Dandelion Food Allergy Immunotherapy
Helping reduce the risk from accidental food exposure.
Living with a food allergy can mean constantly checking labels, worrying about cross-contact, and being prepared for an unexpected allergic reaction.
Food allergy immunotherapy is a treatment designed to gradually change how the immune system responds to a food allergen. The goal is to increase the amount of the allergen a person can tolerate before developing symptoms.
At our clinic, patients are carefully assessed by an allergist to determine whether food allergy immunotherapy may be appropriate for them.
What is Oral Immunotherapy (OIT)?
Oral Immunotherapy, commonly called OIT, involves giving a patient a very small amount of the food they are allergic to and gradually increasing that amount over time.
The goal is not necessarily to make the allergy disappear. Instead, treatment aims to increase the patient's reaction threshold so that a small accidental exposure is less likely to cause a serious reaction.
Treatment is performed according to an individualized plan and under the supervision of an allergy specialist.
How OIT works
Allergy assessment
Before starting treatment, the allergist reviews the patient's allergy history, previous reactions, testing, other medical conditions and current medications.
Additional allergy testing or an oral food challenge may sometimes be recommended.
Starting dose
Treatment begins with a very small, carefully measured amount of the food allergen.
The first doses and dose increases are supervised by the allergy clinic so that the patient can be monitored for a reaction.
Gradual dose increases
If the dose is tolerated, the amount is gradually increased according to the patient's treatment plan.
This process is sometimes called updosing or dose escalation.
Regular dosing at home
Between clinic visits, patients usually take their prescribed dose regularly at home.
It is important to follow the dosing instructions exactly. Patients should never increase their dose on their own.
Maintenance
Once the target dose has been reached, the patient enters the maintenance phase.
Regular exposure to the allergen is generally required to help maintain the level of protection achieved during treatment.
What is Sublingual Immunotherapy (SLIT)?
Sublingual Immunotherapy, or SLIT, is another form of allergen immunotherapy.
Instead of eating a larger amount of the allergen, a very small measured amount is placed under the tongue for a specified period of time.
The allergen interacts with immune cells in the mouth and, with regular treatment, may gradually reduce sensitivity to the allergen.
Food SLIT typically uses much smaller allergen doses than OIT.
How SLIT works
Allergy assessment
The allergist first confirms the food allergy and determines whether SLIT may be an appropriate option.
Small dose under the tongue
A carefully measured amount of allergen is placed under the tongue.
Gradual increase
Depending on the treatment plan, the amount may gradually be increased until the patient reaches a maintenance dose.
Regular treatment
The prescribed dose is taken regularly according to the treatment plan.
Continued monitoring
Patients continue to be followed by the allergy clinic to monitor symptoms, response to treatment and whether adjustments are needed.
OIT vs. SLIT
| Oral Immunotherapy | Sublingual Immunotherapy | |
|---|---|---|
| How it is given | Allergen is eaten | Allergen is placed under the tongue |
| Amount of allergen | Generally larger | Generally much smaller |
| Goal | Increase the amount of food that can be tolerated | Increase the amount of food that can be tolerated |
| Dose increases | Gradually increased | Gradually increased |
| Maintenance | Regular ongoing dosing | Regular ongoing dosing |
| Allergic reactions during treatment | Can occur and may occasionally be serious | Reactions tend to be milder, often involving the mouth or throat |
| Level of desensitization | Generally capable of achieving higher reaction thresholds | Usually lower than OIT |
| Best option | Depends on the individual patient | Depends on the individual patient |
There is no single treatment that is right for everyone. Your allergist will discuss the potential benefits and risks of each approach.
What is the goal of treatment?
The main goal of food immunotherapy is desensitization. This means increasing the amount of an allergen a person can tolerate before experiencing an allergic reaction.
For example, someone who previously reacted to a very small accidental exposure may eventually tolerate a larger amount without developing symptoms. This can provide an additional layer of protection against accidental exposure.
However, the level of protection varies from person to person.
Immunotherapy is not a cure for food allergy
Patients undergoing OIT or SLIT should continue to consider themselves food allergic unless their allergist specifically tells them otherwise.
Patients may still need to:
- Avoid unplanned exposure to their allergen
- Read food labels
- Be aware of cross-contact
- Carry epinephrine when prescribed
- Maintain an allergy action plan
- Follow their prescribed treatment schedule
Immunotherapy is intended to reduce risk, not eliminate the need for allergy precautions.
Who may be a candidate?
Food allergy immunotherapy may be considered for some patients with a confirmed IgE-mediated food allergy. Your allergist will consider factors such as:
- Which food you are allergic to
- Your age
- Your history of allergic reactions
- Allergy testing
- Asthma control
- Other medical conditions
- Current medications
- Your ability to follow a regular treatment schedule
- Your family's goals for treatment
Not every patient with a food allergy is an appropriate candidate.
