OIT Glossary: What Does That Mean?
Oral immunotherapy comes with its own vocabulary. Here are the terms you'll encounter, what they mean precisely, and what they mean for your child's treatment.
Oral immunotherapy
OIT
DEFINITION (ASCIA)
A potential treatment for food allergy that involves gradually increasing amounts of food allergen given under medical supervision. Following this, the food needs to be consumed each day, by eating or drinking the food allergen.
In practice: your child eats a precise daily dose of their allergen, often as a powder mixed into food, starting at a tiny amount and increasing over months toward a target maintenance dose.
The aim is not to cure the allergy, but to raise the threshold at which a serious reaction occurs. Most families doing OIT find that after successful desensitisation, accidental trace exposures that would previously have triggered anaphylaxis no longer do so.
Important: OIT is not a cure. Desensitisation requires continuing the daily dose to maintain protection. Stopping OIT can lead to loss of that tolerance over time.
RELATED TERMS
Build-up phase, Maintenance dose, OFC, ASCIA
Build-up phase
ESCALATION
DEFINITION
The period of graduated dose increases toward the maintenance dose. Each new dose level is introduced under medical supervision before being continued at home.
This is typically the longest and most demanding part of OIT, for peanut allergy, build-up often spans six to twelve months. Updoses happen in clinic, where the child takes the higher dose under observation before going home to continue at that level daily. The build-up phase carries the highest rate of dose reactions, which is why cofactor management (avoiding exercise, illness, sleep deprivation around dosing) is most critical at this stage.
Heads up: Reaction rates are typically higher during build-up than during maintenance. This is normal and expected, not a sign the treatment is failing.
RELATED TERMS
Updose, Maintenance dose, Dose reaction, Cofactor
Maintenance dose
DEFINITION
The target daily dose taken once build-up is complete. It is sustained indefinitely or until a supervised assessment determines the allergy has reached sustained unresponsiveness or remission.
For peanut OIT, maintenance doses in Australian protocols typically range from 300 mg to 1,000 mg of peanut protein. This is roughly equivalent to one to four peanut kernels.
At this stage, daily dosing becomes routine: one dose per day, at the same time, at home. Most families anchor it to a consistent quiet time: after school, after dinner, to ensure rest and observation can follow without disruption to the day.
Why consistency matters: Irregular or skipped dosing can affect your child's reaction threshold at the next dose. If dosing has been interrupted for more than a day or two, contact your allergist before resuming — a temporary dose reduction may be recommended.
RELATED TERMS
Build up phase, Dose adherence, OFC
Updose
DEFINITION
A scheduled increase in the prescribed dose amount, decided by the supervising allergist. Each updose takes the child to the next level on the protocol's dose ladder.
Updosing always happens in clinic, never at home. Your child takes the new, higher dose in the allergy clinic and is monitored for a period (commonly 30–60 minutes) before being cleared to go home. If the clinic dose is tolerated, that becomes the new daily home dose until the next updose appointment. If a reaction occurs at the updose, the allergist will decide whether to hold at the current level or adjust the protocol.
What to bring to an updose visit: Your child should have eaten a light snack beforehand (not on an empty stomach), be well (no illness, no recent fever), and be ready to rest quietly after the dose. Clear your afternoon AND plan for no vigorous activity for at least two hours.
RELATED TERMS
Build-up phase, Cofactor, Observation window
Dose adherence
DEFINITION
The proportion of prescribed doses taken as directed and on schedule. In OIT protocols, adherence is typically expressed as a percentage of total prescribed doses over a defined period, for example, 91% over six months.
Adherence is one of the most important predictors of OIT outcomes. Unlike most medications where a missed dose simply means a missed benefit, missed doses in OIT can reduce tolerance, meaning the next dose may be more likely to trigger a reaction.
Your allergist will generally have a policy around dose holds: during confirmed illness, for example, you may be advised to skip a dose (a planned hold) rather than push through.
Common reasons for missed doses: Travel and routine disruption, illness holds, and simply forgetting. Anchoring your child's dose to a fixed daily routine (the same time, the same environment) is the single most effective way to maintain high adherence over months and years.
RELATED TERMS
Maintenance dose, Co-factor
Co-factor
DEFINITION
A condition present at the time of dosing that lowers the reaction threshold, making an allergic response more likely or more severe than it would otherwise be at that same dose level.
Cofactors are one of the most important concepts in OIT safety. The same dose that your child tolerates easily on a regular Tuesday can provoke a reaction on a day when a cofactor is present. Recognised cofactors in OIT include:
Exercise vigorous physical activity within ~2 hours before or after dosing significantly increases reaction risk. Exercise-induced cofactor reactions are the most commonly reported in OIT families.
Viral illness a cold, fever, or recent infection lowers the threshold. Most protocols advise holding or reducing the dose during illness.
Sleep deprivation a poorly rested child is more reactive. This includes disrupted nights, not just total sleep loss.
Dosing on an empty stomach taking a dose without any food beforehand can increase absorption rate and reaction risk.
Menstruation in older adolescents, hormonal changes around the menstrual cycle have been associated with increased reactivity.
