The most relevant treatment of food allergy is elimination of the offended food. In some cases, such as in cow’s milk allergy in children, a suitable substitution - e.g. an extensively hydrolyzed cow’s milk formula (eHF) or an amino acid formula (AAF) - has to be introduced.
Other therapeutic options of food allergy include Specific Oral Tolerance Induction (SOTI). Increasing doses of the offending food are administered to the patient, aiming to reach clinical tolerance. Various procedures concerning up dosing, maintenance dose and in- or outpatient protocols have been proposed.
Advantages of SOTI are the increased threshold dose for allergic reactions and the substantially reduced risk of severe allergic reactions after inadvertent ingestion. Disadvantages are the permanent state near the threshold dose and the impending influence by augmentation factors.
Several clinical studies have shown efficacy for this kind of treatment for cow’s milk and hen’s egg allergy. However, the natural course of the disease is not influenced and side effects are common. So far, SOTI is an interesting new therapeutic option, but not always ready for daily practice. It should only be used within controlled clinical trials, or in very experienced Allergy Units.