Register Your Interest

For further information about the treatments we offer, or to enquire about your suitability, please complete our register your interest form and a member of our team will be in touch.

Full name of parent/guardian

Full name of your child

Child's date of birth

Child's Age

Phone number

Email address

I am interested in:

SesameEggMilkWheatAlmondCashewPistachioWalnut

PecanMacademiaBrazil NutPine NutPeanutWheatRed LentilMustard

PeaHazelnutCoconutChickpeaMultiple AllergiesOther

If other, please specify

Which allergens would you like to prioritise as part of OIT treatment?

Have you been referred by one of our paediatric allergists?

Yes

Name of the allergist who referred you

No I would like to self-refer

Would you be interested in any of the following other services?

Subcutaneous ImmunotherapyAdrenaline Nasal Spray

How did you hear about us?

How soon would you like to book your assessment and / or treatment?

Have you been under the care of the NHS / another private allergist? If so, please specify

Our Process

I have been referred by one of your Paediatric Allergists I haven’t been referred but have a diagnosis of food allergy

Step 1
Referral Step 2
Assessment Step 3
Consent Step 4
Initial Dose Step 5
Up-Dosing Step 6
Maintenance Step 7
Follow-Up

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

Single OIT

At your child’s first treatment appointment, they will be given a tiny amount of the specific allergen for desensitisation under direct supervision of our specialist nurses. There will be a period of observation thereafter and you should allow 90 minutes for this appointment. As long as all goes well, you will be advised to give your child the same dose every day at home, mixed into a small amount of soft food, until it is time to visit us again (about 2 weeks later) to trial the next, higher dose.

Multi-OIT

If your child is undergoing Multi-OIT, you can expect the first appointment to last approximately 3 hours with the first allergen given, period of observation, second allergen given and period of observation. As long as all goes well, you will be advised to give your child the same dose of both allergens every day at home, mixed into a small amount of soft food, until it is time to visit us again (about 2 weeks later) to trial the next, higher dose.

PALFORZIA

At your child’s first treatment appointment, they will be given a series of tiny but increasing doses of PALFORZIA (from 0.5mg to 6mg of peanut protein) under direct supervision of our specialist nurses. If your child can tolerate at least 3mg, they can continue on to the next step in the treatment pathway. This is the longest visit lasting about 4 hours. If your child reacts to these tiny doses, they may not be suitable to continue the treatment.

Up-Dosing

Single OIT

You will return to our centre every two weeks, so your child can begin the Up-Dosing phase of treatment. If all goes well with supervised administration, you will be advised to give your child the higher dose achieved every day at home. Each up-dosing appointment will be approximately 90 minutes, you will need 8-11 visits depending on the allergen for desensitisation.

Multi-OIT

You will return to our centre every two weeks, so your child can begin the Up-Dosing phase of treatment. If all goes well with supervised administration, you will be advised to give your child the higher dose of both allergens achieved every day at home. Each up-dosing appointment will be approximately 90 minutes and you will need 8-11 visits depending on the allergens for desensitisation.

PALFORZIA

You will return to our centre the next day, so your child can begin the Up-Dosing phase of treatment. We will administer the first dose of PALFORZIA and monitor carefully to make sure your child can keep taking PALFORZIA. As long as this goes well, starting on the next day, you will give your child the same dose of PALFORZIA every day at home, mixed into a small amount of soft food, until it is time to visit us again (about 2 weeks later) to see if your child is ready for the next, higher dose. Up dosing takes about 6 months to complete, with approximately 11 visits in all.

Maintenance

Single OIT

Once your child has reached the maintenance phase they will continue to eat or drink a specified amount of the allergen on a regular basis at home, in order to maintain tolerance. The frequency of this can vary depending on the individual and the food allergen, and may be anywhere from 2-3 times per week, to daily.

Multi-OIT

PALFORZIA

After your child has completed Up-Dosing, they should be showing a decreased sensitivity to peanut allergen. To maintain this treatment effect, they will still need to continue taking PALFORZIA every day. This is called the Maintenance Dose and is around 300mg of peanut protein – approximately equivalent to one very large peanut kernel. Being able to have this without reacting, will confirm that your child is already at a much lower risk of reacting to accidental exposure to peanut (which are usually less peanut than this).

Follow-Up

Single OIT

Follow up will be with your child’s usual Allergist.

Multi-OIT

Follow up will be with your child’s usual Allergist.

PALFORZIA

Once the maintenance dose is being regularly consumed, there is no need for further visits. However, we will still need to have a 6 monthly check up to ensure everything is going well. Research studies show that whilst the maintenance dose must be continued in order to maintain the effect of the treatment, doing so for an extended period of a year or more appears to enhance the effectiveness of the treatment. There will also be a discussion about switching to alternate peanut products and the options include continuing on the PALFORZIA product, or changing to a favoured product containing a similar amount of peanut protein e.g. an M&M sweet, a measured portion of peanut flour or peanut butter. For some patients/families this will be the preferred option. We will discuss a new appointment in order to supervise the first dose of the chosen food and dietary advice will be given on how to continue on such products. It is important to remember that PALFORZIA is not a cure, your child will need to continue carrying an adrenaline device and bespoke emergency plan and avoid peanut.

