Oral immunotherapy treats kids' food allergies and reduces parents' anxiety

Managing a child's food allergy can be an enormous source of stress. Constant vigilance, fear of accidental exposures, and navigating complicated meal plans can deeply impact a family's quality of life. But new research from BC Children's Hospital Research Institute highlights how one treatment option can alleviate certain psychosocial impacts of food allergies for parents and caregivers.

This episode focuses on the experiences of parents whose young children receive oral immunotherapy (OIT) — a well-established treatment that helps kids gradually build tolerance to allergenic foods. Dr. Lianne Soller shares findings showing that OIT not only improves clinical outcomes for kids with food allergies, but also reduces anxiety and increases quality of life for their parents and caregivers.

The conversation explores the broader emotional and practical challenges of parenting a child with food allergies — and how OIT is changing what long-term management can look like for families.

Learn more about topics discussed in this episode:

Preschool oral immunotherapy is associated with improved parental food allergy-specific anxiety and quality of life: A real-world observational study, Clinical & Experimental Allergy

Food Allergy Immunotherapy (FAIT) Program

All episodes written and produced by the Research Communications team at BC Children's Hospital Research Institute.

Theme music: "Life Is Beautiful" by Anastasia Kir

Transcript

Kristen Hovet (00:00)
My name is Kristen Hovet and I'm the interim research communications manager for BC Children's Hospital Research Institute. Joining me today is Dr. Lianne Soller, the research manager at the Division of Allergy in the Department of Pediatrics at UBC and the program manager at the Food Allergy Immunotherapy Program here at BCCHR.

Lianne Soller (00:21)
My name is Lianne Soller I am the allergy research manager at the division of allergy at UBC. And I have been with the allergy clinic for nine years now studying food allergy immunotherapy, which is a form of treatment for children, as well as food allergy prevention and doing lots of research in that area.

Kristen Hovet (00:43)
So to start, just so we're all on the same page with the language and definitions for those who might not be familiar, what is oral immunotherapy or OIT and how does it work for kids with food allergies?

Lianne Soller (00:57)
Oral immunotherapy, also known as OIT, is a treatment that involves a very small amount of the food that somebody is allergic to. So I'll use peanut as an example. With peanut, you start with a very tiny amount. It's usually in a powder form or a milk form, depending on the food allergen. And it's given to the patient, the child or the adults by mouth. So they eat it, and then it's dissolved and swallowed. And it's meant to help with

increasing tolerance to the food over time. So you would start with a really tiny amount and then you build up in steps over a series of months. Once you've completed your buildup phase, you get to the maintenance or the maximum dose. And the maintenance dose is kept in the diet every single day for approximately one year, sometimes longer depending on any symptoms that might happen.

So it does take quite a long time to complete the treatment, but it is very slow and gradual. And so that helps with the safety of the treatment.

Kristen Hovet (02:00)
Your research looked at preschool kids and their parents. Why focus on preschoolers and what makes early childhood such an important time for starting OIT?

Lianne Soller (02:11)
That's a great question. We focused on preschoolers because what we've seen in the literature with oral immunotherapy is that it's much safer at young age. And there's various reasons why that could be. It's not really known for sure why immunotherapy works better in children, especially young children, preschoolers. But it could have to do with the immune system and how the immune system isn't quite set until about age five. So what we've seen is the safety is very good, so there's

fewer reactions in preschoolers than in older children and adolescents. And it's also very effective, similarly effective in older children and adolescents. So the safety factor really does play into our decision to focus on preschoolers. Your second question about starting early. One thing that we really find is that children become a little bit picky as they grow older, as you might know if you have kids. And so starting them on the food treatment early on can prevent some of the longer term

consequences of trying to get your child to eat a food that they've been told their whole life to not eat, that can be very scary and that does cause a lot ⁓ of fear and aversion in older kids. So what we're trying to do is really get the food into the diet by going through the whole treatment and graduating from the treatment when they're young. So then they don't even remember that they had the allergy as they grow up. And that helps to prevent some of the longer term consequences of living with food allergy in school age, adolescence, and even into adulthood.

