Food Allergy Treatment Definitions

Peanut Allergy

As I reported last week, we've been presented with the exciting opportunity to participate in a sublingual immunotherapy program for peanut allergy. As I've begun discussing this opportunity with others, I'm finding a good deal of confusion, both within the food allergy community and beyond, about potential food allergy treatments. The two most promising possible treatments available today are sublingual immunotherapy and oral immunotherapy. Here are a few important definitions when we talk about "food allergy treatments":

Immunotherapy is the process of giving small doses of what a person is allergic to in order to increase tolerance and build immunity to reduce the likelihood of an allergic reaction

In sublingual immunotherapy (also known as SLIT) the allergic person will hold the food extract under the tongue for a short period of time (our allergist's protocol is two minutes) and then swallow it. The dose will be gradually increased over time. Our process will be one office visit every two weeks and daily doses at home at the same level between those office visits. The entire process will take place over 7 months. Following SLIT, patients may participate in a food challenge, or may be recommended for an oral immunotherapy program.

In oral immunotherapy (OIT), an allergic individual swallows a small amount of the food they are allergic to. Treatment begins with a diluted form of the food and is gradually increased during office visits and at home

There are pros and cons to any type of treatment program. I encourage anyone considering SLIT or OIT to do your own research and make the best decision you can for your family. Some will go with a wait and see approach and not take any action right now. Others will decide to move ahead in these still unchartered areas. Here are a few articles and links to get you started if you are considering either method:

Oral Immunotherapy Not Ready for Prime Time, by Dr. Hugh Sampson. In the comments that follow the article, many parents of children who have successfully gone through OIT speak out.

Is Sublingual or Oral Immunotherapy better for Treatment of Food Allergy, published in February 2012 by the American Academy of Allergy, Asthma and Immunology (AAAAI), concluded that neither are optimal. That said, at the March 2012 AAAI annual meeting, presenters offered new research about SLIT and OIT that showed promise and results for both.

It is obvious that things are moving quickly in this area. If you are considering SLIT or OIT, I encourage you to talk to your doctor, read the research and talk to other parents who have been through this. As we move through the SLIT program, I'll keep you apprised of our progress.  If you are interested in talking to someone who has been through OIT, shoot me an email (food allergyassistant@gmail.com) or leave a comment and I can get you in touch with someone.

Peanut Allergy Immunotherapy Has Arrived

Food Allergy Sublingual Therapy

It seems fitting that my 500th Food Allergy Assistant post is one of hope and anticipation.

The letter was addressed "To the parents of...". The return label was from the allergist's office. The envelope was thick and indeed contained the long-awaited announcement.

"Our office has begun peanut sublingual immunotherapy. Do you want to participate?"

Well, yes...but. It turns out we have lots of questions and some logistics to figure out. The office requires a commitment of a two hour appointment every two weeks. Between appointments, we administer the serum at home. There can be no eating for 15 minutes before serum is given and then no eating for 30 minutes after.

It's a lot to ask of a kid.

And then there's the cost. I've seen figures upwards to $3000. Some insurance companies cover it, others don't. It appears that the serum is currently not covered.

We're being offered sublingual immunotherapy or SLIT. This is the process of placing a food extract under the tongue. This is not to be confused with oral immunotherapy (OIT), which is also being actively studied. OIT means increasing amounts of allergenic foods are fed to an allergic individual. This method had a high level of anaphylactic reactions in the past. According to the information we were given, less than 1% of individuals participating in SLIT have experienced allergic reactions.

The next step for me is a little more research, a call to the insurance company and a call to the allergist's office with our questions. I am cautiously excited and will keep you posted on our decision and progress.

Update on Food Allergy and Flu Vaccine

My egg allergic son successfully received the flu vaccine for the first time. No reactions at all! The better news is that our allergist told us this would be the last time we needed to worry about egg protein in the flu shot. There was only a small amount of protein this year, and next year there will not be any, according to her conversations with various manufacturers of the vaccine.

This is great news for everyone with an egg allergy!

In other news, our allergist shared that the office will begin peanut desensitization sublingually this December. She said that milk and egg desensitization should be ready in the office in a year or so. The process involves placing a liquid or tablet under the tongue every day to get the body accustomed to the protein. The therapy can be administered at home, with occasional trips to the office when protein amount is increased.

I'm feeling so hopeful about all of this! There have been many successes with SLIT (Sublingual Immunotherapy) in research studies, and some offices around the country have begun successful programs as well.

Truly, it has been my dream for there to be no need for my food allergy blog and website. I'm getting closer to being put out of business and I couldn't be happier for my food allergic child and the millions of others with food allergy.

In the meantime, I'll keep writing and we should all stay vigilant to keep those with food allergies safe.