Box 4: Recommendations on who could benefit from OIT (indications)	Ethical imperative, data or other considerations in support of the recommendation Level of evidence (applicable when recommendations are based on outcome data from clinical studies)
An accurate diagnosis of IgE-mediated food allergy is essential before proceeding with OIT	Regardless of therapeutic option considered, accurate diagnosis of food allergy is the basis for proper care to avoid futile treatment, including unnecessary avoidance. This recommendation is thus based on the principles of nonmaleficence and sustainability
OIT is indicated for toddlers and preschoolers Important consideration While the likelihood of spontaneously outgrowing milk or egg allergy may be greater than for other foods, their impact on patients and families, if not outgrown, is high. Caregivers should be included in shared decision-making about, whether to initiate OIT early for these foods and based on individual prognosis, considering that OIT is well tolerated and has high efficacy in this age group	This recommendation is based on the principle of equity in eligibility as well as proportionality between risks and benefits, considering patient’s goals and perspectives For desensitization, it is supported by a large amount of consistent clinical evidence. Many OIT studies (RCTs [34, 41, 43, 47, 49, 59, 60] as well as large clinical practice case series [32, 33, 40, 54]) enrolled children starting from the age of 4 or 5 years; some have started enrolment from age three [29, 61] or one [46, 62]. In addition, there is a moderate amount of consistent evidence specifically for this age group from one RCT of milk OIT (unclear risk of bias—Cochrane) [63], one large (N = 270) prospective, multi-center case series in clinical practice of peanut OIT (low risk of bias—IHE tool) [30] and one small (N = 37) prospective, uncontrolled clinical trial of peanut OIT [58]. This is coherent with data from consultations. Level of evidence: HIGH For sustained unresponsiveness, it is supported by a small amount of clinical evidence (1 prospective clinical trial of peanut OIT with retrospectively matched controls observing a large effect size [58]) and is overall coherent with data from consultations. Level of evidence: LOW
OIT is indicated for school-age children and adolescents	This recommendation is based on the principle of equity in eligibility as well as proportionality between risks and benefits, considering patient’s goals and perspectives. For desensitization, it is supported by a large amount of consistent clinical evidence. Most of the evidence for desensitization stems from studies that enrolled children and adolescents with median/mean ages in the range of 6 to 12 years (RCTs [31, 34, 39, 41, 43, 46, 49, 59–61, 64, 65] and large clinical practice case series [32, 33, 40, 54]) In nine RCTs [34, 39, 41, 43, 44, 47, 59, 61, 64] and five large clinical practice case series [29, 32, 33, 40, 54], the upper age limit for enrolment was 16 years or older (up to 27 years [32]). This is coherent with data from consultations. Level of evidence: HIGH For sustained unresponsiveness, it is supported by a small amount of consistent clinical evidence. Most of the limited evidence that is available for sustained unresponsiveness stems from studies that enrolled children with median/mean ages in the range of 6 to 9 years (RCTs [34, 46, 49, 56, 59, 66], CCT [57] and clinical practice case series [40]). Level of evidence: LOW
OIT may be indicated for adults	This recommendation is based on the principle of equity in eligibility as well as proportionality between risks and benefits, considering patient’s goals and perspectives. For desensitization, it is supported by only a small amount of consistent clinical evidence. The limited data available for patients 18 years of age and older, from one double-blind RCT that included a small number of adults [47, 67] and one small case series [44] suggest that desensitization is possible in this age group. Level of evidence: LOW