Oral Immunotherapy. What is it, and does it work?

All of us allergy parents know that the standard treatment for food allergies is strict avoidance and epinephrine when exposed. However, the news media and online web sites are starting to promote a "CURE" for food allergies in the form of Oral Immunotherapy(OIT).

So what is Oral Immunotherapy?

In this context Oral Immunotherapy refers to (also termed desensitization or hypo-sensitization) a medical treatment aimed at patients suffering from allergies that are insufficiently controlled by symptomatic treatments.
This involves administering increasing doses of allergens to accustom the body to substances that are generally harmless (peanuts, egg, milk) and thereby induce specific long-term tolerance.

Let me state right now that Oral Immunotherapy is experimental and should never be preformed without medical supervision. Although these kinds of treatments are experimental, not approved by the FDA, and have shown little in the area of results parent's are lining up to have there children in trials.

All of my research on this subject continued to look back at one study from the UK published in The Lancet (a medical journal) in January of 2014. So I went straight to the horses mouth and printed out the full published journal article. To view full journal article.

The Test

The study was preformed in the UK (University of Cambridge and Cambridge University Hospital) between January 2010 and March of 2013. Participants were age 7-16 with immediate hypersensitivity reactions after peanut ingestion and tested positive to skin prick test for peanuts. Participants were given peanut flour in gradually increasing doses, in 2 to 3 week intervals. Doses ranged from 2mg to 800mg of peanut protein. After each new dosing participants were observed for 2 hours, then doses were given at home for 2 to 3 weeks. Participants were also asked to keep a symptom diary.

Results

At the end of phase 1, 26 weeks(6 months) 24 of the 39 children in the active group were considered to have developed a tolerance to the equilivant of 5 peanuts. This was reported as 62%, while none of the 46 children in the control group had any tolerance to peanuts.
At the end of Phase 2(combination of phase 1 and control group offered OIT) 45 of the 84 children sampled were found to have developed a tolerance to the equilivant of between 5 and 10 peanuts. This was reported as 54%.

Side Effects

31 participants reported nausea and vomiting, 1 reported diarrhea, 21 reported wheezing, and 76 reactions of oral pruritus (itching of mouth, tong, or lips). One patient required the use of intramuscular adrenaline (Epi-Pen).

Follow-up

Tolerance after cessation of OIT was not assessed in this study so there is no way to know if participants maintained any tolerance over time.

So What does all this Mean?

Okay, when I was taking my science courses a sample size this small was not considered statistically significant. And the thought of mixing your control group with you active group data to develop a larger sample size in phase 2 was a down right cheating.

The study itself admits shortcoming with this type of treatment. Patients who had stopped treatment in past studies had shown to loose their tolerance after about 9 months. They had many more reactions then with avoidance, and there was no follow-up. However they still promote this as a success. Even WebMD promotes this article as a "New Hope for Kids with Peanut Allergies".

I remind you to be smart and skeptical of claims of fast and easy cures for food allergies. And if it sounds too good to be true, it probably is.