Kristen Hovet (03:39)
So managing a child's food allergy can be really stressful for the whole family. What are some of the common fears or challenges that parents and caregivers face?

Lianne Soller (03:50)
It's true. There's, there is a lot of fear coming around food allergy. I think the main one is really just that trauma of the first reaction. So you're feeding your new baby their foods and then all of a sudden they're having symptoms. And oftentimes the symptoms can be quite scary to see when it's an anaphylactic reaction. And then, ⁓ you know, you're not prepared. You don't have an epinephrine auto injector, EpiPen. So you're calling an ambulance, you're going to the hospital.

And then you get this diagnosis of food allergy. And I think it's just, seems to be very defeating for parents to hear that diagnosis because there's all these stories about, about how dangerous food allergy can be in the media. And so it's just very scary for a family to see, for a parent to see their baby go through something like that. So that's in the infant phase and it takes quite a long time for parents to really get to be okay with their child having an allergy.

They go through ups and downs with, you know, fears and anxieties over the different life cycle of the child. So when they start daycare, it's really scary because now their child is going to have to eat with other people and maybe they won't know how to deal with an allergic reaction. Or even when their child goes to, you know, birthday party or in school, they go on a camping trip or a trip with school and then they have to eat with other people. So there's so many fears and anxieties that come with food allergy.

And so that's what we're trying to alleviate with the treatment.

Kristen Hovet (05:23)
Before your study, what did we know or not know about how OIT might affect parents' anxiety or quality of life?

Lianne Soller (05:31)
So we knew some information. There were a few studies that were done over the years, but quality of life and anxiety have not been a very important outcome in the clinical trial space and the research space for a very long time. And recently, even in other diseases, this is coming up where a lot of studies are now focusing on the impact of whatever it is that you're studying on the patient's life, because that's so important. That's one of the, probably one of the most important things.

So we knew that the data showed in certain cases it helped with improving quality of life, but in other studies it showed no difference. And the studies were designed very differently. They looked at older children or they looked at adults. And so it was really hard to really understand or have a full picture of what was going on. But from a clinical standpoint, the doctors doing immunotherapy were constantly hearing these like amazing stories from their parents.

⁓ I don't have to worry about this anymore. And it's so great. I'm so happy. And no, I feel like a big weight has been lifted, but we couldn't prove it because we didn't have the data in particular with anxiety, because anxiety has been very, very well studied in other areas, but really not at all in food allergy. And so we actually created our own anxiety tool for food allergy in our hospital at BC Children's Hospital. And we started using it with immunotherapy or OIT patients, parents.

and measuring their anxiety as it relates to food allergy. And what we were starting to find even early on was that our parents were reporting even just starting food allergy treatment. It's just a huge weight is lifted. Some of the families have been waiting for a long time. They're finally feeling hope that something is going to happen. So we're really happy to have this data now because a lot of the other people in the community, not only parents, but a lot of doctors and researchers

they didn't believe us when we would say that anxiety was improved with oral immunotherapy. So, we would say anecdotally, we've heard that so-and-so, but now we have a robust data set to show that it's actually true. And it's across Canada patient group as well. So yeah, we're really happy to have this information. It's definitely a huge, important stuff to have in the literature on immunotherapy.

Kristen Hovet (07:51)
Definitely. And can you go into some detail about what you found specifically? How did parents' anxiety and quality of life change during and after OIT? Or I guess how it was phrased in the study, sort of when it was started and then different time points and then during maintenance.

Lianne Soller (08:06)
Yeah, so we measured the different outcomes. So the two outcomes were anxiety and quality of life. And within anxiety, we have different scales. So we have four different subscales. And so I won't go into too much detail, but basically what we found was anxiety was reduced, meaning people got better and felt better and less anxious about the food allergy from when they started their treatment or their OIT to when they completed their buildup phase or they got to the maintenance phase.

