for to up to five foods at a time. For certain allergies, we will use an FDA-approved product, such as PalforziaTM, when it becomes available. Once your child has reached a “maintenance dose” — a low dose that has proven to protect individuals against exposure to larger quantities of the allergen, your child will remain at this dose for a period of time.
This extended “maintenance” dosing has proven to be protective to large quantities of food allergens. For example, if a child who is allergic to peanuts can tolerate 300 mg of peanut (one very large peanut) daily for more than six months, they can likely tolerate exposure to 2 grams of peanut (seven peanuts).
Because patients participating in oral immunotherapy will receive a food they are allergic to, all dose increases need to occur under medical supervision at CHOP. Before OIT begins, your child will complete oral food challenges to determine their level of sensitivity to each food. This process will be individualized based on your child’s medical history.
A healthcare provider and medical staff are assigned to monitor patients during and after dosing because allergic reactions and anaphylaxis are a risk when patients are exposed to a food allergen — even a controlled amount.
All medications are readily available to treat any allergic reactions, and the Oral Immunotherapy Program team has additional support from within the hospital. Gastrointestinal (GI) symptoms can accompany OIT and will be monitored closely.
To be eligible to participate in OIT at CHOP, children must be:
- A current patient of CHOP's Food Allergy Center in the Division of Allergy
- Age 4 to 24
- Demonstrate positive skin test, blood test or food challenge to at least one food allergen
- In good general health
Note: Patients with other chronic illnesses, like asthma or allergic rhinitis, can participate if their symptoms are under good control.
In addition, families must always agree to carry emergency medications with them.
Patients cannot participate in OIT if they have recently had:
- A severe reaction to any food
- A loss of consciousness
- A drop in blood pressure
Maintenance dosing and exiting food challenge
After your child performs the food challenges, the clinical team will be able to determine when to start OIT dosing and at what dosage. Some children can increase the dosage of their allergen every two weeks, commonly called "up-dosing." Others may need more time to build up their body's resistance to the allergen.
Once your child has reached maintenance dosing, they will return for an OIT Program visit every three months for a year. After a year of maintenance dosing, your child will be offered an exit food challenge to determine how much of the allergen your child can safely consume without adverse reactions.
Your child will continue to follow up with their primary allergist long term to monitor for reactions.
Getting started with OIT
If you believe your child may benefit from oral immunotherapy, talk to your allergy provider and review our Oral Immunotherapy Fundamentals for Families.
Please note: this is newer program with limited spots available. We are in the process of expanding.