What foods can be treated?
Depending on the patient and the treatment program, immunotherapy may be considered for allergies including:
- Peanut
- Tree nuts
- Milk
- Egg
- Sesame
- Wheat
- Other foods
Availability and suitability depend on the individual patient and the allergist's assessment.
Are there risks?
Yes
Because immunotherapy intentionally exposes the patient to something they are allergic to, allergic reactions can occur. Possible symptoms can include:
- Itching or tingling in the mouth
- Hives
- Swelling
- Stomach discomfort
- Nausea or vomiting
- Coughing
- Wheezing
- Throat symptoms
- Anaphylaxis
OIT generally exposes patients to larger amounts of allergen and can cause more treatment-related allergic reactions than SLIT.
Patients and caregivers receive instructions explaining what symptoms to watch for and what to do if a reaction occurs.
When should a dose be delayed?
Certain situations may increase the chance of reacting to a dose. Your treatment team may advise changing or delaying a dose when a patient:
- Is sick or has a fever
- Has poorly controlled asthma
- Is experiencing significant allergy symptoms
- Has recently exercised or plans to exercise
- Has missed several doses
- Has experienced a reaction to a previous dose
Patients should follow the specific instructions provided by their allergist. Never change or increase an immunotherapy dose without speaking with the treatment team.
What happens during an OIT or SLIT appointment?
Appointments vary depending on the treatment plan. During an initial dose or dose increase, the patient may:
- Be assessed by the clinical team
- Receive the prescribed dose
- Remain in the clinic for observation
- Be monitored for signs of an allergic reaction
- Receive instructions for dosing at home
- Schedule the next dose increase or follow-up
Families should plan enough time for observation following supervised doses.
How long does treatment take?
Food immunotherapy is not a quick treatment. The dose-building phase may take several months, followed by ongoing maintenance. The exact schedule depends on:
- The allergen
- The treatment approach
- How well doses are tolerated
- Missed doses or illness
- The patient's treatment goals
Your allergist will explain the expected schedule before treatment begins.
Frequently asked questions
Will OIT or SLIT cure my food allergy?
Not necessarily. The primary goal is to increase the amount of allergen that can be tolerated while receiving treatment.
Some patients develop substantial protection, while others have a smaller increase in their reaction threshold.
Can I start eating the food normally after treatment?
Not unless your allergist specifically tells you to. Patients should continue following their allergy management plan.
Do I still need an epinephrine auto-injector?
If your allergist has prescribed epinephrine, you should continue carrying it unless specifically advised otherwise.
Immunotherapy does not eliminate the possibility of an allergic reaction.
Can treatment cause an allergic reaction?
Yes. Mild reactions are relatively common during food immunotherapy, and more serious reactions can occur.
This is why treatment requires medical supervision and a clear home action plan.
Which is better, OIT or SLIT?
There is no single answer. OIT generally uses larger allergen doses and can achieve higher levels of desensitization, but allergic reactions during treatment occur more frequently.
SLIT uses much smaller amounts of allergen and appears to have a favourable safety profile, although the amount of desensitization may be lower.
Your allergist can help determine which approach may be appropriate for you.
Can more than one food allergy be treated?
In some situations, treatment of more than one food allergen may be considered. This must be assessed individually by the allergist.
What if I miss a dose?
Do not double the next dose. The correct approach depends on how many doses were missed and the patient's treatment protocol.
Contact the clinic for instructions.
Is food allergy immunotherapy right for you?
Food allergy treatment is changing. For some patients, OIT or SLIT may offer an opportunity to increase protection from accidental exposure and reduce some of the uncertainty associated with living with a food allergy.
The first step is an assessment with an allergist. During the appointment, we can review your allergy history, discuss available treatment options, explain the potential benefits and risks, and determine whether immunotherapy may be appropriate for you or your child.
Assessments are by referral, and patients cannot book directly. Ask your family doctor, walk-in clinic, or another healthcare provider to fax a referral to 416 850 9993. Our team reviews it and contacts you to arrange the appointment.
If you are unsure whether immunotherapy is worth asking about, you are welcome to ask us a question first.
Important information
Food allergy immunotherapy can cause allergic reactions, including anaphylaxis. Treatment should only be performed under the direction of a qualified physician experienced in allergy and immunology.
Treatment results vary between patients. OIT and SLIT do not guarantee that a patient will become tolerant to unrestricted amounts of an allergen.
Patients should continue following the allergy avoidance, emergency medication and epinephrine recommendations provided by their healthcare professional.
This page is general information and is not medical advice.