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Wayne Shreffler, MD, PhD, division chief of Pediatric Allergy & Immunology at MassGeneral Hospital for Children and director of the Food Allergy Center at Massachusetts General Hospital, explains the differences between food challenges, which are established methods of care, and oral immunotherapy, which is still in research.

What are the differences between oral immunotherapy and food challenges?

03/Aug/2012

Q: What is Oral Immunotherapy?

A: Oral immunotherapy (OIT) is a procedure intended to gradually reduce the allergic sensitivity of a patient for a given food.

Q: How is it different from a food challenge?

A: A food challenge is a diagnostic procedure to determine whether someone is actually allergic to a specific food. This is the gold standard for diagnosis. It does not change the sensitivity of someone who is allergic.

Q: Has research shown that OIT shows promise?

A: OIT has shown promise for reducing allergic sensitivity. Depending upon the specific study, between 70 to 100 percent of subjects were less sensitive after OIT.

Q: Why do we need to wait to move OIT into clinical practice?

A: There are many reasons why most allergists believe that OIT is still research and not therapy -- a position supported that is supported by the American Association of Allergy Asthma and Immunology (AAAAI) and the Allergy/Infectious Disease Institute of the NIH. 

  • Even though these early studies look promising, there have been relatively few people studied (dozens), and few of the studies have been double blind in design. That means the level of evidence is still pretty weak.
  • Studies are only beginning to address how lasting or complete protection is, and none have yet addressed whether fewer accidental reactions occur for subjects on OIT.
  • We cannot yet identify those people who are most likely to benefit or experience serious side effects from OIT.
  • Serious side effects can and have occurred, including serious allergic reactions and chronic allergic inflammatory problems, like eosinophilic esophagitis.
  • There is no standardized material available to use for OIT that has been shown to be effective. 

Q: What are the dangers of accelerating the clinical trials process?

A: There are at least two important concerns with rolling out OIT as a therapy prematurely. One is that someone will get seriously hurt, which would be terrible for that individual and possibly a set back for all efforts to develop OIT. The second is that we'll miss important opportunities to actually learn how to do this right, before it becomes widely used. Medical history is rife with examples of therapies or tests that are found to do more harm than good after they've become widely used and we need to do our best to avoid that.

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