History of Oral Immunotherapy

Children and adults with food allergies know the drill – they are always on the lookout for the substances that cause a strong immune system reaction. Living with a severe allergy adds stress and causes people to miss out on some activities that are part of everyday life. In response, many wonder if there’s a treatment option for allergies so severe that they can be life-threatening. Thankfully, the answer is yes. Desensitization to allergens using oral immunotherapy, or OIT, is helping many with allergies get some freedom back. Read on to get the facts about this exciting treatment.

History of Desensitization and Oral Immunotherapy

Oral immunotherapy isn’t exactly “new.” Like all immunotherapies, it is based on the principle of desensitization, where the immune system adapts to minor changes over time to build up a tolerance. For example, rapid prescription drug desensitization is commonly done for patients who need life-saving medications that they are allergic to. Patients can also be desensitized to venom. Perhaps the most commonly used form of immunotherapy is the allergy shot, given for seasonal or environmental allergies.

Desensitization Has Been Used for Centuries

“Desensitizing isn’t new to our world. Actually Alexander the Great used to do it. He would desensitize his body for poison before going out to battle,” Dr. Nadeau of Stanford explains.

Source: http://abc7news.com/health/allergy-program-changes-lives-/472356/

Traditional Allergy Shots Are a Type of Desensitization Therapy

Allergy shots, or subcutaneous immunotherapy (SCIT), have been used in the United States since 1911 – without clinical trials!

“The kind of desensitization that allergists have been doing for over 100 years, i.e., allergy shots, never underwent clinical trials,” Sugerman says. “And that’s the way our specialty was born.”

Source: https://www.oit101.org/research/dr-wasserman-normalizing-life-is-oit-goal/

Below are excerpts from a 2005 letter to the Annals of Allergy, Asthma and Immunology from Dr. Lyndon Mansfield in Texas – and Dr. Harry Morrow-Brown’s response.

Dr. Lyndon Mansfield Describes Treatment for Severe Peanut Allergy

Dr. Mansfield describes the case of a six-year-old girl who was so allergic to peanuts that she had two life-threatening anaphylactic attacks in pre-school.

At school, just touching the hand of another child who had eaten a peanut butter sandwich caused another severe reaction.
By the time the epinephrine (adrenaline) had been located she had collapsed. The emergency services administered intravenous epinephrine and she did recover.

However, her parents, who believed they had done everything they could to protect her, were so distressed that the mother considered giving up her job to teach her daughter at home.

Dr. Mansfield suggested that oral desensitisation might protect the child against unintentional exposure to peanuts, although it would be unlikely to enable her to eat peanuts as a normal food. The starting dose was administered in Dr. Mansfield’s office with a full emergency team in attendance in case of anaphylaxis – her only reaction was a slight rash and wheeze. During the subsequent eight-week period the daily dose was increased to four whole peanut kernels three times daily.

The girl has now been on a maintenance dose of two peanuts a day for a year, and has had two accidental contacts with peanuts without a reaction. Tests showed that the peanut-specific IgE antibody in her blood had reduced by more than a half over the year.

Dr. Harry Morrow-Brown Discusses Avoidance vs. Desensitization

I write to support the letter from Dr. Mansfield on how oral desensitization can be a practical alternative to avoidance.

This is far from a new idea, as it was in 1908 that a Dr. Schofield reported in The Lancet (2) how he successfully desensitised a boy who was dangerously allergic to egg by giving him pills containing gradually increasing amounts of egg, while otherwise avoiding eggs completely. The starting dose was 1/10,000 of an egg, a challenge was negative after six months, and thereafter he could eat an egg every day. This treatment was carried out in 1906, the very year that Clemens von Pirquet coined the word allergy!

