Another exciting talk at the Global Food Allergy Prevention Summit 2023 was Sayantani (Tina) Sindher’s discussion on early oral immunotherapy (OIT). OIT has proven to be safe and effective for the treatment of food allergy, however when should treatment be initiated? The PALISADE clinical was one of the first clinical trials to demonstrate that OIT is more effective in younger participants 4-17 years old than in older 18-55 year old participants. This opened up the question of how early OIT could be safely intiated. The POSEIDON and IMPACT trials demonstrate that OIT was safe and effective for children 1-4 and 1-3 years of age with higher success rates in younger children.

The DEVIL trial took this one step further, showing that OIT could be performed safely and effectively in children 9-36 months of age making it the first clinical trial to look at OIT in children less than 1 year old. Importantly although there were no differences in the rate of anaphylaxis between children less than or older than 1 year old, the severity of reactions in less than 1 year olds was significantly lower suggesting that OIT is even safer in younger participants. Ongoing studies are continuing to assess open questions of performing OIT in younger participants including how early treatment should be started and whether there should be differences in OIT protocols for children versus adults.