Food allergen avoidance as the mainstream “treatment” for food allergies is unrealistic and requires complete control over your environment. Avoidance is no longer the only answer. At LAFAI, we offer oral immunotherapy (OIT) as a long-term solution for food allergies. OIT is a form of food allergy treatment that involves feeding an allergic individual with gradually increasing amounts of the target food allergen(s) over several months. The goal of this therapy is to raise the individual’s threshold that may trigger a reaction and provide them with protection against accidental ingestion of the allergen. This level of protection will improve the quality of life for both patients and their families by reducing the fear of accidental ingestion and life-threatening reactions.
Using research guided protocol we offer OIT for common allergens such as peanut, wheat, tree nuts, soybean, egg, milk, and sesame seeds. These methods have proven to significantly improve a patient’s food allergy trajectory by increasing exposure to the actual allergen.
We can also provide treatment with the injectable medication Xolair (omalizumab) in combination with OIT. Recently, the FDA has approved Xolair to serve as monotherapy for food allergies. Clinical trials have shown that the addition of Xolair improves the efficacy of OIT in patients with single food allergies, multiple food allergies, and high-risk food allergies. Patients are shown to experience an increased ability to tolerate the food allergen and experience a significant decrease in the frequency and severity of adverse reactions during OIT. This allows for safe and rapid desensitization to the food allergen(s).
This phase marks the beginning of OIT and takes place on a single day in our clinic. The patient is given small but increasing amounts of food allergen over several hours. The goal is to reach a set maximum dose of food allergen that will be a safe starting dose for at-home administration.
Upon completion of the initial dose-escalation phase, the patient enters the build-up phase, where they return to the clinic every 1-2 weeks for dose increases. Patients are monitored in our clinic after the administration of dose increases. If the increased dose is tolerated, the patient is to continue that specific dose daily at home.
When a patient has successfully reached the maximum allowable dose of food allergen, known as the maintenance dose, they have reached the final phase of OIT. This dose is to be taken daily as maintenance therapy for your food allergy.
Clinical trials have shown OIT to be highly effective in treating food allergies. Studies on peanut, egg, and milk OIT have shown to desensitize approximately 60-80% of patients, and thousands of patients worldwide have successfully completed treatment with OIT.
Evaluations start as early as the age of two. First, schedule an initial consultation in our clinic. During this appointment, our healthcare providers will obtain a detailed medical history and conduct a physical examination. Next, we will conduct a series of allergy tests, including skin prick testing and allergy blood testing. Skin prick testing will be performed in our office. The allergy blood test will be performed at a lab location on a date and time of your choosing. Once we have fully evaluated each test's results, our providers will thoroughly discuss possible treatment options. It is important to understand that a patient’s candidacy for OIT will be based on their healthcare provider’s full evaluation.
The goal of OIT is to reach a state of desensitization where the immune system establishes reduced reactivity or becomes nonreactive upon exposure to the food allergen. Regular exposure to the allergenic food is required to maintain desensitization. However, studies are showing being able to achieve "sustained unresponsiveness." This refers to retention of the protective benefit achieved through OIT, without regular exposure to the food allergen. The earlier OIT is started the more of a chance to achieve "sustained unresponsiveness."
Patients with a confirmed or suspected food allergy will undergo a thorough evaluation by our expert medical team, including a board-certified allergist and immunologist. We review the risks and benefits with the patient and/or family members to determine whether an individual would be considered a candidate for OIT.
Yes, thousands of patients worldwide have successfully completed treatment with OIT. We have strict protocols to ensure the safety of our patients both in the clinic and at home. For OIT dosing in the clinic, patients are closely monitored by our medical team, and we are expertly trained and fully equipped to treat any reactions that may develop. For dosing at home, our team is available 24/7 for any pressing questions or concerns. We provide training and concise educational materials to patients and their families to identify warning signs for allergic reactions and how to respond to them appropriately. There are potential adverse reactions associated with this therapy. The most common symptoms include itching of the mouth or throat and abdominal pain․ Severe allergic reactions, including anaphylaxis, can occur. Our staff are highly trained and equipped to take care of you in an event of allergic systems reactions. The risk of adverse events associated with OIT is outweighed by both the achievement of desensitization and the reduced risk of a severe allergic reaction by accidental exposure. Successful completion of OIT helps alleviate the stress and anxiety families experience surrounding food allergies.
At the current moment patients can undergo OIT for single food allergy desensitization. However, we look forward to implementing multiple food allergies simultaneously in the near future. Our expert medical team thoroughly evaluates patients to determine if they are a good fit for single-food OIT.
When you have a food allergy, your immune system mistakenly identifies a protein in the specific food to be an intruder and overreacts by producing a protien called Immunoglobulin E (IgE) to attack it. These proteins travel to cells that release chemicals and cause an allergic reaction. Xolair is a monoclonal antibody that blocks the binding of IgE to its receptor, thus inhibiting the release of the chemicals in the allergic response. This reduces the risk of an allergic reaction during OIT and allows for increased tolerability of the food allergen(s).
Xolair is currently FDA-approved to treat allergic asthma in individuals of at least six years of age and chronic urticaria (hives) in individuals of at least 12 years of age, and nasal polyposis for patients 18 years of age and older. Recently, the FDA has approved Xolair to serve as monotherapy for food allergies, and thus may be covered by your insurance.
While evidence is based on a meta analyasis of the literature, Oral Immunotherapy is currently considered "off-label" and is not covered by insurances. It will be an out-of-pocket expense.
Currently, there are other biologics being reviewed for use to pre-treat Oral Immunotherapy and we will be following closely for when they are approved.
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