Take a deep dive into the world of oral immunotherapy with Dr. Alice Hoyt, a trusted board-certified allergist and mother, and Pam Lestage, a devoted mom navigating food allergies. They break down the essentials of OIT — from understanding what it is to exploring the risks and benefits. Whether you're an OIT skeptic or enthusiastic supporter, this episode promises insights that will deepen your understanding and enhance your decision-making process.
The Science of OIT
OIT is one method that reprograms the body's immune response, teaching it to be less reactive to a particular food allergen. As in this episode, some immune systems are easier to reprogram than others.
Is OIT Right for Your Family?
Curious about the boundaries of OIT? Dr. Hoyt shines a light on who often is a good candidate for OIT. From children to adults, the conversation extends beyond simple yes or no to why and how.
Risks and Benefits
OIT therapy isn't a casual stroll. OIT takes time, and it can cause mild adverse reaction to severe anaphylactic reactions. That said, OIT can be powerful enough teach the immune system to tolerate a food enough so that a person can be bite-proof or, in some cases, even begin to free-eat the food.
Next Steps
Learn even more about OIT on foodallergyandyourkiddo.com!
Hello and welcome to Food Allergy and your Kiddo. I am your host, dr Alice Hoyt, along with my co-host, ms Pam Lestache. Hey Pam, hey Dr Hoyt, how are you? I am very good. I am super excited about this new series that we're doing. I know we're going to talk about the all you need to know about fill-in-the-blank food allergy situation in under 10 minutes.
Speaker 2:
Yes, if you follow us, you know that we like to be long-winded, but this is going to be great for just like getting your quick information. And then, if you want to listen to more information from past episodes or future episodes, you can find that on our podcast.
Speaker 1:
Okay, so today's episode all you need to know about oral immunotherapy, oit, and under 10 minutes. So Pam is going to hit me with questions and we're going to go through OIT.
Speaker 2:
Okay, so, first and foremost, what is OIT? Excellent question, pam. Oh, thank you.
Speaker 1:
OIT, oral immunotherapy is a treatment for IgE-mediated or anaphylactic food allergies. Oit actually teaches the immune system to tolerate the allergen. For example, say you have a one-year-old little guy who eats peanut butter for the first time and develops hives and vomits, comes in for evaluation, has some skin prick testing that's positive to peanut, has some blood testing that suggests some pretty legit levels to peanut IgE and peanut component tests. Based just on that history alone, we know that we're expecting those tests to be positive. That is an IgE-mediated peanut allergy, because peanut allergy resolves self-resolves maybe 30% of the time. This is a kiddo where I'm definitely considering oral immunotherapy, because with oral immunotherapy we can teach the immune system to tolerate the food. Okay, what do I need to dive into now, Pam?
Speaker 2:
Where do I need?
Speaker 1:
to go, so you.
Speaker 2:
Because you know I could talk for a minute. You kind of gave us an example of a good candidate. So who else is a good candidate? Is it only babies? Is it only older kids? Who are we lumping into? Who can do OIT?
Speaker 1:
That's a really good question. That comes back to sort of like how OIT works. So what OIT does? It teaches the immune system to tolerate the food. If you're dealing with an immune system that is used to being in a very tolerant state, like a baby's, then it's going to be a little bit easier to teach that immune system to tolerate the food. So let me pause right there because you're probably wondering what is she talking about? How is a baby's immune system tolerant? So when a baby is inside of mommy baby and mommy's immune systems, they have to get along, because if they don't get along, bad things happen, and so that baby's immune system is very tolerant of what it's interacting with.
Speaker 1:
Now, when the baby is born, the immune system needs to stop tolerating stuff so much, because if a baby's immune system sees a germ and is just like, okay, germ, come on in, then that's how babies get very sick. So the immune system needs to grow and needs to develop and needs to become less tolerant, but it still needs to tolerate foods. And what we don't know is why some of these kiddos, their immune systems, are not growing tolerance to things like peanuts and eggs and milk, and we know that introducing those foods early, like around four or six months of life, can help the immune system grow tolerance to them. But in the case of somebody who, like the peanut kiddo that I mentioned, they didn't grow tolerance to it. Well, why not? Well, we don't know. But can we teach tolerance? Yes, we can, especially in a younger immune system, because the allergy has not set in. Now, fast forward to their five, six, seven.
Speaker 1:
Can you still do oral immunotherapy? Yeah, you can absolutely still do oral immunotherapy. And what about teenagers, adults? Yeah, you can teach an immune system to do what you want. That being said, once the immune system is set in, it's a little bit more difficult, and it can be a lot more difficult actually, and what I mean by difficult is that you're more likely to have reactions to oral immunotherapy doses, these tiny, tiny, tiny doses of your allergen that you take every day. You're more likely to have reactions, Sort of, the older you are, the higher your testing results are, the more severe your reaction history has been. But ultimately, can you still do OIT? You can, Really.
