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OIT, SLIT, and Xolair
We offer three different treatments for anaphylactic food allergies.
What is Oral Immunotherapy (OIT)?
OIT is a treatment for anaphylactic food allergies.
For over a decade, allergists across the US have been using OIT to treat patients who have IgE-mediated food allergies.
OIT teaches the immune system to tolerate a food. This is accomplished by the patient eating microgram to milligram amounts of the allergen under specific safety parameters.
Here at the Institute, we use real foods - such as peanut butter and bagels - to teach our patients' immune systems to grow tolerance to their allergens.
What is Sublingual Immunotherapy (SLIT)?
Like OIT, SLIT is a treatment for anaphylactic food allergies.
SLIT teaches the immune system to tolerate a food. This is accomplished by the patient placing microgram to milligram amounts of an allergen-containing solution under their tongue and holding the solution in place for a few minutes.
Like OIT, SLIT follows specific safety parameters and is performed under the strict supervision of Dr. Hoyt.
SLIT solutions are formulated based on the patient's specifdic food allergy
What is Xolair (omalizumab)?
Like OIT and SLIT, Xolair is a treatment for anaphylactic food allergies.
For twenty years, allergists have used Xolair to treat allergic asthma. In February 2024, the FDA approved Xolair to prevent anaphylaxis caused by accidental ingestion of any allergen.
Xolair works by preventing allergic antibodies - IgE - from binding to and activating allergy cells.
Who may be a candidate for OIT, SLIT, and/or Xolair?
Any of these may - or may not - be a great treatment option for your child or yourself.
OIT, SLIT, and Xolair are used to treat IgE-mediated food allergies in children and adults.
An IgE-mediated food allergy is a food allergy that involves allergic antibodies called IgE. When these antibodies sense their allergen (such as what happens with a child with peanut allergy eats a peanut), the antibodies trigger the immune system to react. That reaction is called anaphylaxis and may involve hives, swelling, trouble breathing, vomiting, and potentially death, especially if not treated promptly with an epinephrine auto-injector (such as EpiPen or AuviQ).
Patients of any age, including infants, may qualify for OIT. They must:
Have IgE-mediated food allergy (one or more)
Be willing to participate within safety guidelines
Attend multiple in-office appointments (unless participating in a Comfort Concierge plan)
Patients of any age may qualify for SLIT. As with OIT, they must:
Have IgE-mediated food allergy (one or more)
Be willing to participate within safety guidelines
Attend multiple in-office appointments (unless participating in a Comfort Concierge plan)
Patients ages one year and up may qualify for Xolair. They must:
Have IgE-mediated food allergy (one or more)
Meet dosing criteria
Be willing to participate within safety guidelines
What risks are associated with OIT, SLIT, and Xolair?
All three treatments do carry risks.
Because OIT involves daily ingestion of small amounts of the allergen, there is a risk of anaphylaxis. Many children participate in OIT with few or mild symptoms, and this likely is because we at the Institute proceed with conservative protocols and counsel our families at length about safety parameters. Dosing outside of safety parameters, such as when a child has a fever, can lower the threshold to have an allergic reaction.
OIT also carries the risk of eosinophilic esophagitis (EOE). EOE is a non-anaphylactic food allergy that causes inflammation of the esophagus.
SLIT also carries many of the same risks of OIT; however, these risks are significantly less likely to occur.
Xolair is a biologic medication that has been used for two decades. Read more about its risks here.
The risks of potential treatments are discussed at length with our families prior to embarking on the treatment, and we continue to revisit the safety parameters throughout therapy.
Are any of these treatments right for my child?
The answer to this question is personalized to every patient.
At the Institute, we do not recommend nor do we start all patients with IgE-mediated food allergy on OIT, SLIT, or Xolair. That is because these are not necessarily the best treatment plans for all patients - strictly avoiding the allergen is still the best management plan for some children and adults with food allergies. At the Institute, these patients participate in our Avoidance Program.
When OIT versus SLIT?
OIT and SLIT both induce tolerance to a food; however, OIT typically has the power to induce a higher level of tolerance than does SLIT.
SLIT is a great approach for a patient, such as a teenager, who would like to be protected from having a severe allergic reaction if they accidentally take a bite of an allergen-containing food. SLIT has a lesser side effect profile and, thus, is easier regarding scheduling.
OIT is a great approach when a family would like the child to be able to eat more than a bite of the allergen, and many young children who participate in OIT are able to incorporate the allergen into their diets.
So what about Xolair?
Xolair is a great approach when a patient wants to continue avoiding the food and manage food allergies with a shot once or twice per month.
We personalize our recommendations based on evidence and based on your family's unique season of life.
Each of our patients receives personalized recommendations, and each family's goals are critical to clarifying so that the best treatment plan can be developed. Through shared decision-making, we work with our patients and their families to determine the best management plan for the current season of their lives.
If you would like your child or yourself evaluated for OIT, SLIT, or Xolair, please contact our office to schedule a Comprehensive Food Allergy Consultation.