Food Oral 

Immunotherapy

The number one goal is safety; to allow you to eat or drink food without thinking about it.

People with a history of reacting to food ingestion and having positive allergy tests.  If the story is not clear cut, a food challenge may be necessary to confirm an allergy.  Peanut and tree nut OIT is being offered as young as nine months old. Egg and milk allergy can often resolve naturally by age 8, so OIT is often put off until that age for these foods.

The typical patient can finish OIT in 5-6 months.  It could take longer if we have to slow down due to food reactions, infections, or scheduling conflicts on your end.

No.

The first 6-7 doses (very dilute solution) will be given over one 4 hour day in the office.  If all doses are well tolerated, you only have 12-16 weekly/biweekly buildup doses to go.  On the other hand, if you do react to one of the Day 1 doses, you will back up one dose and then finish the remaining Day 1 doses as part of the buildup phase.  Once completed, you will be eating a full serving of the food you were previously allergic to on a daily basis.

The dose is only increased in the office.  Patients typically return every 1-2 weeks for the next updose.  There is no maximum time between visits, as long as you stay on the home dosing of food once a day.

Dosing can be any time of day, though we prefer to avoid nighttime dosing past 8 pm.  The dosing time can vary from day to day, but at least 9 hours apart. Dosing should always be with food. Children should be observed for one hour after dosing, then it is fine to fall asleep.

Do not take your home dose on office visit days.  NEVER increase the dose at home.

Treat the reaction the same way you would any food reaction: antihistamine if there is just a rash, epinephrine 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.

Do not administer the dose less than two hours before boarding and do not administer the dose while flying.  A letter for the Transportation Safety Authority explaining the procedure and need for food solutions to be carried on the plane is available upon request.

There are no preservatives in any of the solutions.  They MUST be kept cold.

Taste is personal; experiment.  Liquid doses can be mixed in your favorite beverage.  Small volumes and the capsule powder doses can 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.

If the solution sits out for more than a few hours or if it appears to have spoiled, it must be replaced.  See Q. 17 below for details on refills.

Exercise should be avoided for at least TWO hours after dosing.  Exercise following dosing increases the chance of a reaction. You should cool down for at least 15 minutes before dosing.  These rules continue to apply even when you are on maintenance.

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.

If less than 72 hours has passed since your last dose, just take the dose immediately, then resume your schedule.  If 3-5 days has passed since last dose, cut the dose in half, and then resume your schedule the next day.  If more than 5 days has passed between doses, call the office for instructions.

At most, there are 4-5 liquid doses before we go to capsules or the food itself.  If you run out of solution or it expires (solutions are stable for 3 weeks), come by the office for more or we can send the solution via FedEx.  If replacement must be made at night or on a weekend or holiday there will be a charge an additional charge.

When dosing with whole peanut you will buy your own roasted peanuts (in the shell if you’re     tree nut allergic). Peanut butter or peanut flour may be substituted (see Peanut Dosing Alternatives handout).  With egg you will buy egg white liquid at the grocery or egg white powder (Judeesglutenfree.com).  You will be asked to bring in whole milk starting on first updose visit of milk OIT.  You can use any whole milk from a local supermarket.  Wheat OIT uses Dave’s Awesome Plain Bagels. Tree nuts can be bought at a local grocery or online.

A scale is needed to make sure you’re getting the right amount of food allergen and can be purchased in our office or at amazon.com:

KEEGH High-Precision Digital Milligram Pocket Scale 50g / 0.001g Reloading, Jewelry Scale

American Weigh Scales GEMINI-20 Portable Milligram Scale

Egg white powder or liquid should be used for all buildup dosing.  When on maintenance of 2 tbsp of egg white liquid or 1 tbsp of egg white powder per day, you can substitute a whole egg when desired.

After you reach the top, or maintenance dose of food and have passed the final, high dose challenge, you can add various forms of the allergenic food to your diet.  You should still be careful not to exercise after eating large quantities of the food.

When the top dose has been reached, we would like to see you in three months, six months and then annually.  We will do blood and skin tests each year to see if you’re losing your allergy.  After a few years, some patients can cut back to dosing 2-3 days a week.  We ask that you continue to keep epinephrine on hand until your tests turn normal, if they ever do.

Milk: 60-120 ml (2-4 ounces) of milk once a day.

Egg: One tbsp. egg white liquid, one tbsp. of 1 tsp egg white powder, or ½ egg once a day.

Peanut: 3-8 peanuts once a day

Wheat: 1/3 of a bagel.

Tree nuts:  2-5 nuts a day.

You may begin a second OIT after being on a stable maintenance dose for one week.  We are combining up to 3-4 foods in one OIT course.

There is an initial equipment charge to cover liquid dilutions that is not reimbursable by your insurance.    Flour capsules are used in some protocols and will be purchased directly from a local pharmacy.  All visits will be billed to your insurance: the multiple dose initial phase is billed as desensitization over several hours, while subsequent single dose visits are billed at a significantly lower cost.  Your insurance plan may or may not cover these charges.