Speaker 1:
Where the big caveat is is why are you doing OIT, OIT? We talk about goals with our patients, right, Pam? We talk about what's really your goal with OIT. Oit can teach you your immune system to be bite-proof, meaning you accidentally take a bite of the food, you won't have a severe, like threatening allergic reaction. In most cases, you tolerate it and go about your merry way. Some people, though, really want to free eat, meaning they want to get that food in their diet and they want to eat as much of it as they want to. And the younger you are, typically some more likely you are to be able to get to free eating With oral immunotherapy, because there is that risk of reaction.
Speaker 1:
Then there's this very annoying safety window, Meaning one hour before the dose to two hours after you're not doing anything.
Speaker 1:
That's raising your heart rate or raising your body temperature, because both of those things lower your threshold to have an allergic reaction. And so when you're thinking about why are you doing OIT, you want to add safety, but you also want to improve that person's quality of life. So where families, you're able to go out with more confidence that an accidental ingestion won't cause a life-threatening reaction. But if the treatment is worse than the condition to that particular family, to that particular child's quality of life, then it's not the right treatment for them, and so that's where OIT can be very challenging sort of the older kids get and adults get, and especially when we're thinking about kids going to college, you know what college kid, what college freshman, wants to be remembering. Okay, one hour before, two hours after, I can't do any of this stuff. Sleep deprivation, alcohol, all those things they lower the threshold to have an allergic reaction. So it has to be a very good conversation with an OIT allergist talking about what is your goal and how is the treatment going to impact your quality of life.
Speaker 2:
Right, we have about two minutes, so I wanna briefly oh my gosh, I know we went to briefly talk about what can they expect, like, what are the faces of OIT, or maybe just how long can they expect to be doing this treatment?
Speaker 1:
Okay, so the way OIT works is you start with a very, very low dose of the food and in some protocols you're gonna do what's called an escalation day, where you start with like super low dose and do kind of like micro doses up over like five hours until you get to a dose, and then you come back the next day and then you do like a small dose again, like a lower dose, not as high as the last dose you did the day before.
Speaker 1:
That's how palforzia is laid out. And then when you're doing that dose, that second day dose, that's your home dose. That you're gonna do every day until you come back two, three, four weeks later to up dose, where you go up just a little bit. So you might have been on like three milligrams of peanut protein and then you're on that every day, take it during your safety window and you come back to the office then you go up to like six milligrams of peanut protein, something like that. And for reference, in a peanut there's about 250, 300 milligrams of peanut protein. So you're starting at very small doses and you can do OIT to lots of other foods too. Shellfish are problems because oh, there's my timer, I know and I know we're still under like, we're like kind of way under 10 minutes, but like way under.
Speaker 1:
but like we definitely want this to be under 10 minutes, we gave ourselves a buffer. Yes, so you do the starting dose and the goal of the starting dose is to be whether it's the escalation day or just one dose on that first day is to be below your reaction threshold, because then you do that dose every day for at least two weeks and you come back and you go up to a little bit more in the office. Two weeks you do that for sometimes 15 doses. It depends on the OIT doc, on the protocol, and then you're in what's called. When you get to like your top dose, you're into what's called maintenance.
Speaker 1:
A lot of times I use half a teaspoon of peanut butter is my maintenance dose, because half a teaspoon's pretty easy regarding like logistics, right, practicality. But also it's about 500 to 600 milligrams of peanut protein. So we know that if you're eating that every day and you're not having a reaction, well, if you accidentally eat a peanut then you're bite-proof because you're eating that amount every day. So you stay on maintenance for at least one, two, three years, depending on your test. We retest every year. Once your tests are low enough, you've been tolerating OIT, then we'll do a full dose challenge. And when I say low enough, it kind of depends on the kiddo We'll do a full dose challenge. Do you have a negative challenge? Then we talk about transitioning you to keeping the food in the diet three days a week or you're in what I call tolerance preservation. If you have a positive challenge, you react. Then we talk about maybe increasing the maintenance dose, but staying on the maintenance dose. I know we're running up against time.
Speaker 2:
Look, ladies and gentlemen, that is OIT and like speedy-gonzalez time.
Speaker 1:
Speedy-gonzalez under 10 minutes. What you absolutely have to know is to talk to your allergist about it. Absolutely thanks, dr Hoyt. Thanks so much for tuning in. Remember I'm an allergist but I'm not your allergist. So talk with your allergist about what you learned today, like subscribe, share this with your friends and go to foodallergyandyourkiddoscom where you can join our newsletter. God bless you and God bless your family.