by Christina Echegaray
Monroe Carell Jr. Children’s Hospital at Vanderbilt has launched a new pediatric Oral Immunotherapy Clinic, which offers a special therapy to peanut-allergic children to reduce risk of a harmful immune response in the event of accidental exposure to peanuts.
Led by Rachel Glick Robison, MD, associate professor of Pediatrics within the Division of Pediatric Allergy, Immunology and Pulmonology, the clinic is located within the Allergy Clinic at Vanderbilt Health One Hundred Oaks.
Around for nearly two decades, oral immunotherapy (OIT) involves a patient eating small, but increasing, amounts of their specific allergen daily over a period until reaching a maintenance level dose. The process is known as desensitization. The maintenance dose is lifelong and must be consumed daily for continued protection.
“The most important thing I tell families is that this is not a curative therapy at this point. This is a way to give you a level of protection against accidently ingesting the allergen in your daily life. We know that if you tolerate the therapy amount, then you would tolerate small amounts of the allergen if you were accidentally exposed. They also still have to carry epinephrine injectors,” said Robison.
Food allergies affect about 1 in 13 children in the United States. Within that group, about 2.5% of all children have a peanut allergy. That number has steadily risen since 2010, with one study showing that by 2017, there was an estimated 21% increase in peanut allergies in the U.S.
A food allergy is a medical condition in which exposure to certain foods triggers a harmful immune response, which can range from mild (itchiness, hives) to severe or life-threatening (difficulty breathing, throat tightening). The top eight most common food allergies are: peanuts, tree nuts, milk, egg, wheat, soybeans, shellfish and fish.
Each year, about 200,000 people require emergency medical care for allergic reactions to food, according to the organization Food Allergy Research & Education.
OIT, Robison says, offers families the chance to broaden their life activities a bit, lessening some of the apprehension of daily exposure to peanuts for fear of ending up in the emergency room.
“If someone has been apprehensive to travel or eat at restaurants, this can provide some benefits for them. I’ve also seen people who, as their child gets older and is approaching school age or college, have concerns about accidental ingestion. For those people who really want some protection against accidental ingestion, we know OIT therapy can help provide that.”
But OIT isn’t for everyone. Robison says she sits down with families for an extensive conversation about all the benefits as well as the risks. She also needs to understand if a child has any other allergic disorders and a family’s lifestyle/habits to ensure compliance to the daily dosing regimen. Some people would rather practice avoidance and not have the daily responsibility.
The clinic currently uses the only FDA-approved OIT for peanut allergy, PALFORZIA, which is approved for children ages 4 to 17.
The first couple doses are given in the OIT Clinic under observation. Each level of dosing lasts about two weeks over about six months until the maintenance dose is reached. Currently, the maintenance dose is lifelong.
Robison, who arrived at Vanderbilt in February 2022, previously helped build a food allergy clinical trials program at Lurie Children’s Hospital of Chicago, and she hopes to help develop something similar at Monroe Carell as understanding and therapies for food allergies continues to evolve.
“I do believe OIT will likely be done earlier with more regularity and in younger kids at diagnosis,” she said. “But OIT is not necessarily a perfect fit for every individual, so there is still a lot of room for other options and therapies that are hopefully coming down the pipeline soon.”