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Comment by joshmarinacci | Hacker News Reader

There’s something I don’t understand. I took allergy shots to treat my sinus allergies to grass pollen, pet dander, and rag weed. It’s not perfect but it built up my tolerance to these so that I can have cats and survive grass season. Why can’t a similar treatment work for food allergies.

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Oral immunotherapy is currently the baseline treatment for things like peanut allergies, and it works, but it requires daily dosing. Also, for adults that start doing it, it often leads to feeling like you have perpetual digestive discomfort. Many people decide the discomfort isn’t worth it and stick with avoidance, especially for things like nut allergies where avoidance is quite doable in the US.

The good news is that if you diagnose food allergies early and start someone on oral immunotherapy when they’re extremely young (<2 years old), the early evidence is that you can build up significant tolerance with basically no side effects. That’s the boat my child is in - we started them on peanut OIT at just over 1 year old, and the worst symptoms were a skin breakout or two, and today they’d probably be able to eat a couple peanuts with no reaction.

The downside is they have to continue their daily dose forever. There are some interesting alternatives coming into the market though.

Edit: they will still need to always keep epipens nearby, but at least now there’s no fear of anaphylaxis when someone nearby on the plane eats a bag of peanuts.

There is a treatment called Palforzia for peanut allergy that works similarly.

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