GENERAL:
What is the goal of this process?
The number one goal is safety; to allow the patient to ingest the allergenic food and foods that contain the allergenic food without worrying about it.
How long before I can eat a full serving of the allergenic food.
Every patient advances at a different rate, however if there are no problems during the escalation phase, the patient should be able to eat a full serving of the allergenic food in 4-8 months.
How often can the dose be increased?
There must be a minimum of 7 days between dose increases (7 doses given), but patients may decide to go longer between dose increases if they choose.
FIRST DAY:
How long does the First Day Procedure last?
The First Day Procedure will typically last up to 5 hours.
Should routine allergy or asthma medications be stopped before the First Day Procedure?
No. Patients should take all routine medications as they normally would.
HOME ADMINISTRATION:
What time of day should home doses be given?
Doses should be given approximately 24 hours apart. The patient should be observed for at least 2 hours after each dose.
How long should my child stay awake after the dose is given?
Patients should be observed for at least two hours after each dose is given. They should not be allowed to sleep during that time.
If there is a reaction at home, what should I do?
Treat the reaction the same way you would any food reaction; antihistamine if there is just rash/hives, Epi-pen or Auvi-Q if there are other symptoms of anaphylaxis. If there are only mild hives or oral itch, DO NOT give antihistamine for the first hour to see if the reaction progresses. If the hives/oral itch are increasing, give antihistamine. Call us after the appropriate immediate intervention. We will give instructions on future dosing.
What if we are flying when the dose is due?
We prefer you take your dose at least 2 hours before arriving at the airport. Do not administer the dose less than one hour before boarding and do not administer the dose while flying. A letter explaining the procedure and need for food solutions for the Transportation Safety Authority is available upon request.
Does the food solution need refrigeration?
There are no preservatives in the food solution. It MUST be kept cold.
What do I do if refrigeration is not maintained or if it smells or tastes different?
If the sample sits out for more than 30 minutes or if it appears to have spoiled, the solution must be replaced. Please call the office. If replacement is made during regular office hours, there is no charge. If replacement must be made at night or on a weekend or holiday there will be a charge of $50. This fee cannot be charged to your insurance.
What if I need additional doses and I am out of town?
Call as soon as you know you will need more. You must be able to tell us the concentration and amount of the current dose. If a staff member needs to come in at night, on a weekend or holiday, there will be an additional charge of $50. This fee cannot be charged to your insurance. If we need to ship doses to you, there will be a further shipping & handling charge.
What if my child is sick and can’t take the doses on schedule?
Do not take the dose if you are sick. We will typically reduce or hold the dose until there has been at least 2 full days where there is no illness.
What if I miss a dose?
If there is a gap of more than 48 hours between doses but less than a week, decrease the dose by 50%. If the gap is longer than 7 days, please call our office.
Can I mask the taste of the food solution?
Yes. Taste is personal; experiment. Try drink powder (Kool-Aide, Crystal Light), chocolate or another beverage. The food powder or small solution volumes can be mixed with a small amount of a semi-solid food such as apple sauce or mashed potato. Try to give the dose in one bite to ensure that the entire dose of oral immunotherapy mixture is taken. If the total amount gets too large, it will be hard to get it all down.
With once daily dosing, is the time of day that the dose is given important?
Time of day is not important but the amount of time between doses is important. We have achieved a delicate balance that depends on a certain amount of the allergenic protein being in their system at all times. You should try to give the once a day dose at the same time every day (21-27 hours between doses).
Does my child need to avoid exercise during the oral immunotherapy process?
Exercise should be avoided for at least two hours after dosing and doses should not be given immediately following exercise. Exercise around the time of dosing increases the chance of a reaction. Exercise restriction applies to both escalation and maintenance dosing. If exercise cannot be avoided during this time, then your child is not a candidate for oral immunotherapy (OIT).
IN-OFFICE DOSE INCREASE / ESCALATION PHASE:
Can I increase my food dose at home?
No. Dose increases need to be performed under close medical observation.
How long does the Escalation Day Procedure last?
