Oral immunotherapy: A possible approach for the therapy of food allergy in children?

The prevalence of food allergy in children is rising. The current gold standard in treating food allergies still remains allergen avoidance; however, oral tolerance induction (OTI) is now an active treatment option for food allergies. In this article, two patient examples are used to illustrate the two therapeutic options for food allergies. Over the past 20 years, multiple studies have shown, that OTI can increase the tolerance level and protect against severe allergic reactions in case of accidental consumption of the allergen. ln the long term, OTI can also lead to the development of a sustained unresponsiveness. Even though OTI causes side effects and allergic reactions, these are usually mild to moderate, showing a good safety profile, especially when certain cautions are taken into account when taking the allergen: such as not taking the daily portion in case of infections, rhinoconjunctival or asthmatic symptoms. OTI improves the quality of life of patients and their families significantly. Pharmaceutically produced peanut powders allow worldwide standardization of this therapy. There is evidence that lower sIgE and young age at initiation of therapy are positive predictive factors for tolerance development. Further studies are needed to identify those patients who will benefit most from such therapy and to know when the most effective time is to start an oral tolerance induction.