Oral immunotherapy: Can kids get rid of allergies?

I can't give you 100% accuracy, but it is currently the only treatment method that has a chance of removing the "lifelong taboo" label for allergic children.

Last week, I had a follow-up visit with a 5-year-old child with peanut allergy. Eighteen months ago, his mouth swelled into a sausage mouth if even half a peanut crumb came into contact, and he was choking for breath. After taking oral immunotherapy according to the regulations, his mother brought him for a follow-up visit last week. She still had half a bag of leftover peanut crumb cookies in her pocket. She said that yesterday the child shared two snacks with the kindergarten children, and nothing happened. The baby jumped so high that he finally no longer had to watch others eat snacks.

If you think this is a miracle drug just by looking at this case, that would be too optimistic. Last month, I even persuaded several parents who wanted to do this treatment. There is a 7-year-old child whose asthma is not well controlled and needs to be nebulized whenever he catches a cold. In this case, the risk of oral immunization is too high. If a severe allergic reaction is induced when the dosage is increased, serious problems may occur.

In fact, the logic of this treatment is simple. It is to do "slow desensitization training" for the immune system - just like your child is originally afraid of dogs, you can't just stuff him in front of a big wolf dog. You have to let him look at the docile little teddy from a distance first, touch it slowly, touch it slowly, and finally lose his fear of dogs. Oral immunization means starting with a dose of allergens as small as a few milligrams that will hardly induce allergies, and slowly increasing the dose to allow the immune system to slowly adapt. "This thing is not an invading bad guy, so there is no need to activate the defense mechanism blindly."

There is a lot of controversy over this therapy in the industry. One group believes that as long as the indications are strictly screened and the operation is standardized, about 60% of children can tolerate it for a long time, even if they eat allergenic foods after stopping the medication.； The other group believes that the current long-term follow-up data is only 5 years at most, and no one can say whether it will relapse after a longer period of time. Moreover, nearly 30% of children will return to their previous allergic state not long after stopping the medication, even if they complete the 2-3 years of treatment, which is equivalent to suffering in vain.

What's more, this treatment is really tedious, and it doesn't end with just one operation: you have to come to the hospital every week in the early stage to increase the dosage, and you have to wait for 30 minutes after eating to make sure there is no reaction before leaving. In the subsequent maintenance stage, you have to give your baby a certain amount of allergens on time every day, and you have to persist for two or three years. I have seen too many parents persist until After half a year, some parents gave up because they found it too troublesome. There were also parents who secretly increased the dosage for their babies. They should have started with a few micrograms of peanut protein, but they directly stuffed half a peanut into the baby. The baby had laryngeal edema and was sent to the emergency department on the spot. After this incident, I have to emphasize repeatedly every time I tell parents about the precautions. You must not adjust the dosage blindly by yourself.

Not all children can tolerate this treatment. I once had a little patient with a milk allergy. After trying the smallest dose of milk protein several times, he broke out in hives and complained of stomach pain. In the end, he had no choice but to stop and continue to avoid the food.

As for whether to give this treatment to your child, I usually tell parents to think clearly about your family’s needs first: if your child has a particularly severe allergy and a small amount of it may induce shock, making him anxious during school and life, seriously affecting his quality of life, then this treatment is definitely worth trying.； If the baby only has two red dots on his mouth after eating eggs, and the taboo does not affect his growth and development, then there is actually no need to join in the fun. After all, safety is always the first priority for allergic babies.