And that's the phase where there's the most work. It's the scariest because you're increasing the dose over time and you're not sure every day if your child will react to that new dose. And once we got to the end of buildup, we actually continued to measure quality of life and anxiety every time the patient would come in for a check-in. So they come in for a check-in either every six months or every 12 months. And so we continued to measure those outcomes over time to see if there was a continued increase or decrease in

quality of life or anxiety. We pretty much knew that we weren't gonna see a huge difference because the major difference is really when they're in the buildup phase and then they sort of just coast until the end. It would be interesting to see once they've completed the treatment after six months or after that if things would get even better or whatnot. So it would be cool to do a followup study afterwards, but.

Yeah, that was the main findings was that anxiety was really decreased. Quality of life was as well, but that was something that was already shown in the literature.

Kristen Hovet (09:38)
You found that parents of children receiving partial OIT reported greater improvements than those doing full or complete OIT. Why might that be? And can you first start by explaining the difference between partial and complete OIT?

Lianne Soller (09:53)
It's a bit of a confusing terminology, I admit. Partial OIT means that we did food allergy, immunotherapy or treatment or OIT to only some of the child's allergens. So for example, the child has five allergens, peanut, cashew, sesame, walnut, and pecan, and we only treated peanut. So that would be partial. Complete means we treated all five of those allergens. We were actually a bit stumped, to be honest.

about why we found that difference. I would have thought that complete OIT, having treated all the allergens, you're now less worried about having to avoid all the allergens because you've now done immunotherapy and so it should be easier. I suspect though that part of the reason is time commitment and how the families every day had to prepare their doses, basically mixing powders or milks.

with water, weighing them, getting their child to eat five allergens instead of one. So I think probably that burden maybe offset the anxiety a little bit. So that might be why we see this difference. And there could be other reasons too that we didn't measure. So I think we'd have to look into it a little bit more because there's also something to be said about some other food allergies that maybe were.

not reported or something like that. So there's various reasons why this could be, but it did honestly stump us initially when we saw the data.

Kristen Hovet (11:24)
Out of curiosity, what would normally be some of the reasons why people would choose doing partial versus complete?

Lianne Soller (11:32)
Initially, when we started doing OIT in 2017 as our Canadian group, we only offered peanut OIT because that was what was available in the literature in terms of data on safety and effectiveness. Peanut allergy is, as you probably know, the most common allergen. It's the most publicized allergen. It's the most focused on allergen in schools, school boards, planes, really the media. So we...

we started offering immunotherapy just to peanuts. So a lot of those patients in the data set are probably those early adopters where they only got oral immunotherapy to one food. But then later on, when we got comfortable offering OIT to peanut, we said, well, why can't we just use the same idea and just weigh tree nuts or weigh sesame and create the same recipes? So that's what we started doing. And so then most of the patients were treating multiple allergens.

I would say the vast majority do treat all of their allergens, but there are still a subset of patients who either they don't care about certain allergies, maybe they're allergic to salmon and it's easy to avoid salmon. So you don't need to treat salmon. And as I said, it's, does take time every day to make the recipes. So there is some shared decision-making with the family and the allergist to decide which foods to treat and whether to treat all of them at the same time or to treat some now and some later.

So it's probably a mixed bag of different reasons why you might've done one or more allergens at a time. But yeah, it's great that there is that option to do just one or multiple and kind of let the family decide based on their lifestyle.

Kristen Hovet (13:15)
How might your research influence how OIT is offered or how we support families going through it?

Lianne Soller (13:22)
So I shared our publication on LinkedIn a couple of weeks ago and this allergist in the US commented that she printed out the paper and she brought it to all the pediatric allergists in her area because she's like, see, this is why I do this. I think it will help allergists who are on the fence about whether it actually helps the patients and it will just empower them to know that yes, it will have a positive influence on my patient population.

