Food Allergy Desensitisation

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Food allergy desensitisation

Food Allergy Desensitisation is an exciting new development. Although desensitisation is now common practice for environmental allergens like grass pollen and house dust mite, food desensitisation is only becoming a reality for patients now. Food desensitisation offers long term hope for individuals with food allergies to potentially reduce their allergic reactions and increase their quality of life.

Food Allergy Desensitisation is also known as Oral Desensitisation (OD), Oral Tolerance Induction (OTI) or Oral Immunotherapy (OIT) or Food Desensitisation.

Previously, the only treatment for food allergy was strict avoidance of the offending allergen, dietary advice and provision of an emergency treatment plan and medication. Now, by giving very small, but gradually increasing amounts of the food that the child is allergic to, this new process can reduce their allergic symptoms.

What is oral desensitisation?

Oral desensitisation (also known as oral immunotherapy) is a process where you gradually introduce increasing amounts of the food into the child’s diet to which they are allergic, to reduce their allergic symptoms. There is also research underway looking at a skin patch to expose the child to the food they are allergic to in this way rather than through the diet.

We are involved in the latest research trials in peanut oral and patch desensitisation. We are offering oral peanut desensitisation in my clinic now and hope to be able to bring the peanut patch desensitisation to the practice soon.

What allergies can oral desensitisation be used for?

The oral desensitisation treatment has been most studied for milk, egg and peanut but there is an increasing body of evidence on using this for sesame, tree nuts and wheat. It is important to note that this treatment leads to a temporary state of desensitisation. This means that exposures to small amounts of the offending allergen must be continued for the long term for the treatment effect to remain. If not, the risk of reaction returns, because the treatment does not necessarily give full and true ‘tolerance’ or a ‘cure’.

Desensitisation is not something that should be done without the close supervision and follow-up by a paediatric allergy specialist, as it can cause severe allergic reactions.

How effective is food desensitisation?

Numerous studies have been carried out around the world that demonstrate that OIT works well for milk, egg, peanut, tree nuts and sesame. Most importantly, the studies for peanut also show an improvement in quality of life. Different studies use different approaches, but most report around 90% effectiveness in children.

Peanut OIT in different age groups

The effectiveness of food desensitisation varies depending on several factors such as the type of food allergy, the individual’s age, and the type of desensitisation treatment received. In children aged 4 to 17, there is now a licenced oral treatment for desensitising to peanut, called Palforzia. For children aged 4 years and under there are other options which Children’s Allergy Doctors offer.

Peanut desensitisation process

The peanut desensitisation process, also known as Peanut Oral Immunotherapy (OIT), involves gradually increasing the patient’s exposure to peanut protein in a controlled medical setting. The process is typically conducted under the close supervision of a healthcare professional and typically begins with a very small dose of peanut protein which is gradually increased over time.

Here is an overview of the peanut desensitisation process:

  1. Evaluation: Before starting treatment, the patient will undergo a thorough evaluation to determine their eligibility for peanut OIT, including an assessment of their peanut allergy and their overall health status.
  2. Baseline testing: The patient’s baseline level of peanut sensitivity will be determined through skin prick tests and blood tests (IgE test or RAST).
  3. Initial dose: The initial dose is always given in a clinical setting and monitored for any adverse reactions.
  4. Dose escalation: The dose will be increased gradually over time, typically at 2-4 weekly intervals in the clinic. This will continue until the patient reaches a maintenance dose, which is typically around 300 mg of peanut protein per day.
  5. Maintenance dose: Once the patient reaches the maintenance dose, they will continue to consume that amount of peanut protein daily to maintain their tolerance.
  6. Monitoring: The patient will be monitored closely for any adverse reactions throughout the treatment process. If an adverse reaction occurs, the dose will be adjusted accordingly.

How safe is peanut desensitisation?

Peanut desensitisation is generally considered safe when conducted under the close supervision of a healthcare professional. However, like any medical treatment, there is a risk of side effects, adverse reactions and reactions due to accidental exposures, especially in individuals with severe peanut allergic reactions.

The most common side effects reported include abdominal pain, nausea, vomiting, oral itching, throat itching, and hives. In rare cases, more serious allergic reactions including anaphylaxis and difficulty breathing have been reported.

Milk and Egg OIT in different age groups

Egg allergy is often outgrown during early childhood, but in some children can persist in later teenage years or even early adulthood. For children with milk allergies, OIT can be started with baked products or fresh milk depending on child and parental preference. For children with egg allergies, OIT is usually started with baked products. Our experienced paediatric allergy dietitian will guide you through the various recipes.

Egg and milk desensitisation process

The process of egg and milk desensitisation, also known as oral immunotherapy (OIT), involves gradually increasing the dose of allergen under medical supervision to build up tolerance over time.

