What is oral immunotherapy (OIT) for allergy treatment?

From the Guidelines

Oral immunotherapy (OIT) is a promising treatment for food allergies, which involves gradual exposure to incremental amounts of a specific food allergen to induce tolerance and desensitization. This approach takes advantage of the body's natural tendency to tolerate items presented to the immune system through oral exposure, promoting regulatory T cells and modulating the immune response through cytokines such as interleukin 10 and transforming growth factor b 1. The goal of OIT is to achieve tolerance, which is accompanied by up-regulation of allergen-specific IgG4 and decrease of IgE. However, it's essential to note that OIT may also result in desensitization, and adverse effects can range from mild oropharyngeal or skin reactions to anaphylaxis.

Some key considerations for OIT include:

• The dose of allergen
• The dose escalation
• The duration of therapy
• The route of administration (for example oral, sublingual, or subcutaneous) 1 It's crucial to weigh the benefits and harms of OIT, as the quality of evidence is currently low, and additional safety and efficacy data are needed before such treatment can be widely recommended 1. Nevertheless, OIT has been found to be generally well-tolerated and safe in highly controlled clinical settings, and it may provide long-lasting benefits for patients with food allergies. I recommend OIT for patients with severe food allergies who haven't responded well to conventional treatments, under the close supervision of a healthcare professional.

From the Research

Definition and Purpose of Oral Immunotherapy (OIT)

• Oral immunotherapy (OIT) is a treatment approach aimed at desensitizing patients to specific allergens, with the goal of inducing tolerance and reducing allergic reactions 2, 3.
• OIT involves the administration of increasing amounts of the allergenic substance orally, with the intention of modifying the immune system's response to the allergen.

Comparison with Sublingual Immunotherapy (SLIT)

• Both OIT and SLIT are forms of allergen immunotherapy, but they differ in their route of administration and the type of immune response they elicit 2, 3.
• SLIT involves the placement of a small amount of allergen under the tongue, where it is absorbed by the immune system, whereas OIT involves the ingestion of the allergen 4, 3.

Efficacy and Safety of OIT

• Research has shown promising results for OIT in the treatment of food allergies, with studies demonstrating its ability to desensitize patients and reduce the risk of allergic reactions 2, 3.
• However, more research is needed to fully understand the efficacy and safety of OIT for other types of allergies, as well as its long-term effects 2, 3.

Current Status and Future Directions

• OIT is still considered an experimental treatment for many types of allergies, and more studies are needed to establish its safety and efficacy 2, 3.
• Further research is also needed to determine the optimal dosing regimens, treatment durations, and patient selection criteria for OIT 2, 3.