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With the increase in food allergy over the past few decades, there is demand for more than our existing management strategy—allergen avoidance (which is not 100% effective) and provision of rescue medication (which also is not always effective). Treatments such as oral immunotherapy (OIT) are not new, with at least one report in The Lancet from 1908.1 A century later, we are finally seeing larger, often multicentre studies report on outcomes. Indeed, OIT is offered routinely in many countries, including the USA, Spain, Italy, Israel and Japan. So why are we not offering OIT in routine practice yet?
The safety aspects of OIT were recently highlighted by Chu et al in a meta-analysis which included 1041 participants across 12 randomised controlled trials.2 As summarised by Archivist,3 although OIT induces desensitisation, patients who undergo OIT experience an increased rate of allergic reactions including anaphylaxis when on treatment. For peanut OIT, the risk of anaphylaxis increases threefold, with a relative risk of 3.12 (95% CI 1.76 to 5.55). In fact, this is likely to be an underestimate: there is such heterogeneity in how OIT studies report their outcomes and reluctance to share these data that it is difficult to accurately assess outcomes. For example, a Medical Research Council/National Institute for Health Research-funded study of peanut OIT in the UK, the STOP-2 study, did not report rates of anaphylaxis; one patient in the study self-administered intramuscular epinephrine on two occasions due to …
Contributors Both authors have contributed to the preparation of this editorial.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests PJT has acted as an Investigator for Aimmune Therapeutics and DBV Technologies in respect of food allergy desensitisation studies and has received speaker fees from DBV Technologies and personal fees in respect of Advisory Board membership for both companies. PJT reports grants from UK Medical Research Council and NIHR/Imperial BRC in respect of food allergy research; travel expenses from Allergenis; personal fees from ILSI Europe outside the submitted work.
Provenance and peer review Commissioned; internally peer reviewed.
Patient consent for publication Not required.