Oral Immunotherapy

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It’s a stressful combo — a child with a food allergy and your fears of accidental exposure that triggers a reaction. It probably keeps your mind racing.

Lots of kids have food allergies, especially to peanuts. And fear of an allergic reaction if they’re exposed can have you worrying all the time. Does a new food have trace levels of peanuts? Can they safely go to school or birthday parties? What happens if you’re not there and they have a reaction? You want to protect them. But you can’t always be with them. And they hate feeling left out of fun with friends.

At Cleveland Clinic Children’s, we understand your worries — and your child’s fear of missing out. Oral immunotherapy (OIT) for food allergies, including the very common peanut allergy, can help give you peace of mind. This gradual treatment can help your child build a tolerance to a trigger food and possibly prevent complications from accidental exposure. And it’s done safely under the watchful eye of an experienced Cleveland Clinic Children’s pediatric healthcare provider.

Why Choose Cleveland Clinic for Oral Immunotherapy?

Demonstrated expertise:

Our fellowship-trained pediatric allergists and other skilled providers are experts in oral immunotherapy for food allergies. We can help desensitize your child for less risk of complications from accidental exposure to trigger foods.

Personalized care:

We’ll spend time with your child getting to know them, understanding their food allergy and figuring out if oral immunotherapy is right for them. Then we’ll build a personalized treatment plan to make sure they can have a safe OIT experience.

Collaborative care:

We work as a team to treat your child’s whole health, as well as their food allergies. In addition to allergists (immunologists), your child may see providers from other specialties, including dietitians and behavioral health experts. Meet our team.

Research and innovation:

Our experts lead oral immunotherapy clinical trials research. For peanut allergies, we use an oral immunotherapy powder from boiled peanuts in children as young as 1 year old and use a skin patch instead of oral treatments in children ages 3 and younger.

Industry leaders:

Cleveland Clinic Children’s is among a small number of U.S. hospitals offering early oral immunotherapy to children 4 years old and younger. Early desensitization can sometimes prevent an allergy or let kids with allergies eat regular portions of trigger foods.

National recognition:

Cleveland Clinic Children’s is a trusted healthcare leader. We’re recognized through the U.S. for our expertise and care.

Virtual visits:

Sometimes it’s hard to wrangle kids out of the house and into the car. At Cleveland Clinic Children’s, virtual visits may be available for some of your child’s appointments. This convenient and safe alternative to an in-person visit lets you meet with your child’s providers one-on-one from the comfort of home. All you need is an internet connection and smartphone, tablet or computer.

Testing Before Oral Immunotherapy at Cleveland Clinic Children’s

Peanut allergies are one of the most common food allergies in kids. We used to think peanut allergies were lifelong but have learned that roughly 1 in 5 kids eventually outgrow them. For those who don’t, we may recommend OIT. It can help them, and you, worry less about accidental exposure.

It’s important to remember that oral immunotherapy isn’t a cure for food allergies. But it can make it possible for your child to tolerate accidental exposure without a reaction. Not all kids respond to this therapy, so we’ll carefully test your child before we recommend OIT.

If your child has unmanaged asthma or eosinophilic esophagitis (EoE), oral immunotherapy is probably not an option for them. You must also be willing and able to give your child epinephrine injections at home.

Meet Our Oral Immunotherapy Pediatric Team

When your child comes to Cleveland Clinic Children’s for oral immunotherapy, they’ll work with a team of compassionate, experienced providers, including:

Pediatric allergists (immunologists)
Pediatric dietitians
Pediatric behavioral health specialists
Pediatric nurse practitioners
Pediatric physician assistants

This team will work with your child and you to develop a personalized treatment plan based on your child’s allergic reactions and overall health. We want you both to feel comfortable with the plan.

Providers Who Treat Food Allergies With Oral Immunotherapy

Locations

Our healthcare providers see patients at convenient locations throughout Northeast Ohio and Florida.

Treating Food Allergies With Oral Immunotherapy at Cleveland Clinic Children’s

At Cleveland Clinic Children’s, we only recommend oral immunotherapy if we’re confident your child will benefit from it. OIT can be used for a variety of food allergies, not just peanuts. And we now offer early oral immunotherapy for children ages 3 and younger. It’s important that OIT is done under the careful supervision of your child’s pediatric allergist.

OIT for peanut allergies

For peanut allergies, we can use Palforzia™, an FDA-approved peanut allergen oral powder on children between ages 4 and 17, if we decide they’re eligible.

We’ll have them start taking peanut protein powder in tiny doses. We’ll then gradually increase the amount over time to build tolerance and minimize the risk of life-threatening complications like anaphylaxis.

Our food allergy experts are certified Palforzia providers, meaning we maintain high safety standards throughout treatment. On the rare occasions that anaphylaxis occurs, we detect early signs and work quickly to stop it with injectable epinephrine.

Your child will take their first dose and any doses where we increase the amount of powder (up-dosing) at their pediatric provider’s office. This lets their provider carefully watch how your child responds to their first dose and future dosing increases.

Your child will continue to take each dosage level of peanut powder at home, between up-dosing appointments. That’s why it’s important to always have injectable epinephrine available at home. You’ll need to keep an eye on your child for any reaction symptoms.

It can take years for your child to achieve peanut desensitization using oral immunotherapy. Regular follow-up visits are necessary to monitor progress and tailor your child’s care. And it’s important that they continue to avoid peanuts in their diets because oral immunotherapy doesn’t cure the allergy.

Sublingual immunotherapy

Your child’s provider will put small doses (drops) of the allergic protein (at amounts too low to cause a reaction) under your child’s tongue daily. Your child will need to be able to hold the drops under their tongue for two minutes, then swallow. This therapy can help your child build a tolerance without having an allergic reaction.

Taking the Next Step

Everyday encounters with foods that trigger allergic reactions don’t have to define your child’s life. Or your family’s. Oral immunotherapy doesn’t cure allergies. But it can help your child become desensitized — so you don’t have to worry so much about accidental exposure to a trigger food (like peanuts) at school, birthday parties or summer camp. At Cleveland Clinic Children’s, our providers will walk your family through what to expect from OIT and see if it’s a good option for your child. If it is, they might be able to enjoy a little more freedom — and you might be able to feel a little more at peace.