Food Oral Immunotherapy

Food Oral Immunotherapy (OIT) is an evidence-based treatment that helps reduce allergic reactions to food through gradual, controlled exposure. It builds tolerance by regularly administering small but increasing amounts of the allergenic food, eventually reaching a maintenance dose.

This approach has long been used for environmental allergies such as grass pollen, tree pollen, house dust mite, and pet dander. Now, with a growing body of high-quality research, OIT is transforming care for children with food allergies.

Imagine not having to worry about your child having reactions to accidental exposure to their food allergen?

Food allergies can place a heavy emotional and practical burden on families. OIT can provide hope and a proactive pathway forward, helping children:

• Feel safer and more confident

• Participate more freely in everyday life

• Look ahead to a future with fewer allergy limitations

At Children’s Allergy Doctors, we offer food oral immunotherapy to peanut, cashew, walnut, hazelnut, Brazil nut, almond, macadamia, sesame seed, pumpkin seed, flaxseed, mustard seed, coconut, pea (green and yellow split pea), lentil and wheat in children up to 4 years of age. The upper age limit for starting oral food immunotherapy is 4 years due to the increased safety of this approach in younger children, fewer gastrointestinal side effects, and a higher likelihood of achieving remission.

For children aged 5 years and above, we will be introducing sublingual immunotherapy to foods starting in March 2026. This treatment approach has been shown to have fewer side effects (including a lower risk of anaphylaxis), particularly in older children. It also does not require avoidance of sport or physical activity for two hours after the daily allergen dose, unlike oral food immunotherapy, which can be more restrictive for older children.

We offer baked egg and milk oral food immunotherapy in children up until the age of 10 years.

Watch the interview below to get a parent’s perspective on food oral immunotherapy:

What is food oral immunotherapy?

Food oral immunotherapy is a medically supervised process where increasing amounts of the food allergen are introduced daily into the child’s diet, to reduce their allergic symptoms in case of accidental exposure to that food. The team at Children’s Allergy Doctors have been involved in the latest research trials in peanut oral immunotherapy, and we are proud to have conducted oral food immunotherapy in over 100 children to date, without a single case of anaphylaxis.

What allergies can oral immunotherapy 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, legumes and wheat. It is important to note that oral immunotherapy treatment requires ongoing dosing of the food allergen to maintain its benefit. 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 oral immunotherapy?

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 80-90% rate of desensitisation in children.

Peanut, tree-nut, seed, legume and wheat oral immunotherapy process

This Oral Immunotherapy process involves gradually increasing the child’s exposure to peanut protein in a controlled medical setting. The process is conducted in a Consultant-led, multidisciplinary clinic, under close supervision, starting with a very small dose of the food 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 OIT, including an assessment of their food allergy and their overall health status. A decision on the number of OIT foods to performed at once is decided at this point.
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. Baseline testing: The patient’s baseline level of peanut sensitivity will be determined through skin prick tests and blood tests (IgE test or RAST).
4. Dietetic appointment: The bespoke protocol is discussed with both parents, and training is provided in multiple different formats to ensure parents are clear on this and how to make up the doses.
5. Initial dose: The initial dose is always given in a Consultant-led, multidisciplinary clinic and monitored for any adverse reactions for 1-2 hours.
6. 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. 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.
7. Maintenance dose: Once the patient reaches the maintenance dose, they will continue to consume that amount of peanut protein daily to maintain their tolerance.
8. Monitoring: A free dietetic consultation is offered at 6 months into the maintenance dosing, to assess progress, answer any queries patients may have, and ensure adherence to the golden rules of oral immunotherapy.
9. Support: A bespoke 7-days a week OIT email and free nurse-led helpline Monday-Friday 9-3pm is available throughout the OIT process.
10. Follow-up: At one year follow-up we perform repeat allergy testing and, if the results have reduced substantially, we offer a supervised feed / oral food challenge to a larger quantity of the food allergen (typically 1 teaspoon or 1 tablespoon)
11. Longer term dosing: Once the child is able to tolerate a tablespoon of the food, and has been on maintenance dosing for at least 3 years, then we aim to reduce the dosing to three times a week.

Milk and baked egg oral food immunotherapy

Egg allergy is often outgrown during early childhood, but in some children can persist. For children with egg allergies, if they are unable to tolerate baked egg as a supervised feed or oral food challenge, OIT can be commenced using baked egg products. Our experienced paediatric allergy dietitian will guide you through the various recipes. The baked egg OIT programme consist of 6 updosing visits, each performed in the Consultant-led, multidisciplinary clinic. After one year on the maintenance dose, if the egg allergy tests have reduced enough, we then perform a supervised feed or oral food challenge to boiled egg.

Milk allergy is often outgrown during early childhood, but in some children can persist. For children with milk allergies, if they are unable to tolerate baked milk as a supervised feed or oral food challenge, OIT can be commenced using fresh milk. The milk OIT programme consist of 3 updosing visits, each performed in the Consultant-led, multidisciplinary clinic, followed by home updosing in very small increments up to 3ml neat cow’s milk. After one year on the maintenance dose of 3ml neat cow’s milk, if the milk allergy tests have reduced enough, we then perform a supervised feed or oral food challenge to a larger volume of neat cow’s milk.

How safe is oral food immunotherapy?

Oral food immunotherapy is considered safe when conducted under the close supervision of a Consultant-led, multidisciplinary team. 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 food 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.

What are the potential benefits of oral food immunotherapy?

• Increased tolerance: The goal of oral food immunotherapy 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 oral immunotherapy can improve their overall sense of well-being.

It is important to note that oral food immunotherapy 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 oral food immunotherapy 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, multidisciplinary clinic. We share lots of resources about the process. including dietetic, practical and psychological considerations as well as books for children and parents to review before they decide to embark upon oral immunotherapy.

Here is a photo of a patient who has reached the maintenance dose of their oral food immunotherapy programme with our specialist paediatric allergy dietitian Mrs Karen Wright. 

Is oral food immunotherapy 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 oral immunotherapy 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 oral immunotherapy treatment.
• Overall health: Children with uncontrolled asthma or other health conditions may not be suitable candidates for food oral immunotherapy treatment.
• Age: At Children’s Allergy Doctors we perform food oral immunotherapy to fresh milk, baked egg, wheat, peanut, tree-nuts, legumes and seeds in children 4 years and younger. In older children, we perform oral food desensitisation to baked egg and fresh milk desensitisation but not peanut, seeds, legumes, tree-nuts or wheat. In March 2026 we plan to start sublingual food immunotherapy to foods in older children.
• 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 oral immunotherapy 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 oral food immunotherapy?

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 £500 per visit for one OIT food, £550 per visit for two OIT foods and £600 per visit for 3-4 OIT foods. You will only be charged for the treatments your child receives. If your child requires further appointment due to reactions/missed doses, these will be charged at the same rate. If your child has asthma and requires spirometry before each up dosing visit, this will be an additional charge.

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 admin@childrensallergydoctors.com.

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.”