# Improving Safety in Food Allergen-Specific Oral Immunotherapy
## 4 Discussion  
The reviewed studies show marked variability in OIT protocols for milk, egg, and peanut allergies, reflecting differences in clinical goals, patient characteristics, and safety considerations. This section critically evaluates these variations, their rationale, and clinical implications. Food allergies have been characterized by an increasing prevalence over the past few decades, particularly within the pediatric population. This condition significantly impacts quality of life and may lead to nutritional deficits and growth impairments [8]. The most common food allergens in early childhood--milk and eggs--are staple foods that substantially contribute to the daily intake of energy, protein, calcium, vitamin A, vitamin D, and various B vitamins [8]. Conversely, peanuts rank among the leading causes of food-induced anaphylaxis resulting from unintentional ingestion [92]. Consequently, there is a growing emphasis on preventive strategies and proactive measures in the research surrounding food allergies. The management of food allergies is complex and encompasses allergen avoidance, individualized dietary guidance, and a comprehensive treatment plan that includes emergency medications such as oral antihistamines, adrenaline auto-injectors, and inhaled salbutamol. It is essential for patients to possess a written treatment plan containing emergency contacts and to receive training on the correct use of adrenaline auto-injectors. While the avoidance of food allergens and the management of clinical symptoms remain the primary approaches in food allergy treatment, oral immunotherapy (OIT) has emerged as an alternative strategy that aims to address the underlying pathophysiology of the condition. Numerous studies have been published on OIT, exhibiting significant variability in study protocols--including differences in administration regimens such as the initial dosing, dose increments, timing between doses, and target maintenance doses. Furthermore, these studies present varying outcomes concerning efficacy, safety profiles, and quality of life assessments among treated individuals. In this review, we concentrated on safety considerations and potential modifications to existing protocols to enhance safety during OIT. Regardless of the chosen protocol, specific preconditions must be met to maximize safety. Initiation of the OIT protocol should involve a shared decision-making process between healthcare providers and caregivers. Patients and caregivers must be informed of OIT-related goals, risks, and benefits, as adherence to the treatment plan is crucial [2]. It is advisable for OIT to be conducted under the supervision of a clinical team that is experienced in food immunotherapy and adept at managing allergic reactions of varying severities, including anaphylaxis [2]. The dose increases during the build-up phase, when patients are most vulnerable to adverse reactions, should be conducted in a hospital or day treatment center equipped with appropriate resources and personnel to address any type of allergic reaction [2]. Before commencing OIT, it is critical to determine the suitability of the patient. Although milk and eggs are prevalent allergens in children, these allergies are often outgrown early in life, and it may be prudent to await the natural development of tolerance. Thus, the European Academy of Allergy and Clinical Immunology (EAACI) guidelines recommend postponing OIT for milk and egg allergies until the child reaches four years of age. Nonetheless, these guidelines also advocate for the careful consumption of various forms of allergens that children can tolerate (e.g., baked milk or egg) [2]. In contrast, peanut allergies are more likely to persist into adulthood. Interestingly, OIT demonstrates high efficacy and safety in young children, likely attributable to the adaptive plasticity of the immune system [37; 38].