Important: If multiple cofactors are present at once, for example, your child is tired AND just came off the sports field, the combined effect is greater than either alone. Many families choose to hold the dose rather than risk a compounded reaction.
RELATED TERMS
Dose reaction, Dose adherence, Observation window
Dose reaction
GRADE 1–4
DEFINITION
An adverse response occurring following an OIT dose, classified on a standardised scale of grade 1 (mild) through grade 4 (severe/life-threatening). Grading follows international consensus criteria used by allergists and researchers.
Dose reactions are common in OIT, particularly during the build-up phase, and experiencing one does not automatically mean the protocol needs to change. Most are grade 1 and resolve without medication. Your protocol will specify how to respond to each grade, and when to use your adrenaline autoinjector.
GRADE | SEVERITY | TYPICAL SIGNS
G1 Mild
Oral itch, mild hives, mild abdominal discomfort. Usually resolves without medication within 20–30 minutes.
G2 Moderate
Urticaria, vomiting, mild respiratory symptoms (wheeze, cough). Antihistamine or salbutamol may be used. Epinephrine generally not required.
G3 Severe
Severe respiratory compromise, significant bronchospasm, or multi-system involvement. Epinephrine indicated. Call 000.
G4 Life-threatening
Cardiovascular collapse, hypotension, loss of consciousness. Epinephrine immediately. Call 000. This is anaphylaxis.
Always follow your ASCIA Action Plan. If you are unsure whether a reaction warrants epinephrine, use it. Epi first, epi fast. The risk of giving it unnecessarily is far lower than the risk of delaying it in true anaphylaxis. Your allergist will review any reaction with you and adjust the protocol if needed.
RELATED TERMS
Co-factor, Observation window, ASCIA
Observation window
DEFINITION
The post-dose period during which the family remains alert and monitors the child for signs of a reaction. Most OIT protocols specify a minimum observation window of 30–60 minutes following each home dose.
The observation window is not passive. It means your child is nearby, calm, and not exercising, and a parent or carer is watching for early signs of a reaction (oral itch, skin changes, behaviour changes in young children).
Most dose reactions, if they occur, begin within the first 30 minutes of dosing. The observation window also means keeping the EpiPen accessible, not in a bag in the car, but within arm's reach.
Timing tip: Many families dose at the same time each day specifically to make the observation window predictable. For example, just after school and before dinner, when a parent is home and the child can sit and watch something quietly. This naturally structures the rest window without requiring extra effort.
RELATED TERMS
Dose reaction, Co-factor, Dose adherence
Oral food challenge
OFC
DEFINITION (ASCIA)
A supervised test dose performed under medical supervision by a clinical immunology/allergy specialist. Increasing amounts of the allergen are given at set intervals in a clinical setting with immediate access to emergency treatment.
OFCs are used to confirm allergy, assess tolerance thresholds, and in OIT to evaluate the outcome of treatment at key milestones.
In the context of OIT, a food challenge typically appears at two key moments: before treatment begins. This confirms the allergy and establish a baseline threshold. OFC occurs at the end of treatment to assess whether desensitisation or sustained unresponsiveness has been achieved.
The end-of-treatment OFC is the formal measure of whether OIT has worked. It involves giving increasingly large amounts of the allergen under clinic conditions to determine what the child can now tolerate.
An OFC is not the same as the home doses your child takes daily. It is done in a clinic specifically equipped to treat anaphylaxis, with medical staff present throughout.
After a successful end-of-treatment OFC: A positive result, meaning the child tolerated the challenge dose, is the most significant milestone in OIT. It confirms that treatment has achieved its target. Your allergist will discuss what this means for ongoing dosing and daily life.
RELATED TERMS
Oral immunotherapy, Maintenance dose, ASCIA
ASCIA
PEAK BODY
DEFINITION
The Australasian Society of Clinical Immunology and Allergy is the peak professional body for clinical immunology and allergy specialists in Australia and New Zealand. ASCIA sets the evidence-based guidelines and protocols that govern how OIT is practised in Australian clinics.
When your allergist refers to a "protocol," they almost certainly mean an approach aligned with ASCIA's position papers and guidelines.
ASCIA's OIT position paper, most recently updated in July 2024, defines the current evidence base, recommended outcomes to target, safety requirements, and the conditions under which OIT should be offered. ASCIA is also the body behind the ASCIA Action Plan for Anaphylaxis, which every OIT family carries.
Raffy is built around ASCIA's graduated exposure framework. The phases, outcomes, and clinical terminology used in your Raffy reports map directly to ASCIA's definitions so that what you track at home is the same language your allergist uses in clinic.
Useful ASCIA resources for families:
allergy.org.au — OIT for families · Find a specialist · ASCIA Action Plan
RELATED TERMS
Oral immunotherapy, OFC, Dose reaction
Definitions aligned with ASCIA Position Paper: Oral Immunotherapy for Food Allergy (updated July 2024) · ASCIA Position Paper: Oral Food Allergen Challenges · WAO Grading System for Systemic Allergic Reactions (2024)
Raffy · OIT Companion App · raffyallergy.com
Clinical education resource only: not a substitute for medical advice from your allergist.