How We Work
Important Notice: Just because your child is suitable for desensitisation, does not mean it is the right treatment for them. It’s critical that there is a process of shared decision making, discussing the benefits, risks, alternatives and implications of not undertaking the food allergy desensitisation treatment. This process will be supported by lots of written information to help you make the right decision for your family, which may well be to continue to avoid peanuts.
Oral Desensitisation (OD), also known as Oral Tolerance Induction (OTI or OIT) or Food Desensitisation, is a treatment that involves giving very small, but gradually increasing, amounts of the food that the child is allergic to. The intention of OIT is to increase the tolerance to the food so that larger amounts of it can be consumed without causing any symptoms and, as a result, accidental exposures to small amounts of the food should not cause reactions.
OIT has been most studied for milk, egg and peanut.
In 2020, PALFORZIA became the first licensed food immunotherapy treatment initially in the US and then in Europe. This was the result of large, international studies to show its effectiveness and safety.
Each PALFORZIA dose contains consistent, precise amounts of peanut protein in the form of a peanut flour. The flour will be sprinkled from a capsule, or sachet at higher doses, and mixed with preferred soft foods that can be eaten cold e.g., yoghurt (milk or soy, allergies depending) or applesauce. The PALFORZIA doses are accurately measured which is important when the OIT journey is to start at very low doses e.g. 3mg of peanut protein which equates to 100th of a peanut kernel containing 300mg of peanut protein.
It is important to recognise that oral immunotherapy to food leads to a state of desensitisation (a temporary state, where greater amounts of peanut can be tolerated without symptoms) and not necessarily true ‘tolerance’ (a permanent state where any amount of food allergen can be consumed without any risk of reaction). In practice, this means that the regular doses of the allergen must be continued regularly in the long term for the treatment effect to remain. If it isn’t, the risk of reaction returns.
It is also important to realise that oral immunotherapy is ‘allergen specific’ i.e. the improved tolerance will only be to peanuts and not to any other food allergens that your child may be allergic to.
The Palisade and Artemis trials have also demonstrated that the reaction severity that occurs to very high amounts of peanut decreases on therapy, and levels of tolerated peanut (and immune changes that support such changes) improve over time.
Following the success of our PALFORZIA programme, we have now extended our services to include desensitisation to a growing number of other allergens such as sesame, cashew, walnut, wheat and hazelnut using accurately measured doses which are increased in a precise manner under supervision until the maintenance dose of protein has been achieved. We will be launching other food allergy immunotherapy programmes so please do not hesitate to reach our team should you have an interest in a particular OIT programme.
Our Process
Referral
Please advise your Allergist that you would like to move forward with food desensitisation and they will complete and send the necessary referral form and most recent medical report to our Admin Team.
Assessment
When one of our Paediatric Allergists has determined your child is suitable for oral immunotherapy, they will complete and send a referral form to our Admin Team. A ‘virtual’ assessment appointment will then be arranged with a member of the Clinical Team who will be looking after your child on the programme. They will discuss the process and ensure that you fully understand what is involved. The assessment will cover the detailed history provided by your allergist, focussing on the particular allergen selected for desensitisation. This is your opportunity to have answered any additional questions you may have.
Consent
If it is felt your child is suitable for the treatment, you will be provided with written information and given plenty of opportunity to ask any questions. When you feel ready, you will be asked to sign a consent form to indicate that you have fully understood the risks involved. Older children will be asked to sign an assent form confirming they are motivated and willing to undergo therapy. If you do not already have them, you will be prescribed adrenaline autoinjectors e.g. Epipen and trained in their use, so that you are well prepared to deal with a more severe allergic reaction.
Initial Dose
Up-Dosing
Maintenance
Follow-Up
Referral
A referral from one of our Professors to the service is required in the first instance.
Your child’s current allergy status will need to be confirmed, please note that up to date skin prick tests, blood tests or spirometry may be required to ensure suitability, any child whose asthma or eczema is not extremely well controlled, would not be suitable for starting treatment.
If your child has not been seen before, our Admin Team will direct you appropriately to the Professor’s private clinics on receipt of your suitability form.
Assessment
When one of our Paediatric Allergists has determined your child is suitable for oral immunotherapy, they will complete and send a referral form to our Admin Team. A ‘virtual’ assessment appointment will then be arranged with a member of the Clinical Team who will be looking after your child on the programme. They will discuss the process and ensure that you fully understand what is involved. The assessment will cover the detailed history provided by your allergist, focussing on the particular allergen selected for desensitisation. This is your opportunity to have answered any additional questions you may have.
Consent
If it is felt your child is suitable for the treatment, you will be provided with written information and given plenty of opportunity to ask any questions. When you feel ready, you will be asked to sign a consent form to indicate that you have fully understood the risks involved. Older children will be asked to sign an assent form confirming they are motivated and willing to undergo therapy. If you do not already have them, you will be prescribed adrenaline autoinjectors e.g. Epipen and trained in their use, so that you are well prepared to deal with a more severe allergic reaction.
