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Oral Immunotherapy Can Play Key Role in Food Allergy Management in Preschool-Aged Patients
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The authors note that further research is needed to clarify cost-effectiveness, long-term adherence, and psychosocial impacts of oral immunotherapy.
In a review published in Clinical & Experimental Allergy, investigators highlight both the advantages and disadvantages of avoidance and carrying epinephrine in case of accidental ingestion—the historic standard management approach for food allergy. They argue that, based on accumulating evidence, oral immunotherapy (OIT) should play a key role in the management of food allergies in preschool-aged children.1
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Food allergies are common, yet potentially life-threatening conditions that typically begin in early childhood. Oftentimes, these do not resolve throughout an individual's lifetime. This diagnosis can lead to negative physical and mental health consequences for a child. Historically, food allergy management has typically involved strict dietary avoidance of the trigger foods and carrying an injectable form of epinephrine to treat potential reactions.1
OIT has demonstrated its ability to be an effective treatment option for young patients with food allergies, with recognition of its potential in the medical literature dating as far back as the early 20th century, according to the authors. As evidence showing support of OIT and recognition of the risk of accidental reactions in those practicing avoidance grows, the implementation of OIT into clinical practice has grown more common. In this review, the investigators outlined why OIT can have a significant role in the treatment of food allergies in preschool children. In this literature, preschoolers are defined as children who are 0 to 5 years of age.1
Previous evidence suggests that the early introduction of allergenic foods (at approximately 6 months of age), in addition to ongoing regular ingestion, has the potential to prevent food allergy development in those who are at an increased risk of allergy. Compared with avoidance, the Learning Early About Peanut study found an approximate 80% reduction in peanut allergy when the food was introduced early and 2 grams of peanut 3 times per week were consumed. The results of more recent studies suggest implementation barriers, meaning that there may be difficulty maintaining real-world regular ingestion of the food following early introduction. Other barriers may include inadequate education and poor adherence at a population level. For these reasons, the current study authors urge that prompt initiation of OIT—preferably in infancy—is an important treatment option for failed primary prevention.1
The review highlights consequences with the “wait-and-see” approach to the natural resolution of food allergies, with recent data pointing to lower resolution than previously thought. For those who do not outgrow their allergies, waiting until school age to offer OIT can mean missing the window of opportunity where OIT is safest and prolongs unnecessary dietary restrictions. Alternatively, for those who do outgrow their allergies, research indicates they may not reintroduce the food because of fear and aversion, and in turn, patients can become resensitized, which puts them at risk of severe reactions.1
Additionally, the risks that are associated with allergen avoidance are higher than previously believed, according to the authors. Allergen avoidance is often imperfect and can carry an increased risk of severe reactions when compared with the risk of severe reactions while on OIT treatment, particularly in preschoolers. Allergic reactions can be stressful; however, the authors noted that it is preferable to have this occur during treatment with OIT because caregivers are more alert following a scheduled dose, rather than having this occur at a potentially unexpected time following an accidental exposure.1
Finally, the authors highlighted a growing body of evidence that supports favorable safety and effectiveness of OIT in preschoolers, with preliminary data suggesting infants have a higher likelihood of remission. OIT has the potential to significantly improve patients’ quality of life, but future research is necessary to better identify how it can specifically impact preschool-aged children. Additionally, this research can better clarify the cost-effectiveness, long-term adherence, and psychosocial impacts of OIT on patients.1
“This research highlights a critical shift in how we approach food allergies—moving from strict avoidance to controlled exposure in early childhood, which not only reduces the risk of severe reactions but also helps prevent long-term negative consequences of living with food allergies,” said corresponding author Lianne Soller, PhD, of the University of British Columbia, in Canada.2