In 1985 John W. Gerrard reported to the AAAAI meeting in New York (3) on six cases of peanut allergy desensitised via the oral route. I was present and recall how severely he was criticized for giving such dangerous treatment. In 2004 Meglio et al (4) successfully desensitized 15 out of 21 children proven by double-blind-placebo-controlled challenge to be severely allergic to milk. After the initial stages this treatment was carried out at home without problems. Three children could not be completely desensitized, but because they could tolerate small amounts of milk they were no longer in danger.

John Freeman, who was the first to use subcutaneous immunotherapy in 1911 (5), taught many thousands of patients how to give themselves grass pollen injections safely every day for 54 days with excellent results. Every spring up till 1959 up to 6,000 patients attended St. Mary’s Hospital in Paddington to receive their vaccine kits and meticulous instruction in self-inoculation. Although the top dose of 1.0ml of 10% w/v aqueous grass pollen extract was very high, and the final objective a negative skin test to grass pollen, the daily increase was very gradual and no serious incidents were reported.

Complete avoidance of the causative food is the standard medical advice today, but this policy places the main responsibility for avoidance on the parents and on the child, who is left vulnerable to accidental ingestion and anaphylaxis.

Must we condemn more and more unfortunate children and adults to live in constant fear of a dangerous reaction and required to carry epinephrine auto-injectors, with inevitable disruption of the quality of life of the whole family? Surely the better alternative would be inducing tolerance by very gradual reintroduction of the causative food, as reviewed by Niggemann (6)?

I suggest that the uncontrollable danger presented by accidental ingestion of an unknown amount of peanut should be compared with the controllable risk of oral/sublingual desensitization, using appropriate dilutions of standardized peanut extracts.

A trial of this method must take great care to establish a starting dose below the threshold of reaction, thereafter increasing the daily dose very gradually to avoid reactions and allow ample time for tolerance to be acquired. Meticulous instruction and collaboration with carefully selected families would be essential. I feel sure that many would prefer to take an active part in treatment rather than live in constant fear of anaphylaxis.

A clinical trial of oral/sublingual induction of specific tolerance to peanut or other foods would demonstrate a practical answer to an increasingly common problem.

1. Mansfield l. Successful oral desensitisation for systemic peanut allergy. Annals Allergy Clin. Immunol. 1006; 97: 266
2. Schofield AT. A case of egg poisoning. Lancet 1908; 1:716
3. Shenassa MM, Perelmutter L, Gerrard JW. Desensitisation to peanut. J Allergy Clin Immunol. 1985: 75: No 1 pt 2, p177 Abstract 291
4. Meglio P, Bartone E Plantamura M, Arabito W, Giampietro PG. A protocol for oral desensitisation in children with cow’s milk allergy. Allergy 2004; 59:980-987
5. Freeman J, Noon L. Further observations on the treatment of hay fever. Lancet 1911; 2:814-816
6. Niggemann B, Staden U, Rolinck-Werninghaus C, Beyer C. Specific oral tolerance induction in food allergy. Allergy 2006; 61: 808-811

First published in 2005. Source: http://www.foodsmatter.com/allergy_intolerance/anaphylaxis/articles/desensitisation.

With Treatment, Many OIT Patients No Longer Live in Fear

When Liseetsa Mann started her journey to treat her son with OIT in 2009, there were only 4 board-certified allergists doing OIT in their practices, and she only knew of 2 of them. By 2013 she had built her “list” to 20 doctors. By early 2016 her list went over 60 doctors in 20-something states. But that still leaves lots of areas NOT covered. OIT parents travel: Many will drive up to 17 hours each way to seek treatment for their child. Thrown together by circumstance, finding freedom and empowerment, lasting friendships are developed among entire families. We see this in our OIT Facebook groups too. Our OIT doctors are special humans, they are SO MUCH MORE than doctors. Many say that doing OIT and freeing people from food allergy is the most rewarding thing they have done in their careers.

While allergy patients do travel for OIT treatment, Chacko Food Allergy Treatment Center makes it easy for you with seven respected Atlanta-area allergy clinics. Call us today at (678) 668-4688 and we will find the clinic most convenient to you and your family.