Why I perform oral immunotherapy to foods

After years of thoughtful and careful consideration, I have decided to pull the trigger and offer oral immunotherapy (OIT) to foods.  This decision was not undertaken lightly.  There are a number of reasons why the researchers who conduct OIT in academic settings state why it should not be offered in a real-world setting.  I am completely open to this criticism, and patients need to know that this is a big issue in the world of allergy.  Given this, the decision to offer OIT is wrought with controversy, and I wanted to explain how I arrived at it.  

There is the question as to whether or not OIT provides desensitization or immune tolerance.  If the patient is merely desensitized to the food, and if he/she stops ingesting the food for a period of time after the OIT protocols have been completed, then the patient will become re-sensitized to the food and have reactions if they are exposed to it.  If the patient becomes immune tolerant to the food, that means that after the OIT protocols have been completed if he/she is re-exposed to the food after a period of absent ingestion there would not be an allergic reaction, as the immune system has shifted away from an allergic pathway.  From my understanding of the current state of research, it seems that both outcomes are possible, and it is impossible  at the onset of therapy to identify a patient who would become desensitized from OIT vs. immune tolerant.  To me, this is a moot issue.  I am approaching the situation as follows: once the patient has completed OIT, he/she will be treated as if a desensitization has taken place and immune tolerance has not been reached.  If the patient does not continue eating the food as prescribed every day, then he/she will be brought into the clinic and an oral food challenge will be performed to sort out the issue.  

The second reason stated as to why not to perform OIT is that the therapy may fail.  I estimate that one in every four patients may not reach maintenance dosing for a variety of reasons, including allergic reactions.  This is no different from allergy shots, which all allergists routinely provide to their patients.

The third reason to not perform OIT to foods is the cost of the therapy.  This is certainly valid.  The current recommended treatment for food allergy is strict avoidance.  This, aside from maybe a yearly visit to the allergist and the cost of an epinephrine injector, is free.  There would also be the cost of allergy tests both for diagnosis and possible repeated tests every 1-2 years to monitor the trending of the specific allergy antibody to the food, in case the patient might "outgrow" the food allergy.  This certainly is much cheaper than OIT.  OIT will involve weekly office visits.  It will also involve prescriptions for epinephrine injectors, allergy testing charges, and an oral challenge at the onset of the protocol in many cases.  The cost in out-of-pocket dollars for OIT vs the cost of strict avoidance for treatment of the food allergy must be carefully considered by each family. 

In my mind, here is strongest reason why to perform OIT.  It is the psychological benefit.  Having a food allergy, or multiple food allergies, is difficult.  It is difficult for the child, for the parents, and for other members of the family such as siblings, grandparents, and aunts and uncles.  Multiple studies have documented this.  Studies have also shown that children with food allergies are bullied for having them.  This is the study that finally tipped me, and made me pull the trigger on offering OIT to my patients.  OIT improves quality of life.  Assuming maintenance dosing with OIT is reached, children are no longer afraid of the food or afraid of being bullied because they have a food allergy, and family members have peace of mind when the child is at school or away from home that they will not have a serious allergic reaction to the food when they are not around.  That is why we do it - so the family can take control of their life, and vanquish the fear.  

I promise to carefully lay out the pros and cons of OIT with each and every family.  It is not a miracle cure, and it is not easy, but I do think it can be life changing.  Don't hesitate to give us a call, shoot us an email, or make an appointment. 

Allow me to introduce a new way of doing things.

Well, here we are with my first blog post.  There will be at least a few others, if only because I have a few topics I want to address very, very soon.  But I don't want this blog to just fade away.  I’d like to have a weekly posting, if not more.  There are so many websites, many of them different types of clinics, that have blogs I've visited over the last several months while I was planning the re-launching of our website.  I can't tell you how many of these blogs had postings that were YEARS old.  It means that the writer(s) of the blog no longer felt that it was worth it, and the blog couldn't go on any longer.  I suppose their message was not being successfully placed, or in some way it just wasn't worth doing anymore.  I do not want that to be this blog.  Time will tell.

If you had been to my old website (and according to the metrics you probably had not), you will notice a stark difference.  The fabric of this website is much richer and colorful and textured, but more importantly there is content.  I want patients to learn about their conditions prior to seeing me, or have a chance to freshen up on some things if they need to.  Education is a big part of this website, in addition to the standard fare you will find with other clinic websites.    I hope this blog will allow me to keep people up-to-date on the latest allergy, asthma and immunology topics, and more broadly health in general.

In reality, the re-launch of this website corresponds with the re-launch and re-focusing of the clinic itself.   If you are an established patient of mine already, I think you will find the changes, or the upcoming changes (depending on when you're reading this), refreshing.  If you are a prospective patient of mine, I want to directly tell you something.  I don't know as I write this if I can accomplish it – time will tell; but I want this clinic to be fundamentally different from almost every clinic you have ever been to.  I want you to have easy access to my staff and to myself.  I want your questions answered and concerns addressed promptly.  And I want you to feel empowered by what you learn from us - to take charge of your disease and to feel confident that you’ve got this, and you're going to feel better. 

Welcome to The new Center for Allergy & Immunology.