I think it might also help reduce the stigma around anxiety for parents because, you know, a lot of parents think they're the only one that has anxiety with their child's food allergy. But reading this paper and seeing how many of the families have higher anxiety and then how oral immunotherapy can decrease your anxiety to such a degree. I think that'll provide some comfort to those families and also those families who are themselves on the fence about OIT because

they don't know if it's gonna help them, well, it might help them with their anxiety. So I think there's many reasons why this could help the patient population.

Kristen Hovet (14:29)
And what advice would you give to parents who are considering OIT for their child?

Lianne Soller (14:35)
A lot of it has to do, the decision really has to do with, so there's pros and cons as there is with everything. Parents who are on the fence, there could be many reasons why they're on the fence. They're scared, they don't have time, their kid doesn't want to do it. In the U S they can't afford it. In Canada, that's not really an issue because you can buy your product at the grocery store. But what I would say is to talk to your doctor, find it, first of all, find a doctor that offers immunotherapy because if they don't offer it then.

they won't be able to help. So find a doctor in your area that offers oral immunotherapy and talk to them about your situation and see what they have to say. There's lots of publications on decision aids and decision tools to help families and allergists get through that information together and what information is really important to share from the allergist standpoint with the family so that they have a complete informed decision around whether they want OIT or not. And what some of our doctors say is,

try to make it so that they really don't want to do it. And then if they still want to do it, then they're probably a good candidate. It's really not for everyone. And it's not the only option. And that's a really important point to make, is it's not the only option. There's still the option of avoidance. And if avoidance works for your family and you don't have the time in your schedule to sit for two hours after the dose, which is something that you do need to do in this case for OIT, then it's okay.

You don't have to do it. You don't have to feel like you're doing the wrong thing for your child if you're practicing avoidance.

Kristen Hovet (16:07)
From what I've seen in the media is that it seems like these kinds of allergies are on the rise. So it might be something that more and more parents are having to consider. I think it's a really important area of research for sure. What excites you most about where your research is headed next?

Lianne Soller (16:25)
Ooh, so many things. So I just said that oral immunotherapy is not the only option. There's still avoidance. Well, thankfully there's also clinical trials into new treatments that are coming down the pipeline. So it's not only oral immunotherapy. There's a tablet for sublingual immunotherapy that we're actually studying right now. And there's going to be some injectable medications coming down the pipe as well. So yes, right now it's oral immunotherapy or nothing, but in...

coming years we will have some other options and there hopefully will be a nice menu of options for families to choose from. That's one area I'm really excited about and then the other area is we're really focusing a lot now on bringing some of the work that we've done in research into clinical care. So we actually have a doctor that works with us now in our allergy clinic because of all the data that we accumulated on anxiety and quality of life over the years.

We were able to advocate for funding for a clinical position in our allergy clinic for ⁓ cognitive behavioral and anxiety counseling. So we're really, really excited about that. And that's one area of research that we're continuing to expand on with anxiety and quality of life. And then finally, we're doing a lot of work in adolescents and young adults, which is an area that is really exciting and new. And nobody has touched that age group because they're still so scared of offering immunotherapy in that age group.

So we're doing it in a very safe measured way and really excited about the work that we're doing there as well.

Kristen Hovet (17:55)
So a question that we're asking all podcast guests, how does your research help children live their best lives?

Lianne Soller (18:03)
I love that question. Not only for the children, but for the parents of the whole family is affected by food allergy and immunotherapy, oral immunotherapy, or some of the other options that we're working on with research. They give the family hope and freedom to explore the world in a different way. And we've had so many families tell us that when they finish their treatment,

that just the world opened up. They can go travel in Asia now. They can feel confident with their adolescent going to university in Toronto and staying in a dorm. And so I think it's kind of an obvious answer. Doing the treatment allows you to live your best life. I mean, if it's not an option for you and that's okay, but those that want it, those that want the treatment, they've had such a positive experience that it does allow them the freedom to live that best life.