The Escalation Day Procedure will typically last 1½ -2 hours.
Do I take my home dosing on the day of the office visit for dose increase?
No. There should be at 21 hours and no more than 27 hours between doses. NEVER increase the dose at home. If the up-dose office visit is scheduled more than 27 hours since the last dose, give one additional dose about 12 hours before the scheduled up-dose visit.
MAINTENANCE PHASE:
What is the follow up schedule when maintenance dosing is reached?
When the full dose has been reached, there is a follow-up at 1 month (with lab) and then every 6 months. Food specific IgE levels will likely be drawn yearly on maintenance dosing.
How long do I have to take a daily maintenance dose of the allergenic food?
It is unclear at this time, however some patients are able to successfully stop daily OIT after 3-5 years.
How much of the allergenic food must my child eat during the maintenance phase of the oral immunotherapy process?
- Cashew, Hazelnut, Almond, Pistachio, Macadamia, and Peanut: 8 nuts
- Walnut and Brazil nut: 3 1⁄2 nuts
- Pecan: 7 pecans
- Egg: 2 tsp egg white powder or 2 T of liquid egg white
- Milk: 240ml (8 oz) whole or 2% milk
- Wheat: 75 Wheat Chex (3/4 cups) or 1 slice of whole wheat bread
- Chickpea: 16 chickpeas
- Soy: 240ml (8 oz) soy milk
- Sesame: 5.6 grams of sesame seeds
- Sunflower seed: 8 grams of sunflower seeds or 7 grams of Sunbutter
In most cases the food may be freely added to the diet after reaching the maintenance phase of Food OIT treatment.
If the time comes when the frequency of the maintenance dose changes, we will let you know. Until then, the patient should continue the daily maintenance dose as directed.
When can foods containing the allergenic food be introduced into the regular diet?
Foods containing the allergenic food may be introduced into the diet at the end of the entire oral immunotherapy escalation process after approved by our office.
MULTIPLE FOOD ALLERGIES:
If my child is allergic to multiple foods will completing OIT for one food help treat other food allergies?
Each Food OIT Program is food specific. Completing one program does not treat other food allergies.
Can two oral immunotherapy foods, one on maintenance dose and one on increasing dose be given at the same time?
Yes.
How soon after completion of the oral immunotherapy process can a second oral immunotherapy program be performed for another food?
Your child may begin a second oral immunotherapy program after he/she has been stable on a maintenance dose for one month.
OTHER:
At what point can we buy our own food?
Every allergenic food is different. Our staff can provide further details.
- Peanut, Tree Nuts, Chickpea, Sunflower, Sesame: When dosing with whole food, patients will be required to buy their own food. Nut butters and flours may be substituted for the peanut or tree nut during escalation dosing.
- Egg: Patients should purchase liquid egg white or egg white powder for home dosing after dosing with provided solutions is complete.
- Milk: Patients should purchase whole milk for home dosing after dosing with provided dilutions is complete.
- Soy: Patients should purchase soy milk for home dosing after dosing with provided dilutions is complete.
- Wheat: When dosing with Wheat Chex cereal, patients will be required to buy their own Wheat Chex cereal and bring to each dosing appointment. Wheat bread may also be used
Can whole eggs be substituted for liquid egg white?
Liquid egg white should be used for all escalation doses. Patients may dose with either egg white powder or liquid egg white during the maintenance phase, and egg may then be freely added to the diet. Whole egg should never be used in place of liquid egg white or egg white powder for the daily egg dose.
At what point can the milk product be varied?
When the escalation is complete, if everything goes well, maintenance doses may be given with either 2% or whole milk and any brand of cow’s milk may be used.
May Egg BeatersTM be used for dosing in egg OIT?
Egg Beaters are not permitted because they are not complete eggs.
How is the oral immunotherapy program billed and what does it cost?
The Day #1 procedure is billed as a Rapid Desensitization Visit. Subsequent dosing office visits are billed as an office visit. The actual reimbursement varies by insurance plan. We strongly advise you to wait to schedule the Day #1 office visit until after our office provides you with an estimate of insurance coverage.