Brazil Nut Oral Immunotherapy (OIT)

Allergies to tree nuts, such as Brazil nuts, are usually persistent, and the majority will not outgrow their Brazil nut allergy. When an individual has a tree nut allergy, their immune system reacts to the proteins in the nuts.

People with a peanut allergy are at a higher risk about 30-40% of also having a tree nut allergy. There are eight kinds of tree nuts: almonds, Brazil nuts, cashews, hazelnuts, macadamia nuts, pecans, pistachios, and walnuts.

Nut allergies, including Brazil nut allergies, have been associated with severe allergic reactions more commonly than most other foods. However, it is important to note that the severity of allergic reactions is unpredictable.

Until recently, the approach taken to manage a Brazil nut allergy is to avoid the allergen. Oral Immunotherapy (OIT) for food allergens is a form of treatment which gradually helps reduce a child’s sensitivity to the food they are allergic to, thereby lowering the risk of accidental allergic reactions. We are very pleased to be able to offer oral immunotherapy for Brazil nuts to patients.

Will OIT cure my food allergy?

No – food OIT is designed to reduce sensitivity to the allergen and thus reduce the risk of accidental reactions. If it proves effective, the child needs to continue to have a small amount of it in their diet on a regular basis. Without this, they will be allergic again. New research has suggested that OIT in young children (under 5) still in the window where they may spontaneously outgrow their allergy, may be more likely to do so as a result of OIT.

How often do I have to take OIT?

There are three (3) parts of the process: the initial dose escalation phase, up-dosing phase, and the maintenance phase.

The initial dose escalation phase must be completed at the start of the process and will vary depending on the treatment but as well as having the first dose(s) it is also an opportunity to explain the whole programme to you in detail. As long as the dose is tolerated, you can progress to the next stage.
There are between seven (7) and eleven (11) steps of the up-dosing phase depending on the treatment programme. The first dose of each up-dosing level is given under direct supervision, because this is when there is the highest risk of a reaction. If you tolerate the first dose of a new level, you will continue to take that dose level every day at home. The food allergen should be taken with a meal at the same time each day. You will return to the clinic every two (2) weeks during the up-dosing phase although this can be longer if preferred. Once all up-dosing steps are complete you will begin the maintenance phase.
During the maintenance phase you will continue to take agreed maintenance dose every day. After completion of a year of treatment, you may wish to change the form of the allergen to something your child prefers.

How do I take OIT?

This will depend on the food but usually it would be mixed up with a small amount of a semi-solid food such as pudding, applesauce, or yogurt but not a liquid. Always wash your hands immediately after handling the allergen.

What side effects should I expect?

Side effects are common, especially in older children, but are usually mild. The most common side effects are stomach pain/cramping and itching of the mouth or throat. These symptoms are usually mild and typically do not require intervention. Antihistamines, or reducing the dose can be helpful if these are problematic. It is important to be aware that food allergens can cause severe life-threatening reactions, known as anaphylaxis, in the same way that the food in other forms can do. Symptoms include but are not limited to: trouble breathing, wheezing, chest tightness, throat tightness, trouble swallowing, swelling of lips, face, tongue or eyes, dizziness, fainting, severe stomach pain, vomiting, and/or diarrhoea. If you experience any of these symptoms, stop and seek medical attention immediately. You will be trained in recognising and treating severe reactions at the start of treatment.

Do I have to keep my Epinephrine Auto-Injector (EpiPen)?

Food OIT is not a cure for allergy. It is important to continue to avoid the allergen and continue to carry an epinephrine auto-injector wherever you go.

Can I do more than one course of OIT at the same time?

Multi-OIT available to those patients under 6 years of age considered low-risk and suitable by their clinician. Your referring clinician will assess your suitability to do multiple OIT. Suitability will be considered on a case-by-case basis.

Can I take extra doses of allergen to speed up the process?

No – it can only be taken once a day as prescribed. You cannot make adjustments to your dosing as this will increase your risk of a severe reaction.

Will OIT treat any of my other food allergies?

No. It’s a very specific treatment so it will have no impact at all on your other food allergies. The exception will be OIT to cashew, which should have an effect for pistachio allergy and walnut OIT for pecan allergy.

Who should not have OIT?

Patients who have Eosinophilic Esophagitis (EOE) or uncontrolled asthma should not be considered for food OIT. Also it is only suitable for patients under the age of 18.

If I am over 17, can I still start PALFORZIA?

No, PALFORZIA is only approved for treatment for patients aged 4 through to 17 years.

If my child is under 4, can they still start PALFORZIA?

No, PALFORZIA is only approved for treatment for patients aged 4 through to 17 years but we can still do peanut OIT using regular peanut.

Can I take my OIT dose before bed?

You should stay awake for one hour after taking the dose in order to monitor symptoms. It can potentially cause serious adverse reactions so it’s important to be awake.

Can I exercise before or after taking my dose?

In order to prevent the risk of an adverse event, you should not exercise or take a hot bath or shower for three (3) hours after taking the dose. If you have exercised or taken a hot shower or bath do not take the dose until you have cooled down, are not sweating, and your heart rate is beating at your normal rhythm.

If I am sick, should I skip my dose?

If you are sick you should contact our office to discuss this with the clinician as certain illness can potentially increase the risk of an adverse event. No adjustments should be made to the dose without consulting one of our clinicians.

I am ready to get started, what Is my first step?

Complete our suitability form and send it to us at office@oit.clinic

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.

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.

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

Follow-Up

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

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

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.

Maintenance

Single OIT

Multi-OIT

Follow-Up

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

To find out if your child is suitable for oral immunotherapy, just complete our simple questionnaire

Please Register Your Interest Am I Suitable?