OIT: All You Need to Know in Under 10 Minutes

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Take a deep dive into the world of oral immunotherapy with Dr. Alice Hoyt, a trusted board-certified allergist and mother, and Pam Lestage, a devoted mom navigating food allergies. They break down the essentials of OIT — from understanding what it is to exploring the risks and benefits. Whether you're an OIT skeptic or enthusiastic supporter, this episode promises insights that will deepen your understanding and enhance your decision-making process.

The Science of OIT

OIT is one method that reprograms the body's immune response, teaching it to be less reactive to a particular food allergen. As in this episode, some immune systems are easier to reprogram than others.

Is OIT Right for Your Family?

Curious about the boundaries of OIT? Dr. Hoyt shines a light on who often is a good candidate for OIT. From children to adults, the conversation extends beyond simple yes or no to why and how.

Risks and Benefits

OIT therapy isn't a casual stroll. OIT takes time, and it can cause mild adverse reaction to severe anaphylactic reactions. That said, OIT can be powerful enough teach the immune system to tolerate a food enough so that a person can be bite-proof or, in some cases, even begin to free-eat the food. 

Next Steps

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This podcast is the official podcast of the Hoyt Institute of Food Allergy. Information on, within, and associated with this site and Food Allergy and Your Kiddo is for educational purposes only and is not medical advice.

Episode Transcript

Speaker 1 (00:11):
Hello and welcome to Food Allergy and your Kiddo.
I am your host, dr Alice Hoyt,along with my co-host, ms Pam
Lestache.
Hey Pam, hey Dr Hoyt, how areyou?
I am very good.
I am super excited about thisnew series that we're doing.
I know we're going to talkabout the all you need to know
about fill-in-the-blank foodallergy situation in under 10

(00:32):
minutes.

Speaker 2 (00:33):
Yes, if you follow us , you know that we like to be
long-winded, but this is goingto be great for just like
getting your quick information.
And then, if you want to listento more information from past
episodes or future episodes, youcan find that on our podcast.

Speaker 1 (00:49):
Okay, so today's episode all you need to know
about oral immunotherapy, oit,and under 10 minutes.
So Pam is going to hit me withquestions and we're going to go
through OIT.

Speaker 2 (01:04):
Okay, so, first and foremost, what is OIT?
Excellent question, pam.
Oh, thank you.

Speaker 1 (01:10):
OIT, oral immunotherapy is a treatment for
IgE-mediated or anaphylacticfood allergies.
Oit actually teaches the immunesystem to tolerate the allergen
.
For example, say you have aone-year-old little guy who eats
peanut butter for the firsttime and develops hives and
vomits, comes in for evaluation,has some skin prick testing

(01:34):
that's positive to peanut, hassome blood testing that suggests
some pretty legit levels topeanut IgE and peanut component
tests.
Based just on that historyalone, we know that we're
expecting those tests to bepositive.
That is an IgE-mediated peanutallergy, because peanut allergy

(01:54):
resolves self-resolves maybe 30%of the time.
This is a kiddo where I'mdefinitely considering oral
immunotherapy, because with oralimmunotherapy we can teach the
immune system to tolerate thefood.
Okay, what do I need to diveinto now, Pam?

Speaker 2 (02:11):
Where do I need?

Speaker 1 (02:11):
to go, so you.

Speaker 2 (02:13):
Because you know I could talk for a minute.
You kind of gave us an exampleof a good candidate.
So who else is a good candidate?
Is it only babies?
Is it only older kids?
Who are we lumping into?
Who can do OIT?

Speaker 1 (02:28):
That's a really good question.
That comes back to sort of likehow OIT works.
So what OIT does?
It teaches the immune system totolerate the food.
If you're dealing with animmune system that is used to
being in a very tolerant state,like a baby's, then it's going
to be a little bit easier toteach that immune system to
tolerate the food.
So let me pause right therebecause you're probably

(02:50):
wondering what is she talkingabout?
How is a baby's immune systemtolerant?
So when a baby is inside ofmommy baby and mommy's immune
systems, they have to get along,because if they don't get along
, bad things happen, and so thatbaby's immune system is very
tolerant of what it'sinteracting with.

(03:10):
Now, when the baby is born, theimmune system needs to stop
tolerating stuff so much,because if a baby's immune
system sees a germ and is justlike, okay, germ, come on in,
then that's how babies get verysick.
So the immune system needs togrow and needs to develop and
needs to become less tolerant,but it still needs to tolerate
foods.
And what we don't know is whysome of these kiddos, their

(03:34):
immune systems, are not growingtolerance to things like peanuts
and eggs and milk, and we knowthat introducing those foods
early, like around four or sixmonths of life, can help the
immune system grow tolerance tothem.
But in the case of somebody who, like the peanut kiddo that I
mentioned, they didn't growtolerance to it.

