Food Allergy Treatment
Increasing options are now available for managing food allergies
Our Allergy Centre of Excellence is one of the largest providers of Oral Immunotherapy (OIT) worldwide.
Your treatment choice will depend on your child's age, specific allergies, and other allergies, such as asthma, and will always follow a shared decision-making process.
Our child-friendly and responsive team aims to make the treatment journey as stress-free, fun and empowering as possible.
Which treatment options are available?
The default option is to avoid your known allergens and be upskilled in identifying allergens in different foods, recognising allergic symptoms, and treating allergic reactions. This is a valid approach for food allergens that are easier to avoid, e.g., Macadamia nut.
We default towards hybrid, i.e. home and clinic-based, introduction protocols for egg and milk allergy in most young infants.
For all other children, OIT is an option (where protocols exist).
OIT can be administered using different protocols and food-related products.
At the Allergy Centre of Excellence, we have developed unique protocols based on best practices and the use of food products readily available in the UK.
We are the largest provider of Palforzia therapy in Europe.
Which foods are available for OIT?
Our ACE offers OIT for
peanut (if 4-17yr, Palforzia must be used)
milk
wheat
egg
sesame
coconut
lentil (red)
chickpea
Tree nuts
cashew (which typically suppresses Pistachio)
walnut (which typically suppresses Pecan)
almond
hazelnut
brazil
We continue to add allergens for treatment - pine nut, mustard and macadamia nut - ETA 2025
How many foods can we simultaneously treat?
OIT to a single allergen
OIT to 2 allergens simultaneously - if 6-12 years of age.
OIT to 3 allergens simultaneously - if < 6yr age.
Please note:
We do not offer wheat, milk or egg in a multi-food regimen (for logistic and safety reasons)
Your child must be under the age of 6 years if peanut is one of the chosen allergens in a multi-food regime
Palforzia (peanut) for children 4-17 years of age
The use of monthly Omalizumab (Xolair) injections, will suppress reactivity to multiple food allergens
What are the logistics around an OIT program?
In our protocols, we anticipate 8-12 visits, including the initial treatment visit, where training around the process is given.
Additional visits are sometimes required if there are side effects or other illness/missed doses that require extra supervision when the treatment is restarted.
The average time needed to reach the maintenance dose is around 20 weeks, and during this time, it is likely that some email/telephone support will be required.
Once the maintenance dose is reached, your child will need to continue daily dosing; otherwise, the protective effect may be lost.
Over time, we will discuss the option of near-daily dosing with patients and families, depending on their symptoms (if any) whilst on maintenance dosing.
Omalizumab (Xolair) treatment
is administered 2-4 weekly while avoiding allergens.
administer for 2-3 months before travelling to areas where your food allergen is a common ingredient in cuisines or there are language barriers…
administer whilst commencing multi-allergen OIT. We hope to commence this program will begin within ACE in 2025.
Tell me more about Xolair (omalizumab)
Xolair (omalizumab) is approved to treat food allergies in certain patients. It works by reducing the levels of IgE, a protein involved in allergic reactions. By targeting IgE (like a sponge), Xolair helps to decrease the risk of severe allergic reactions, such as anaphylaxis, after accidental exposure to a food allergen.
Xolair can help decrease the risk of severe allergic reactions, including anaphylaxis, which can be life-threatening.
Xolair does not cure food allergies, and it is important to continue avoiding the foods you are allergic to. We offer Xolair at The Portland Hospital, London.
Tell me more about Oral Immunotherapy (OIT)
Immunotherapy is a method to reduce the sensitivity and risk of reaction to specific allergens. It has been widely used for treating hay fever, pet and house dust mite allergies, and it is now available for particular food allergens. The aim is to improve the quality of life for children and their families.
Oral Immunotherapy to food was first described in 1908 in the Lancet - ‘a case of egg poisoning’ - by a physician practicing in Harley Street (pre NHS). This report (freely available on the link above) is highly informative. It reflects the process of OIT rather well, where even very allergic patients can enjoy a rise in the threshold of the allergen to which they are allergic.
Standard care for managing food allergies has focused on avoiding allergens and facilitating the treatment of adverse reactions after allergen exposure.
An increase in the development of immunotherapy treatments for food allergy has driven our knowledge forward. Initial studies mainly focused on school-age children in whom food allergies are likely to be persistent. However, increasing evidence indicates that delivering immunotherapy for food allergies to preschool-age children may provide higher success rates. Conversely, the natural resolution of food allergies occurs primarily in these younger age groups, resulting in challenges in selecting patients who will ultimately benefit from these treatments.
Both immunotherapy and natural history studies reveal the inherent plasticity of the immune system in early life, which may be more amenable to intervention. This raises a delicate yet unknown balance between the optimal timing of intervention and waiting for the natural resolution of the food allergy.
The field of OIT to foods has enjoyed a massive leap forward thanks to the rigorous extensive international studies (Palisade & Artemis) that underpin the licensing of a peanut OIT product. These studies show us the best regimens and products for successful OIT and the associated risks and side effect profiles.
The medical supervision of incremental baked egg and milk products in allergic children is common practice in many NHS UK clinics, often using ladders, also represents a form of immunotherapy/desensitisation.
OIT is not curative i.e. for most allergens, ongoing therapy is required to ensure tolerance.
It is controversial whether OIT to baked eggs and milk ‘hurries up’ the process of developing natural tolerance to all eggs and dairy, but it has been associated with an increase in QOL in those eating these baked foods (unsurprisingly).
OIT seeks to raise the threshold at which a reaction would occur, rendering your child ‘bite-proof’ i.e. protected from accidental everyday exposures.
OIT is allergen-specific and protects only against the allergen that is eaten.
Mild side effects on OIT are common and usually affect the GI system.
More severe allergic side effects can occur, sometimes unpredictably, i.e. after months of tolerance. This can arise due to co-factors such as exercise, infections, and medication use… Emergency medication will, therefore, always be required on your person while undergoing OIT.
Please feel free to discuss advances in the field and the potential for OIT for your child when consulting with Prof du Toit or Dr Foong.
Our doctors have been PI or Co-Investigators on many OIT and Epicutaneous patch trials and remain actively committed to clinical research.