1. What is the goal of Food Allergy treatment?
The number one goal is safety; to allow you to eat or drink food without thinking about it.
2. Who is a candidate for Food Allergy treatment also known as oral immunotherapy (OIT)?
People over eight years old with persistent egg or milk allergy. Peanut OIT is being offered at an even younger age (five), since they don’t tend to naturally outgrow the allergy and the potential for a severe reaction to inadvertent peanut consumption is high. Please refer to the Facebook group, Private Practice OIT, to see how the process has worked for others.
3. How long will the entire Food Allergy process take?
The first day procedure will last ~4 hours. If there are no reactions to that day, you/your child can finish the OIT in 5-6 months.
4. Should routine allergy medications be stopped before the first day procedure?
5. What is the timeline for the OIT protocol?
The first 7-8 doses (very dilute solution) will be given over one 4 hour day in the office. If you make it through all these doses without symptoms, you only have 13-16 buildup doses to go (1-2 weeks apart). On the other hand, if you do react to one of the Day 1 doses, you will back up one dose and then have the rest of Day 1 doses advanced weekly, before reaching the buildup phase. Once completed, you will be eating a full serving of the food you were previously allergic to once a day.
6. How often can the dose be increased?
During the buildup phase one hour office visits for a single increased dose should be a week apart. There is no maximum time between visits, as long as you stay on the 1-2 times a day home dose of food.
7. What time of day should home doses be given?
Once daily doses can be given any time of day, preferably with food. Twice daily doses should be 12 hours apart, +/- 3 hours. Children should be observed for one hour after dosing and should not be allowed to sleep during that time.
8. What about home dosing on the day of the office visit?
Do not take your home dose of office visit days. NEVER increase the dose at home.
9. 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 a rash, Epi-Pen if there are other symptoms of anaphylaxis. If there is just one hive or a few, DO NOT give an antihistamine for the first hour so we can see if the reaction progresses. If there are more hives, definitely give the antihistamine. Call us after the appropriate immediate intervention. We will give instructions on further dosing.
10. What if we are flying when the dose is due?
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 on request.
11. Does the food solution need refrigeration?
There are no preservatives in any of the solutions. They MUST be kept cold.
12. What about masking the taste of the food solution?
Taste is personal; experiment. Try a drink powder (Kool-Aid, Crystal Light), chocolate, or another beverage. Small volumes could be mixed with a semi-solid food such as apple sauce or mashed potato, but not in too much, because you have to consume the entire amount.
13. What do I do if refrigeration is not maintained or if it smells or tastes different?
If the solution sits out for more than 30 minutes or if it appears to have spoiled, it 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.
14. Do I need to avoid exercise during the OIT process?
Exercise should be avoided for at least TWO hours after dosing. Exercise following dosing increases the chance of a reaction.
15. What if I am sick or my asthma is flaring and I can’t take the doses on schedule?
You’re right, you need to be VERY careful when you are sick as you may be more susceptible to reacting to the food. If you are having vomiting, ‘cold’ symptoms, worsening nasal allergies, or an asthma flare requiring your rescue inhaler more than once a day, call the office for dosing directions.
16. What if I forget a dose at home?
If you miss a dose by less than 24 hours, just take the dose immediately, then resume your schedule, spacing the next dose at least nine hours later. If you miss from 24-72 hours, cut the dose in half, and then resume your schedule with the next dose no sooner than six hours later. If more than 72 hours pass between doses, call the office for instructions.
17. What if I can’t return in one week and need more doses?
If you run out of solution, come by the office for more at no charge. With peanut and egg there will buildup to powdered food in capsule form. You will buy these from a local pharmacy and you’ll have to contact them to buy more. If you are out of town we can ship the solution on ice via FedEx at a charge of $25 plus shipping. Capsules can be mailed from the pharmacy.
18. At what point can we buy our own food?
When dosing with 1 whole peanut you will buy your own roasted, shelled peanuts. A scale is needed to make sure you’re getting the right amount of peanut (American Weigh Scales GEMINI-20 Portable MilliGram Scale, <$25 Amazon). Peanut butter or peanut flour may be substituted (see Peanut Dosing Alternatives handout). With egg you will buy egg white powder for the last five doses of buildup and all maintenance dosing. It can be obtained from Barry Farm, 20086 Mudsock Rd, Wapakoneta, OH 45895, www.barryfarm.com. You will be asked to bring in whole milk starting on Day One of milk OIT. You can be purchase Horizon Organic Whole Milk at local supermarkets. Nature’s Own 100% Whole Wheat bread from your local grocery is used midway through wheat OIT buildup.
19. Can whole eggs be substituted for egg white powder?
Egg white powder should be used for all dose increases and maintenance dosing (no Egg Beaters). When on maintenance of 1 tbsp of egg white powder per day, then other forms of egg may be added to the diet. Whole egg should never be used in place of egg white powder for the daily egg dose.
20. At what point can the milk product by varied?
When the OIT is complete, if everything goes well, you can use any brand of 2% or whole milk.
21. When can foods containing the allergenic food be introduced into the regular diet?
After you reach the top, or maintenance, dose of food and have passed the final challenge dose, you can add various forms of the allergenic food to your diet.
22. What is the follow up schedule after the OIT is complete?
When the full dose has been reached, there should be a follow up in three months and then six months later.
23. How much of the allergenic food must my child eat after the OIT is complete?
240 ml (8 ounces) of milk once daily for 2 weeks, then return for a 16 oz. challenge. If they do well, they will drink 8 oz. of milk a day.
One tablespoon of egg white powder must be eaten once daily for 2 weeks, then return for a scrambled egg challenge, and then 2 weeks later a challenge to 2 eggs. If they do well, they eat 1 egg equivalent daily.
Your child must ingest the equivalent of 10 peanuts once daily for three months, then return for a 20 peanut challenge. If they do well, they will eat 8 peanuts once daily.
24. How soon after completion of the OIT process may a second food OIT be performed?
You may begin a second OIT after being on a stable maintenance dose for one month.