Age of implementation and multidisciplinary support enhancing food oral immunotherapy adherence

Published: March 13, 2024

Oral Immunotherapy (OIT) is transforming the treatment landscape for food allergies. However, despite the promise of OIT in mitigating allergic reactions, families can face significant challenges in adhering to treatment protocols, reducing likelihood of overall treatment success, largely due to the fear of reactions and taste aversions associated with allergenic foods.

In a recent comprehensive study published in The Journal of Allergy and Clinical Immunology: In Practice, Trevisonno, et al. provide new insights into these challenges. Conducted across multiple sites in Canada and the U.S., this research surveyed parents managing their children's food allergies with OIT. The study drew on a robust sample to understand barriers to OIT from the perspectives of families actively engaged in the treatment process, with a particular focus on barriers to treatment initiation and adherence, as well as the value of allied health professions such as dietitian and psychologist support.

The survey, which included responses from 397 families, highlighted that the most formidable barriers to initiating OIT were the fear of allergic reactions (45.6% indicating this as a 'very significant' barrier) and concerns over the need to use epinephrine autoinjectors (38.5%). Notably, taste aversion emerged as the primary obstacle to continuing OIT, with 22.4% of families citing it as a significant challenge. This sensory aversion often resulted in delays in reaching the maintenance phase of OIT or temporary discontinuation of the treatment. Importantly, this food aversion barrier was most prominent in children > 6 years of age (p < 0.001) consistent with a psychological understanding of distaste acquisition. The study also emphasized the pivotal role of dietitians in facilitating OIT. Families that consulted dietitians were better equipped to manage taste aversion and more likely to maintain consistent allergen dosing, highlighting the importance of professional dietary advice in successful OIT adherence.  This study underscores the complexity of implementing OIT as a treatment strategy for food allergies, pointing to both psychological and sensory barriers that can hinder effective management. The significant age-dependence to significant taste aversion identified by this study further supports the importance of early OIT implementation. Finally, this study calls for greater integration of dietitians and mental health professionals in OIT protocols to support families, ensuring higher adherence rates and more successful long-term outcomes for children with food allergies.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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