OIT, SLIT, Xolair - The alphabet soup of food allergy treatment

For decades the only available treatment for food allergy has been strict avoidance of the food and emergency treatment (epinephrine) in case of an allergic reaction.  Researchers continue to study treatments for food allergy that may decrease the risk of severe reaction from an accidental exposure to a food allergen.

While there is no cure for food allergies, there are now several treatment options that can help prevent severe reactions in case of accidental exposure to the foods.  Two of these involve slow and gradual exposure to the foods in order to desensitize the patient.  The third option is a medication named Xolair.  After going through any of these treatment regimens, people MUST continue to regularly be exposed to their allergen, or receive Xolair to maintain their desensitized state.  Epinephrine must remain available at all times.

Treatment of food allergy (beyond avoidance and carrying epinephrine) is optional.

Allergy & Asthma Care offers 3 treatment options for food allergies

Oral Immunotherapy (OIT)

During OIT, people start eating tiny amounts of their allergen and overtime the amount is gradually increased until they are eating a small amount of the food daily at home (for example, a few peanuts). This generally protects them from having a severe allergic reaction if they accidentally take a bite of their allergen during the rest of the day. Allergic reactions can happen with OIT. In studies, allergic reactions occur in about 10-15% of patients who participate in OIT.  There are many restrictions surrounding the dosing of OIT that must be followed indefinitely to decrease the risk of severe reaction.

There is one FDA-approved OIT peanut formulation. There are no FDA approved formulations for other foods. At Allergy & Asthma Care, we are using store bought peanut products for OIT. This allows for a more individualized approach to treatment and is a cost savings.

Sublingual Immunotherapy (SLIT)

Sublingual Immunotherapy involves holding a tiny amount of liquid “SLIT solution” under the tongue to absorb the allergen. The SLIT solution is made of the allergen (for example peanut flour) plus a mixture of water and food-grade glycerin or sometimes a liquid form of the allergen (for example, cashew milk).   SLIT uses much less allergen than OIT. At the end of SLIT build up, the person is still only ingesting a tiny amount of their allergen every day. While there is still a risk of allergic reaction, the risk of reaction from each daily dose is less than in OIT. The downside of SLIT is that it will likely take longer to achieve full protection from an accidental bite of the food. However, because the amount of protein is so tiny, there are fewer restrictions around dosing with SLIT than OIT.

Xolair (omalizumab)

Xolair is an injectable medication that has been used since 2003 for the treatment of asthma. In 2024 Xolair was approved to treat food allergy in children 1 year and older. Studies showed that after 5 months of treatment with Xolair, patients were able to eat a significantly larger amount of their allergens without reaction. Xolair accomplishes “bite proof” protection for most people in a less targeted way than OIT and SLIT. Xolair has been useful for patients who cannot tolerate the restrictions for OIT/SLIT and for patients with multiple food allergies. Like OIT and SLIT, patients must continue to take Xolair to keep their protection.

At Allergy & Asthma Care we are committed to providing individualized treatment to our patients in a safe environment. We have been slowly expanding the foods that we are offering for use in OIT and SLIT. We also have a number of patients on Xolair for food allergy.  If you or your child has a food allergy and is interested in considering OIT, SLIT or Xolair,  please call our office to set up an appointment.