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Treatment Options

Oral Immunotherapy (OIT)

A structured, medically supervised path some families take with their allergist. Here's what the journey looks like, what it can offer, and what to weigh before deciding.

The Treatment Journey

Three phases, building step by step.

Initial dose escalation, months of gradual build-up, then a maintenance dose held steady — each phase clinic-supervised before the next begins.

What is OIT?

Oral immunotherapy, or OIT, is a treatment in which a child eats a small, precisely measured amount of their allergen — as a food or as a regulated product — in gradually increasing doses, under an allergist's ongoing supervision. The goal is desensitization: raising the amount of the allergen a child's body can tolerate before reacting, which can lower the risk of a serious reaction from an accidental exposure.

OIT is not a cure, and it does not mean a child can eat the allergen freely afterward. Most children who complete OIT continue eating a regular "maintenance" dose to keep their tolerance level up, and many still carry emergency medication and follow food-avoidance guidance day to day, just as before.

A parent and child cooking together in the kitchen

The treatment journey

OIT protocols vary by clinic, but generally follow three phases:

  • Initial dose escalation. On the first day, a very small starting dose is given in clinic, with the care team watching closely for any reaction over several hours before your child goes home.
  • Build-up (up-dosing) phase. Over roughly six months to a year, the dose is increased in clinic-supervised steps, typically every one to two weeks, while your child continues the current dose daily at home in between visits.
  • Maintenance phase. Once a target dose is reached, your child eats that amount regularly — often daily — for months to years, with ongoing check-ins with the allergy team.

In the United States, the FDA approved the first oral immunotherapy product specifically for peanut allergy in children in 2020. Many allergy programs, including some in Canada, also use food-based OIT protocols built around the actual allergen rather than a packaged product. Which approach is used, and whether it's available to your family, is something to ask your allergist directly — availability and specific programs change over time.

Benefits and considerations

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Potential benefits

  • May raise the amount of allergen needed to trigger a reaction, which can reduce the risk from accidental exposures
  • Can bring some families a greater sense of preparedness for everyday situations like school and travel
  • Gives families a structured, medically guided path to explore, alongside continued avoidance and emergency planning
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Considerations

  • Reactions during treatment — usually mild, sometimes more significant — are common, which is why every dose increase happens under supervision
  • It is a real time commitment: frequent visits, and a daily home dose that must be kept up consistently
  • It does not remove the allergy — most children still need to avoid the food, carry emergency medication, and stay in close contact with their allergist
  • Not every child or every allergy is a candidate; your allergist will assess whether it's appropriate

Why medical supervision matters

Because OIT works by deliberately exposing a child to their allergen, every dose increase carries some risk of an allergic reaction, including — in rare cases — a serious one. That's why OIT is only started, adjusted, and monitored by an allergist, in a clinical setting equipped to manage a reaction, with a clear emergency plan agreed on in advance. Any home dosing between visits follows a schedule your allergist sets, and any change in your child's health, medications, or symptoms should be reported before continuing.

Common questions families ask

  • Is my child a candidate for OIT, and for which of their allergies?
  • What does the appointment schedule look like during build-up?
  • What's our emergency plan if a reaction happens at home?
  • How long would maintenance dosing continue, realistically?
  • What happens if we need to pause or stop treatment?
  • How does OIT compare to sublingual immunotherapy for our situation?
Compare with Sublingual Immunotherapy Attend a Free Information Session
Treatment decisions should always be discussed with qualified healthcare professionals, such as your child's doctor or allergist. This page is educational information, not medical advice.

Related reading: Sublingual Immunotherapy (SLIT), Future Research, and our FAQ.

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