Oral Immunotherapy (OIT) is a medical treatment for people with IgE-mediated food allergies to reduce the risk of severe allergic reactions.

It is done under medical supervision and involves eating a measured amount of your allergen(s) every day. Over at least 6 months, the dose is gradually increased until you reach a maintenance goal. Most people stay on maintenance for a year before deciding to continue the same maintenance dose indefinitely or increase tolerance further.

The goal of OIT is not to cure food allergies, it is to increase tolerance and reduce severe allergic reactions. 

Even after completing OIT, you will still be allergic and should continue to:

• Carry epinephrine
• Avoid intentional exposure
• Inform restaurants about your allergies

Some research shows that people who complete OIT and stay consistent with their maintenance dose may tolerate significantly higher amounts of their allergen.

This post reflects my personal experience with Oral Immunotherapy (OIT) and is not medical advice. OIT should only be done under the supervision of a qualified allergist. Always consult your doctor before making decisions about allergy treatment.

This post may contain affiliate links. If you purchase through these links, I may earn a small commission at no extra cost to you. I only recommend products I trust.

Table of Contents

• What Is OIT?
• Why I Decided to Do OIT
• What to Expect During the OIT Process
• What Happens If You Have an Allergic Reaction During OIT?
• My OIT Journey
• What People Don’t Realize About OIT
• Final Thoughts

Why I Decided to Do OIT

I decided to start OIT when I was living in New York City. I had heard about it and being surrounded by the best doctors made me feel like it was the right time to try. I am in my 20s, love to travel, have a corporate job that involves work travel, attend weddings, and have a busy, unpredictable lifestyle. I wanted more flexibility and less fear so I could fully enjoy all of these experiences.

What to Expect During the OIT Process

Before Starting OIT

Your allergist will most likely confirm your allergies through:

• Skin tests
• Blood tests
• Food challenges (to confirm what you are not anaphylactically allergic to)

First Day of OIT

Your first dose is done in your doctor’s office under close supervision and will be the smallest amount. Mine was 1mg, which was about half a miniature spoon and I had to use a toothpick to scoop it out.

During this visit, you will learn everything you need for the program. This includes safety guidelines like waiting 2 hours after dosing before exercise or heat exposure, how to measure and prepare your doses, and when to use epinephrine (when you are having trouble breathing or multiple body systems are involved). You will also be given your materials. I received a lunch box with allergen flours, measuring spoons, a scale, and informational packets to guide me through the process.

These are the containers I use to prepare my doses.

Ongoing OIT Routine

OIT follows a consistent routine:

1. Go to doctor’s office for a new dose
2. Have vitals taken
3. Take the dose
4. Wait 1-2 hours for monitoring
5. Get instructions on how to measure dose (spoons or scale)
6. Take that dose daily at home for about two weeks

This process repeats until you reach maintenance.

What Happens If You Have an Allergic Reaction During OIT?

Reactions can happen during OIT, especially when increasing doses. Something that is comforting to me is that they are typically controlled.

My allergist provides an app with specific instructions for different types of reactions, which has been very helpful. For example, when to take antihistamines for mild reactions.

Mild reactions, like itchiness, can be common. More severe reactions can mean lowering your dose, slowing your progression, or adjusting your plan. Something interesting is that adults can respond differently than children, factors like hormones, being hungover, stress, and other factors can impact reactions.  Most of the time your allergist can work around them to keep you moving forward safely.

My OIT Journey

Before starting OIT I completed food challenges for all nuts except:

• Peanuts
• Cashews
• Pistachios

This confirmed what I needed OIT for. I had avoided all nuts my entire life, but through testing and food challenges, I found that I had outgrown some allergies and only needed OIT for these three.

I take peanut flour and cashew flour daily. Pistachios are cross-reactive with cashews, so I will introduce them once I reach maintenance.

It is really cool to see it working. I had an allergic reaction to 18mg and 12mg and now I am eating 240mg.

My planned maintenance is 1.5 peanuts, 1.5 cashews, and 1.5 pistachios (after challenging after reaching maintenance). After one year of maintenance, I will challenge an increase to 3 peanuts, 3 cashews, and 3 pistachios.

What People Don’t Realize About OIT

OIT is both a physical and mental process. It can be really scary to intentionally eat something you are anaphylactically allergic to.

It requires consistency. You have to plan your doses around your day and prepare and measure your doses accurately. You will also have to adjust your dosing when you are sick or are traveling.

But, there is flexibility. There are guidelines for skipping doses, taking reduced doses, and restarting after a break. Your allergist and team are there to support you throughout the process.

I have been doing OIT for over a year now, including international trips and being sick, and it has been manageable with the right plan and a supportive team.

Final Thoughts

OIT has not been easy, but I have learned so much through the process. It has already started to reduce my fear and increase my confidence in everyday life. I am really proud of myself for committing to it and challenging myself.