(03:55):
Well, why not?
Well, we don't know.
But can we teach tolerance?
Yes, we can, especially in ayounger immune system, because
the allergy has not set in.
Now, fast forward to their five, six, seven.
Can you still do oralimmunotherapy?
Yeah, you can absolutely stilldo oral immunotherapy.
And what about teenagers,adults?
Yeah, you can teach an immunesystem to do what you want.
That being said, once theimmune system is set in, it's a

(04:19):
little bit more difficult, andit can be a lot more difficult
actually, and what I mean bydifficult is that you're more
likely to have reactions to oralimmunotherapy doses, these tiny
, tiny, tiny doses of yourallergen that you take every day
.
You're more likely to havereactions, Sort of, the older
you are, the higher your testingresults are, the more severe

(04:42):
your reaction history has been.
But ultimately, can you stilldo OIT?
You can, Really.
Where the big caveat is is whyare you doing OIT, OIT?
We talk about goals with ourpatients, right, Pam?
We talk about what's reallyyour goal with OIT.
Oit can teach you your immunesystem to be bite-proof, meaning

(05:03):
you accidentally take a bite ofthe food, you won't have a
severe, like threateningallergic reaction.
In most cases, you tolerate itand go about your merry way.
Some people, though, reallywant to free eat, meaning they
want to get that food in theirdiet and they want to eat as
much of it as they want to.
And the younger you are,typically some more likely you
are to be able to get to freeeating With oral immunotherapy,

(05:27):
because there is that risk ofreaction.
Then there's this very annoyingsafety window, Meaning one hour
before the dose to two hoursafter you're not doing anything.
That's raising your heart rateor raising your body temperature
, because both of those thingslower your threshold to have an
allergic reaction.
And so when you're thinkingabout why are you doing OIT, you

(05:49):
want to add safety, but youalso want to improve that
person's quality of life.
So where families, you're ableto go out with more confidence
that an accidental ingestionwon't cause a life-threatening
reaction.
But if the treatment is worsethan the condition to that
particular family, to thatparticular child's quality of

(06:11):
life, then it's not the righttreatment for them, and so
that's where OIT can be verychallenging sort of the older
kids get and adults get, andespecially when we're thinking
about kids going to college, youknow what college kid, what
college freshman, wants to beremembering.
Okay, one hour before, twohours after, I can't do any of
this stuff.
Sleep deprivation, alcohol, allthose things they lower the

(06:33):
threshold to have an allergicreaction.
So it has to be a very goodconversation with an OIT
allergist talking about what isyour goal and how is the
treatment going to impact yourquality of life.

Speaker 2 (06:48):
Right, we have about two minutes, so I wanna briefly
oh my gosh, I know we went tobriefly talk about what can they
expect, like, what are thefaces of OIT, or maybe just how
long can they expect to be doingthis treatment?

Speaker 1 (07:01):
Okay, so the way OIT works is you start with a very,
very low dose of the food and insome protocols you're gonna do
what's called an escalation day,where you start with like super
low dose and do kind of likemicro doses up over like five
hours until you get to a dose,and then you come back the next
day and then you do like a smalldose again, like a lower dose,

(07:25):
not as high as the last dose youdid the day before.
That's how palforzia is laid out.
And then when you're doing thatdose, that second day dose,
that's your home dose.
That you're gonna do every dayuntil you come back two, three,
four weeks later to up dose,where you go up just a little
bit.
So you might have been on likethree milligrams of peanut

(07:47):
protein and then you're on thatevery day, take it during your
safety window and you come backto the office then you go up to
like six milligrams of peanutprotein, something like that.
And for reference, in a peanutthere's about 250, 300
milligrams of peanut protein.
So you're starting at verysmall doses and you can do OIT
to lots of other foods too.
Shellfish are problems becauseoh, there's my timer, I know and

(08:09):
I know we're still under like,we're like kind of way under 10
minutes, but like way under.
but like we definitely want thisto be under 10 minutes, we gave
ourselves a buffer.
Yes, so you do the startingdose and the goal of the
starting dose is to be whetherit's the escalation day or just
one dose on that first day is tobe below your reaction

(08:32):
threshold, because then you dothat dose every day for at least
two weeks and you come back andyou go up to a little bit more
in the office.
Two weeks you do that forsometimes 15 doses.
It depends on the OIT doc, onthe protocol, and then you're in
what's called.
When you get to like your topdose, you're into what's called

(08:52):
maintenance.
A lot of times I use half ateaspoon of peanut butter is my
maintenance dose, because half ateaspoon's pretty easy
regarding like logistics, right,practicality.
But also it's about 500 to 600milligrams of peanut protein.
So we know that if you'reeating that every day and you're
not having a reaction, well, ifyou accidentally eat a peanut

(09:16):
then you're bite-proof becauseyou're eating that amount every
day.
So you stay on maintenance forat least one, two, three years,
depending on your test.
We retest every year.
Once your tests are low enough,you've been tolerating OIT,
then we'll do a full dosechallenge.
And when I say low enough, itkind of depends on the kiddo
We'll do a full dose challenge.
Do you have a negativechallenge?
Then we talk abouttransitioning you to keeping the

(09:39):
food in the diet three days aweek or you're in what I call
tolerance preservation.
If you have a positivechallenge, you react.
Then we talk about maybeincreasing the maintenance dose,
but staying on the maintenancedose.
I know we're running up againsttime.

Speaker 2 (09:52):
Look, ladies and gentlemen, that is OIT and like
speedy-gonzalez time.

Speaker 1 (09:56):
Speedy-gonzalez under 10 minutes.
What you absolutely have toknow is to talk to your
allergist about it.
Absolutely thanks, dr Hoyt.
Thanks so much for tuning in.
Remember I'm an allergist butI'm not your allergist.
So talk with your allergistabout what you learned today,
like subscribe, share this withyour friends and go to
foodallergyandyourkiddoscomwhere you can join our

(10:18):
newsletter.
God bless you and God blessyour family.