Available online 23 March 2023

Food allergy remains a common problem and a lifelong condition for many children. In recent years food allergy management has increasingly involved conversations about food oral immunotherapy. While ethical considerations of autonomy, beneficence, non-maleficence, and justice implicitly inform these conversations, applying these principles can be complex, particularly in young children. Families of young children assume a role of surrogate decision maker and must balance immediate risks with the hope of longer-term benefits.

To explore implementation of oral immunotherapy in children through an ethical lens.

To evaluate OIT through an ethical lens, a literature search was conducted to explore currently published frameworks in this arena.

Evaluation of the harm principle, the basic interest principle, and the best interest principle of parental decision making can be informative. Shared decision making continues to be central to the process of engaging with patient-family units to individualize the best care, at the right time, and minimize decisional discord. While OIT is well positioned to promote health and well-being, challenges to equity, sustainability, and organizational support must be considered to improve access for appropriate patients.

While approaches to food OIT may be tailored to the individual context of each patient-family unit, ethical principles must guide decisions to initiate and continue therapy. Traditional ethical principles of autonomy, beneficence, non-maleficence, and justice remain cornerstones when considering the ethical context of OIT.

© 2023 Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology