Food Allergy Options

Here at Mid Island Allergy we understand that living with food allergies is difficult and individual lifestyle needs vary. We take a very individualized approach and tailor you or your child’s food allergy treatment course based on what fits best for you.

Our treatment options include oral immunotherapy (OIT), a modified OIT protocol or sublingual immunotherapy (SLIT) and we treat children as young as one year of age. Our goal is for you to maintain the best quality of life while living with food allergies.

Commonly Treated Foods: Peanuts Tree Nuts Milk Eggs Wheat

Treatment is available for other food and multiple foods can be treated at the same time.

Treatment Options

Traditional Oral Immunotherapy (OIT)

We have been offering oral immunotherapy (OIT) by the traditional protocol since 2016. After an initial visit for where your dose is increased every 20 minutes (escalation phase), you will come to the office every 1-2 weeks for a gradually increasing dose (build up phase). That dose is taken daily at home until the next time you come in. Following each dose there is a two-hour rest period. The typical time course is 4-8 months to your top dose.

Modified OIT Protocol

Depending on your level of sensitivity the standard OIT protocol can be modified. For less sensitive patients this may mean a faster build up with no escalation phase and for more sensitive patients this may mean a slower protocol that fits your individual needs.

Sublingual Immunotherapy (SLIT)

Administering allergens under the tongue, or sublingual immunotherapy (SLIT) only requires a fraction of the dose administered orally. By virtue of such a low, effective dose, adverse reactions are rare. We offer food SLIT in patients over 5 years old (they have to be mature enough to hold the small dose under their tongue for two minutes). This is accomplished in 4 to 8 visits, 1-2 weeks apart. There is a 30-minute rest period after daily dosing.

Risks of Food Immunotherapy

The process of OIT and SLIT involves the ingestion of foods to which you/your child are allergic. As such, there is a risk of allergic reactions which could occur with either the in-office doses or home doses. Most allergic reactions that occur are mild. Mild allergic reactions may include itching of the throat or mouth, upset stomach/nausea, heart burn. Serious allergic reactions are rare but could include anaphylaxis (a potentially life-threatening allergic reaction) which may require emergency treatment and hospitalization. If an allergic reaction were to occur, the dose will be adjusted based on the severity of the reaction.

Another potential risk is Eosinophilic Esophagitis (EoE), or, allergic inflammation of the esophagus. This is rare with SLIT therapy but may be as high as 7% with OIT therapy. In patients that develop EoE, the dose is typically reduced and further treatment options will be discussed.

Benefits of Food Immunotherapy

Food immunotherapy has a significant impact on quality of life. This encompasses the emotional and social impact regarding foods eaten and improvement in the anxiety that is significant part of a food allergy diagnosis. At the “bite proof” dose, patients’ dietary restriction on foods labeled as “may contain...” or “manufacture in a facility…” can be lifted. For OIT, escalation to higher doses even allows patients to freely eat the food for which they are being treated.

Do's & Don't's of OIT

Doses should never be given on an empty stomach. A carbohydrate rich meal prior to all doses is preferred.

A probiotic (such as Florajen) will be started prior to OIT.

Patients must be observed for 30-60 minutes after ingesting their home dose.

Two Epinephrine injectors must be available at all times.

The same caregivers, educated on procedure and risks, should be administering the home doses.

Exercise restriction after all doses: 2 hours following ingestion of home dose; 3 hours after in-office dose escalation.

Ambient temperature restriction following ingestion.

Asthma/allergic rhinitis must be fully controlled.

Some females may need to reduce or stop temporarily during menstrual periods.

During infections (such as upper respiratory infections, fevers, diarrhea / vomiting) doses may need to be reduced or held temporarily.

Continue to avoid food allergen other than the treatment dose.

Home dosing should not be done on the day of an OIT follow-up visit.