The Future of Food Allergy Treatment: Exploring Oral Immunotherapy

Food allergies continue to affect millions of children and adults worldwide, causing reactions that range from mild to severe, life-threatening anaphylaxis. Traditionally, food allergy management and treatment have relied on emergency response strategies like injectable epinephrine and strict avoidance of allergens.

Recent advancements in food allergy treatment methods, particularly oral immunotherapy (OIT), have provided new hope for individuals seeking long-term solutions for food allergies and anaphylaxis.

What is Oral Immunotherapy (OIT)?

Oral immunotherapy (OIT) is an emerging treatment for food allergies that involves gradually introducing small doses of the allergen over time. OIT aims to increase tolerance to common food allergens by desensitizing the immune system. The goal is to reduce the severity of allergic reactions or, in some cases, eliminate food allergies entirely.

The process of oral immunotherapy for food allergies follows these four steps:

1. The initial dose of the allergen in a clinical setting.
2. The dose gradually increases over time until a tolerated dose is achieved.
3. The dose will increase every couple of weeks until a maintenance dose is reached. The patient will consume it at home each day for months or years.
4. Some may achieve long-lasting desensitization to their allergen, allowing them to consume it without restriction.

Food allergens treated with oral immunotherapy (OIT) include milk, egg, peanut, tree nut, wheat, soy, and sesame. Allergic reactions can occur during OIT sessions but typically involve localized symptoms such as itchy mouth or upset stomach. For some, life-threatening allergic reactions like anaphylaxis can occur during OIT.

How Effective is OIT for Food Allergies?

Oral immunotherapy (OIT) for food allergies is not a new concept. The first clinical trial of OIT dates back to 1908, when OIT was successfully tested on a 13-year-old boy with an egg allergy.

Desensitization rates in oral immunotherapy (OIT) typically define the efficacy in clinical trials. Approximately 60 to 80% of patients with specific food allergens, including peanuts, milk, and eggs, have experienced desensitization with OIT. While other food allergen desensitization rates have not been as closely studied, studies suggest the efficacy of oral immunotherapy may vary depending on each food allergy.

The Benefits of Oral Immunotherapy for Food Allergies

Oral immunotherapy (OIT) is a potential treatment option and solution for those with known food allergies. OIT offers numerous benefits for those with mild to severe food allergies. It can help reduce the risk of severe allergic reactions, improve quality of life, and contribute to long-term tolerance.

Reduced Risk of Severe Allergic Reactions

One of the primary purposes of oral immunotherapy (OIT) is to lower the risk of severe, life-threatening allergic reactions. OIT allows those who live with life-threatening food allergies not to have to fear every time they eat.

While it is not a cure for food allergies, it can significantly lower one’s tolerance and increase the threshold at which an allergic reaction occurs. While no type of allergic reaction is ideal, not having to be constantly anxious and frightened by life-threatening anaphylaxis due to OIT is a considerable benefit.

Improved Quality of Life

Food allergies and anaphylaxis are often a source of constant anxiety and inconvenience, especially for children and families. Oral immunotherapy (OIT) for food allergies can help mitigate food-allergy anxiety by providing a safety net for those at risk. This reassurance enables individuals to navigate daily life with more confidence and ease.

Potential for Long-Term Tolerance

Some individuals undergoing OIT achieve sustained unresponsiveness to food allergens. This means that even after treatment is complete, they can consume their allergen without experiencing a reaction. While OIT results vary from person to person, ongoing food allergy research continues exploring methods to improve long-term tolerance to food allergens.

The Risks and Challenges of Oral Immunotherapy

While oral immunotherapy (OIT) offers promising benefits for those with food allergies, it also carries potential challenges and risks, including:

• Allergic reactions
• Strict adherence
• Not a universal solution

Some OIT patients may experience mild to severe allergic reactions during treatment. Due to this potential risk, patients are carefully monitored and under clinical supervision during OIT sessions. The success rate of OIT depends on consistent dosing, which can be difficult for some individuals to keep up with. Consistent dosing with OIT can be incredibly challenging for young children and busy families.

The Future of Food Allergy Treatment

Oral immunotherapy (OIT) is just one avenue in the evolving landscape of treatments for food allergies. Researchers continue to explore alternative and complementary therapies, including sublingual immunotherapy (SLIT), epicutaneous immunotherapy (EPIT), and anti-IgE antibody medications.

Sublingual Immunotherapy (SLIT)

Sublingual immunotherapy (SLIT) is an FDA-approved alternative to allergy shots, providing symptom relief for some common allergies. SLIT are tablets placed under the tongue designed to increase tolerance to allergens such as pollen, cat dander, and dust mites. While it is approved for treating rhinitis (hay fever) and asthma, it is currently being studied as a treatment for food allergies.

Epicutaneous Immunotherapy (EPIT)

Epicutaneous immunotherapy (EPIT) directly exposes the skin to food allergens through an adhesive dermal patch. EPIT, the patch-based immunotherapy, is developing patches to treat peanut, milk, and egg allergies.

Anti-IgE Antibody Medications: Omalizumab (Xolair)

Omalizumab is a monoclonal antibody that helps weaken allergic reactions to peanut, tree nuts, egg, milk, and wheat in food-allergic children. The Food and Drug Administration (FDA) has approved this anti-IgE antibody medication, marketed as Xolair, to reduce allergic reactions, including anaphylaxis.

However, it is important to note that individuals taking omalizumab (Xolair) still need to avoid food they are allergic to. Omalizumab is not approved for the emergency treatment of life-threatening anaphylaxis.

The KeepSmilin4Abbie Foundation helps fund research in detecting the early signs of anaphylaxis to enable early intervention. Click here to get involved and see how you can help #stopanaphylaxis®.

References:

• American Academy of Allergy Asthma & Immunology, 2025. The Current State of Oral Immunotherapy.
• The Journal of Allergy and Clinical Immunology: In Practice, 2024. New Approaches to Food Allergy Immunotherapy.
• Food Allergy Research and Education. Oral Immunotherapy (OIT) in Practice.
• Human VAccines & Immunotherapeutics, 2012. Future therapies for food allergy.
• Food Allergy Research and Education. Oral Immunotherapy (OIT).
• American College of Allergy, Asthma, & Immunology, 2017. Immunotherapy with allergy tablets.
• John Hopkins Medicine. Sublingual Immunotherapy – Allergy Drops.
• Food Allergy Research and Education. Epicutaneous Immunotherapy (EPIT).
• National Institutes on Health, 2024. Antibody reduces allergic reactions to multiple foods in NIH clinical trial.