Oral Immunotherapy

Oral Immunotherapy (OIT) to Foods

Oral food immunotherapy (OIT) is an emerging treatment for food allergies that aims to increase the amount of an allergenic food a patient can safely tolerate. Unlike avoidance strategies, which focus on preventing reactions, OIT works by gradually exposing the immune system to the allergen under controlled conditions, helping to build tolerance over time.

OIT is not suitable for everyone. Patients undergo a thorough assessment by an allergy specialist, including a detailed history, allergy testing, and review of previous reaction severity. Treatment is tailored to the individual’s allergy profile, age, and overall health, ensuring safety and effectiveness. Foods commonly treated with OIT include peanuts, milk, and egg, sesame, tree nuts, though other allergens can be considered in our specialised clinics.

The therapy involves gradual, supervised introduction of the allergen in small, controlled doses, which are slowly increased over course of months. During this process, patients and families are educated on recognising and managing reactions, including the use of adrenaline (epinephrine) auto-injectors if needed. While OIT may not cure food allergy, it can help reduce the risk of severe reactions from accidental exposure, providing greater confidence and potential for improved quality of life for patients and families.

Our clinic offers oral food immunotherapy to carefully selected patients under close medical supervision. With the guidance of an allergy specialist, OIT can provide a safe, structured approach to managing food allergies, offering protection, empowerment, and improved day-to-day living for patients and their families.

How Safe Is OIT?

Most reactions during oral immunotherapy are mild, such as brief stomach discomfort or small hives. However, anaphylaxis can occur in roughly 1–4% of patients over the course of treatment. Most anaphylaxis reaction occurs on the up-dosing day or if the child is sick. For safety, every up-dose increase is done in our clinic with at least one hour of monitoring and full access to emergency medications. You child will have a clear sick day plan to follow given by your doctor.  Reactions can also happen at home, even to a dose that was previously tolerated, so families must be confident with their anaphylaxis action plan and administering adrenaline auto-injector.

Our clinic uses a slow, stepwise dosing schedule to lower the risk of reactions while still progressing towards tolerance. A small number of patients may develop eosinophilic esophagitis (EoE), though the exact connection to OIT is unclear.

Food Challenges

What are the Alternatives to OIT?

Avoiding the allergen remains the standard of care, and most allergists do not yet offer OIT, though adoption is increasing with the United States Food and Drug Administration (FDA) approving a commercial peanut OIT product (not available in Australia).  
 
In February 2024, the FDA approved Xolair, an injectable biologic for severe food allergies in children and adults. Given every 2–4 weeks, it reduces sensitivity to peanut, cashew, milk, and egg in about two-thirds of patients, helping lower the risk and severity of allergic reactions. Xolair is not PBS approved in Australia for food allergies; but is PBS approved for other conditions such as severe asthma and chronic spontaneous urticaria.  if you are interested to hear about it, our suggestion is to discuss with your specialist. 
Food Challenges

What are the costs of OIT?

Before starting OIT, you will receive a clear breakdown of expected costs. Roughly, costs include the consultation (which may be partially rebated by Medicare or private health insurance) and oral challenge visits. Families should be aware that gap fees apply for each visit, and these will be outlined in advance. 

Oral immunotherapy (OIT) itself is not covered by Medicare or private health insurance. For patients with Medicare, the consultation is covered, though there is a gap fee for each visit, including oral challenges. For those without Medicare, we recommend checking with your private health insurance provider to see if the medical consultation can be partially reimbursed, noting that a gap fee will still apply to cover the oral challenge and consultation. 

Food Challenges

Questions? We got you.

How do I book an appointment?

The first step in booking an appointment is to obtain a referral from your GP or another specialist. While a referral is not required, having one enables you to claim applicable Medicare rebates and helps our team appropriately triage your condition for review. Once you have your referral, you can schedule an appointment by booking online or contacting our practice directly and uploading your referral – our team will be in touch to schedule an appointment

Please bring a valid referral letter, Medicare card, and any recent investigation results, previous skin prick or patch testing reports, and relevant medical correspondence. For children, bringing their red book with recent growth measurements is also helpful.

Avoid antihistamines for 3–5 days before your appointment, as they can affect skin testing. You may continue nose sprays, asthma medications, antibiotics, and steroid creams. Do not apply moisturisers or topical steroids on areas likely to be tested (for example forearms, legs, back).

If you are suffering from a condition that you need to take oral anti histamines or steroids to control to manage your symptoms, continue to take those medications. Our doctors can arrange other forms of testing if required after the consultation.

Initial appointments approximately take around an hour, which may include skin prick testing if required. Follow-up appointments are typically shorter.

We prefer face-to-face appointments but we also offer telehealth consultations for selected patients or circumstances.

Harmony Allergy & Immunology Clinic is conveniently accessible by public transport, including Translink bus services. The Sunnybank clinic offers free onsite parking and street parking is also available around the Sunnybank hospital.

Skin prick testing applies a small amount of allergen (commercial extract or fresh food) to the skin which is then gently pricked to check for a reaction. The test takes 1–2 minutes, with results read after 15–20 minutes. Your doctor will determine if it’s appropriate for you.

Allergy testing is done by trained staff in a fully equipped medical setting. Reactions are rare, usually limited to mild itchiness at the test site, and can be promptly treated if needed.

Ensure you are well and avoid antihistamines 3–5 days before the test. Bring entertainment (toys, books, iPad, laptops) and for children, their favourite foods. You may need to bring the food or drug being tested which the staff will advise. We do not recommend bringing siblings; if necessary, bring an extra support person.

Ensure you are well before your appointment. You will be monitored by a health practitioner for at least 30 minutes after your immunotherapy dose. If taking your medication or vaccine home, please bring a small cooler with ice pack.

Are you ready to request an appointment?

Schedule a consultation with our experts to discuss your allergy needs.