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How to Incorporate Oral Immunotherapy into Your Clinical Practice

  • Immunotherapy and Immunomodulators (B Vickery, Section Editor)
  • Published:
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Abstract

Purpose of Review

The purpose of this review is to discuss how to best incorporate oral immunotherapy into your clinical practice based on recent evidence and guidelines, and address controversies.

Recent Findings

Oral immunotherapy is the food immunotherapy treatment with the most literature supporting its use. Recent data from both randomized clinical trials and real-world studies show OIT is especially safe and effective in preschoolers, while avoidance may be less safe than previously thought. OIT guidelines support its use outside of research.

Summary

Oral immunotherapy can be safely and effectively incorporated into your clinical practice, with careful planning and consideration of scenarios where benefits outweigh risks. Baseline oral food challenges are necessary in clinical trials, but in clinical practice, these are best done when the history is unclear due to resource limitations. There is a role for both regular food and FDA-approved products. Future research should focus on optimizing safety and adherence in the real-world setting.

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Author information

Authors and Affiliations

  1. Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

    Elissa M. Abrams, Stephanie C. Erdle, Scott B. Cameron, Lianne Soller & Edmond S. Chan

  2. Division of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada

    Elissa M. Abrams

  3. BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada

    Stephanie C. Erdle, Lianne Soller & Edmond S. Chan

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  1. Elissa M. Abrams
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  2. Stephanie C. Erdle
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  3. Scott B. Cameron
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  5. Edmond S. Chan
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Corresponding author

Correspondence to Edmond S. Chan.

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Conflict of Interest

EMA received an unrestricted educational grant from Novartis and is a member of the scientific advisory board for Food Allergy Canada. SCE and SBC have nothing to declare. LS participates in research sponsored by DBV technology. ESC has received research support from DBV Technologies; has been a member of advisory boards for Pfizer, Pediapharm, Leo Pharma, Kaleo, DBV, AllerGenis, and Sanofi Genzyme; is a member of the healthcare advisory board for Food Allergy Canada; was an expert panel and coordinating committee member of the National Institute of Allergy and Infectious Diseases (NIAID)–sponsored Guidelines for Peanut Allergy Prevention; was co-lead of the CSACI oral immunotherapy guidelines; and was a member of the committee for the American Gastroenterological Association & AAAAI/ACAAI Joint Task Force guidelines on the management of eosinophilic esophagitis.

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Abrams, E.M., Erdle, S.C., Cameron, S.B. et al. How to Incorporate Oral Immunotherapy into Your Clinical Practice. Curr Allergy Asthma Rep 21, 30 (2021). https://doi.org/10.1007/s11882-021-01009-8

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