Here’s a general overview of the steps involved in OIT:

  1. Diagnosis: A doctor will perform allergy tests to confirm an egg or milk allergy and determine the severity.
  2. Preparation: The patient will be advised to avoid consuming the allergen in question and may be prescribed an emergency treatment, such as an epinephrine auto-injector, in case of an allergic reaction.
  3. Initial dose: The patient begins with a very small, safe dose of the allergen, which is gradually increased over time.
  4. Dose escalation: The dose is gradually increased under medical supervision in the doctor’s office or at home, depending on the patient’s progress and tolerance. This process can take several months to a year.
  5. Maintenance dose: Once the maintenance dose is reached, the patient is advised to consume the allergen on a regular basis to maintain tolerance.
  6. Monitoring: The patient will be monitored closely for any adverse reactions throughout the treatment process. If an adverse reaction occurs, the dose will be adjusted accordingly.

How safe is egg and milk desensitisation?

The safety of egg and milk desensitisation varies from person to person and depends on several factors, including the severity of the allergy, the method of desensitisation, and individual response to treatment. It is important that accidental exposures to small additional amounts are avoided during the desensitisation process.

Most, if not all children, will have some allergic reactions during the treatment but these are virtually all mild. Typical reactions are rashes, lip/face swelling and abdominal discomfort and less commonly, wheeze. In rare cases, more serious reactions, such as difficulty breathing and anaphylaxis, have also been reported.

What are the potential benefits of food allergy desensitisation?

  • Increased tolerance: The goal of food allergy desensitisation is to increase the patient’s tolerance to the allergenic food, which reduces the risk of a severe allergic reaction.
  • Improved quality of life: For individuals with food allergies, being able to eat the allergenic food without fear of a reaction can greatly improve their quality of life.
  • Reduced risk of accidental exposure leading to allergic reactions and emergency medication use: With increased tolerance to the allergenic food, individuals with food allergies may be less reliant on emergency treatment, such as epinephrine auto-injectors, to manage their allergies.
  • Increased social and psychological well-being: Food allergies can have a significant impact on an individual’s social and psychological well-being. By reducing the fear of a reaction and increasing the patient’s ability to enjoy a wider variety of foods, food allergy desensitisation can improve their overall sense of well-being.

It is important to note that food allergy desensitisation is not a cure for food allergies and that patients must continue to strictly avoid exposure to the allergenic food and carry emergency treatment even after completing the treatment. Additionally, the success of desensitisation varies from person to person, and the long-term benefits and risks of treatment are still being studied.

What support can I expect for my child during the programme?

You and your child will be counselled throughout the programme and will be seen at regular intervals in a consultant-led clinic. If you have queries about your child’s food allergy between appointments, you should contact us.

If your child has a severe allergic reaction, you should follow your allergy management plan and go to your nearest A&E, just as you would do if your child was not on the programme.

Is food desensitisation treatment the right for my child?

OIT is not right for all children. Here are some factors that may be considered when determining if food desensitisation is the right treatment for your child:

  • Severity of allergy: Children with severe allergies, such as those who have had life-threatening reactions in the past, may not be suitable candidates for food desensitisation treatment.
  • Overall health: Children with uncontrolled asthma or other health conditions may not be suitable candidates for food desensitisation treatment.
  • Age: At Children’s Allergy Doctors we perform food desensitisation to baked / fresh milk, baked / fresh egg, wheat, peanut, tree-nuts and sesame in children 6 years and younger. In older children, we perform food desensitisation to baked egg, baked milk and fresh milk desensitisation but not peanut, sesame or tree-nuts.
  • Motivation: Children must be willing to strictly avoid exposure to the allergenic food and comply with the treatment regimen, including daily dosing and regular follow-up visits, in order to be considered suitable candidates for food desensitisation treatment.

Please consider this information carefully to limit the risk of you attending an assessment visit and finding your child is not suitable for the treatment.

What is the cost of food allergy desensitisation?

Suitability for OIT will be addressed as part of your child’s routine appointment when an allergy diagnosis is made. If you have had recent allergy testing, it’s helpful to provide this in advance. This initial clinic visit will be billed at standard outpatient consultation rates as would any allergy testing or food challenges required.

As a treatment for allergy, unfortunately food allergy desensitisation will probably not be covered by your health insurance, which normally only covers diagnosis of allergy.

If your child is suitable for OIT and you wish to progress, we will provide a tailored plan for this treatment. The plan would typically include a total of 6-14 visits, including an initial visit where the first dose of allergen will be given. This will take place alongside full training with written and verbal advice on how to perform all steps safely and ways to incorporate the plan into the daily routine. Each visit will be charged at £450. You will only be charged for the treatments your child has received. If your child requires further appointment due to reactions/missed doses, these will be charged at the same rate.

We work closely with our paediatric allergy dietitians who can provide advice and recipes, and help you source products to make this easier for you and your family to complete.

An annual follow up, along with a food challenge to check the acquired level of tolerance, may be recommended. This will ensure that the management of the food allergy is continuing to be effective and so we can make any necessary adjustments to the treatment plan. This will help further with reducing the risk of any potential future adverse reactions.

If you have any further questions, please contact our practice team on 0203 146 7721 or email

What parents say:

“Extremely happy we chose to see Dr Brough with our 1 year old son. He has several allergies and her aim is to get him eating as much as we can. She is very proactive and reassuring.”


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