Step 1
Referral Step 2
Assessment Step 3
Consent Step 4
Initial Dose Step 5
Up-Dosing Step 6
Maintenance Step 7
Follow-Up

Referral

This pathway is for families considering Oral Immunotherapy (OIT) for their child (up to 17 years of age) who:

Have not been assessed privately by one of our Consultant Paediatric Allergists (Professors Fox, Du Toit or Lack)
Do have a confirmed allergy diagnosis from their NHS (or other recognised) allergy service

This pathway allows you to understand whether OIT may be suitable for your child before committing to a full treatment programme, at a lower initial cost.

First – register your interest Self-Referral OIT Diagnostic Gateway and a member of our team will reach out to you. You will need to email us:

Your child’s most recent clinic letters(s)
Relevant test results confirming an allergy diagnosis
Documentation from your NHS or other allergy team

We will then pass this information to a member of our clinical team who will review the information, assess suitability and if confirmed suitable for an assessment, we can then schedule this appointment for you.

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

This appointment is approximately 1 hour with a member of our team (Dr David Mass, Dr Ru-Xin Foong or James Gardner). This is typically an in-person assessment where we will determine suitability of oral immunotherapy. Skin prick testing and spirometry may be required which are included in the cost (£450.00). If blood testing is needed, this will incur an additional charge.

Our assessor will discuss the treatment process and ensure that you fully understand what is involved. The assessment will cover the detailed history, focussing on the particular allergen selected for desensitisation. This is your opportunity to have answered any additional questions you may have.

Consent

Initial Dose

Single OIT

Multi-OIT

PALFORZIA

Up-Dosing

Single OIT

Multi-OIT

You will return to our centre every two weeks, so your child can begin the Up-Dosing phase of treatment. If all goes well with supervised administration, you will be advised to give your child the higher dose of both allergens achieved every day at home. Each up-dosing appointment will be approximately 90 minutes and you will need 8-11 visits depending on the allergens for desensitisation.

PALFORZIA

Maintenance

Single OIT

Multi-OIT

PALFORZIA

Follow-Up

Single OIT

Follow up will be with your child’s usual Allergist.

Multi-OIT

Follow up will be with your child’s usual Allergist.

PALFORZIA

What is immunotherapy?

Immunotherapy is the practice of administering gradually increasing doses of an allergen in order to reduce the sensitivity and risk of reacting to it. It was first carried out over 100 years ago and is now in widespread use around the world, in particular for hayfever and allergies to house dust mite and pets. It is sometimes referred to as ‘allergy vaccination’ or ‘desensitisation’. More recently, there has been intensive interest in the possibility of applying the same principle to help treat food allergies, which can be potentially life threatening.

What is oral immunotherapy?

Oral Desensitisation (OD) to food, also known as Oral Tolerance Induction (OTI or most commonly OIT), 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 the food can be consumed without causing any symptoms and, as a result, accidental exposures to small amounts should not cause reactions. This treatment has been most studied for milk, egg and peanut. In early 2020, PALFORZIA, a peanut containing capsule, became the first licensed food immunotherapy treatment. Increasingly, OIT has been used for allergies to sesame, treenuts and wheat although as the safety and effectiveness of these seems to mirror that of the other allergens, there have been relatively few published studies, despite the treatment now being widely available in North America.

How does oral immunotherapy work?

Over the past decade there has been a large increase in the number of research studies looking into desensitisation and these have included careful observation of how the treatment impacts on the immune system. It appears that regular exposure to the food causing allergy, but at a level below that which causes a reaction, causes the immune system to increase production of a specific antibody called IgG4. This has a blocking effect on the allergic antibody, known as IgE, and enhances tolerance to the food. As IgG4 levels increase, the effect is greater, allowing more of the food to be tolerated. We are still in the infancy of our understanding as to what is really happening at a molecular level but the science is advancing and we hope that soon there will be a simple blood test that will directly guide desensitisation. However, until we have such a ‘biomarker’, desensitisation is very much led by how well the patient is tolerating food and slowly increasing the level of exposure, rather than anything being gained by lots of blood tests.

Which food allergies can be treated with immunotherapy?

Most research has been done on desensitisation to milk, egg and particularly peanut. There are a small number of studies looking at OIT to other foods such as chickpea, wheat, sesame and tree nuts and also using other methods e.g. using patches of food on the skin or putting drops under the tongue. PALFORZIA is the only licensed OIT product in the UK, EU and USA. However, OIT to a wide variety of foods is available in many parts of the world as part of routine clinical practice.

How long does the oral immunotherapy process take?

This depends on the protocol being used – some are faster than others, as well as the response of the individual patient. A typical protocol will require approximately 8 – 12 steps when the dose of food allergen is increased with at least a two-week gap between doses. However, reactions or other factors (such as incidental illness or missed doses) may mean a longer gap between doses is required or this may just be preferred. Once the top dose (maintenance) has been reached, then the patient needs to continue to take this regularly to maintain the effect. The frequency of this dosing can be reduced (but not stopped) over time without apparent loss of effect.

Is oral immunotherapy the right treatment for my child?

Even if your child is suitable for immunotherapy, it does not mean that it is the right treatment for them. For many patients, continuing to avoid the food they are allergic to, coupled with an appropriate emergency action plan is the right way to manage the allergy. Desensitisation carries a risk and also has an impact on your day-to-day life during the updosing period and beyond. If your child is medically suitable, there is an important process of shared decision making, alongside detailed information about the treatment, to help you decide if it is the right thing to do. We will not consider your child for treatment without going through this process and you will be required to sign a consent form to confirm that you have discussed the pros and cons of each approach.