Oral immunotherapy: a promising treatment option for infants and toddlers with food allergy

Published online September 30, 2024

Food allergies are common in children and often are managed with strict dietary avoidance. Oral immunotherapy (OIT) is an alternative treatment option for some children with food allergy. OIT consists of orally administering small quantities of food protein and gradually increasing it over time (updosing) to raise a child’s tolerated dose. OIT has largely been studied in older children; however, increasing evidence suggests that younger children have the most benefit. Peanut OIT in early life increases the likelihood of a child achieving sustained unresponsiveness: a lack of an allergic reaction after a period of avoidance. Despite the recognized benefits, there have been several barriers to implementing OIT in clinical practice, including the substantial clinical resources required to offer in clinic updosing. These barriers may contribute to prolonged waits for some families hoping to start their child on OIT.
    
In a recent study published in The Journal of Allergy and Clinical Immunology: In Practice, Huang et al. examined the safety and feasibility of OIT for peanut, tree nut, and/or sesame allergic infants and toddlers using commercially available food products. In this retrospective cohort study, all children began OIT by 24 months of age or earlier. After performing an initial in-clinic oral food challenge, the remaining updosing was performed at home, in clinic, or a combination thereof.

There were 52 infants included in this study, and the average age of OIT initiation was 12 months. Most children were undergoing OIT for peanut allergy, though some were on OIT for tree nut and sesame seed allergies. Some infants were on multifood OIT, and this was found to be as safe as single food OIT.  Most children in this study updosed exclusively at home, and there were no increased adverse outcomes compared to those who updosed in clinic. After starting OIT, most infants had no allergic reactions, though some experienced mild symptoms such as skin rashes. No children on OIT had reactions that required treatment with epinephrine. Most children were still on OIT at study completion.

This study showed that infants with peanut, tree nut, and/or sesame allergy respond well to treatment with OIT using commercially available food products, which can vary in terms of their ease-of-use for busy parents. Home updosing may be a reasonable option that may increase OIT accessibility during a period of life when children have the most benefit. Further research would be helpful to explore the full spectrum of risks and benefits of treating food allergic infants and toddlers with OIT.

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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