Practical protocols and clinical experience from an academically based oral immunotherapy program

Food allergy represents a significant public health burden with implications on quality of life and persistent risk of accidental allergic reactions. Therapeutic immunomodulation for food allergy has only recently entered clinical practice. Oral immunotherapy (OIT) has emerged as an effective approach for increasing allergen reaction thresholds; however, its implementation remains limited due to systemic factors. This review aims to describe the development, implementation, and outcomes of a standardized OIT program for immunoglobulin E (IgE)-mediated food allergy at an academic pediatric allergy institution.

An OIT program was developed with the objectives of improving accessibility, standardizing treatment approaches, minimizing adverse events, and allowing individualized treatment goals ranging from protection against accidental exposure to dietary liberalization.

OIT represents an effective, safe immunomodulatory treatment for IgE-mediated food allergy. The implementation of a standardized OIT program allowed expansion from an initial pilot program to a large clinical service involving thousands of patients. Both single-food and multifood OIT protocols were feasible and safe. Most adverse reactions were mild-moderate and gastrointestinal or cutaneous in nature. Severe reactions and eosinophilic esophagitis (EoE) were uncommon when patients were appropriately selected and monitored. Standardized protocols, careful patient selection, extensive counseling, and systematic monitoring are essential to optimize outcomes and minimize risks.