"How long will my kiddo be on OIT?" - 5 Minutes with a Food Allergist

On this episode of Food Allergy and Your Kiddo's 5 Minutes with a Food Allergist, Dr. Alice Hoyt answers a dad's question about how long kiddos are on OIT.

Resources

📖 Navigating Food Allergies: A Parent’s Guide to Care, Coverage, and Confidence by Dr. Alice Hoyt - preorder from Amazon and more 

For Parents ➡️ Office Hours for Parents 

For Providers ➡️ Food Allergy Pediatric Hub

For Schools ➡️ Code Ana

For Potential Patients ➡️ Hoyt Institute of Food Allergy

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Transcript

Hey there. I'm Dr. Alice Hoyt here at the Hoyt Institute of Food Allergy, and co host of the food allergy and your kiddo podcast. So I'm here today to talk with you in Five Minutes with a Food Allergist about oral immunotherapy. And in particular, I will be answering a question today. From one of our listeners. We'll call him "Dad O."  The question is: "Hi, Dr. Hoyt. My kid has been doing it in a clinical study for about one year now. I was wondering if though it is a lifelong treatment. I know that there's still a lot of research to be done. But I just wanted to see what you thought. Thanks again for what you do." Thank you for what you do, Dad O, and let's, let's discuss oral immunotherapy. And let's discuss the duration of it. So first of all, oral immunotherapy also called OIT, it is a process in which we give a kiddo or an adult, the food to which they're allergic, and over time, after small, tiny, tiny amounts, increasing amounts over months, sometimes years. Their immune system develops what we call tolerance to the food. Sometimes this up dosing can take a few months, sometimes it really can take a year, more than a year. It really depends on the kiddo on the severity of the allergies on the family. Because ultimately oral immunotherapy, the purpose of it absolutely is to improve safety. But with that improved safety comes an improvement in quality of life. And so before I before I embark on a treatment plan of oral immunotherapy with a family, I made sure I talked with them about what what is their goal with oral immunotherapy? Because to answer your question, Dad O, at this time, we really don't know how long an individual child or adult needs to be on oral immunotherapy in order to preserve that tolerance the day they've developed. There's a lot of talk right now about saying putting food allergies into remission, meaning let's really suppress the food allergy. So so much that we're saying the kiddos in remission, but we don't throw around the word cure, because we just don't know when in which kiddos a food allergy can return. If and this is the big caveat really is. If after the build up after the kiddo has been on a maintenance dose of oral immunotherapy for one year, two years, three years, depending on the kiddo depending on the allergen. When they stop doing that very intentional ingestion of that very specific dose of that allergen, if they totally stopped doing it in very strictly avoid the allergen, how long will that tolerance be preserved? You know, how long until if they're completely avoiding it for six months, one year until when they ingest it again, will that tolerance have dropped and then that allergy has come back up? Depending on the food, like peanut versus egg: peanut these days, you sort of have to be intentional about intentional about ingesting peanut; as opposed to egg, egg is kind of hidden in foods. And once we start getting a staple food as we call them, that it rolled a staple food into the diet, then we really don't want to like an egg like egg, we really don't want to take it out of the diet if we've gone through oral immunotherapy with with that kiddo. So they are able to incorporate the staple food into their diet and sort of walk away at some point under the very explicit instructions and direction of an allergist can kind of walk away from the maintenance dosing. But again, every kiddo is different. And in that example, then that continued exposure to egg helps maintain the tolerance. And thereby the allergy stays in remission. When it comes to peanut, especially some of our kiddos who have peanut allergies and they really don't like the taste of peanut, then it can be more challenging to ultimately get to a point where they're able to eat peanut in the diet enough so that that tolerance stays high enough to where you're safe. And the two goals that I really have patients in our families really think about and talk about before we embark on this challenge. Number one: is do the goal for the kiddos to be bite proof and they accidentally take a bite of something and they're safe, they don't have a reaction or if they do have a reaction, it's not severe - typically we don't like that. We want it to be like no reaction, right? Or the second is your goal to have the child free eat. And these goals, they're very important to discuss, have that shared decision making that we talked about so much here on the podcast, and have a good shared goal going in? Of course we would love the moon right? We would love all kids to be able to free eat if they want to, right. But we would also like all kids to be able to go through the therapy and then if they don't want to eat it, not have to eat it. But unfortunately, that is just not the case right now. We know that in most cases, you do have to keep the food in the diet in some capacity. And just right now, unfortunately, Dad O, we don't know what that looks like for each individual kiddo. So I do hope that was helpful when you have a question, go to foodallergyandyourkiddo.com and submit your questions to us and we'll see you next time for Five Minutes with a Food Allergist.