Allergy & Asthma Frequently Asked Questions
The cost varies depending on how many visits are required, and the length of each visit. Most commercial insurances cover the cost of the desensitization. Patients are responsible for deductibles and co-pays. Our administrative staff can provide you with the insurance codes needed for you to discuss coverage with your insurance carrier.
When one tolerates 3 peanut M&Ms (equivalent to 2 ½ peanuts).
While there are some individuals who are unable to complete the desensitization, studies report that the vast majority of individuals are successful, although there are often “bumps along the way.”
Home doses can be missed for a maximum of 3 days, without the need to contact the office on how to proceed. After missing doses for 3 days, one may need to have the next dose administered in the Allergy office.
It depends. A very minor “cold” with no fever does not interfere with routine dosing. However, if fever or gastrointestinal symptoms (nausea/vomiting/diarrhea) are present or if one feels very unwell, phone the office for advice as to whether or not a dose should be taken or skipped.
Yes, there are several precautions. Avoiding sports/exercise and hot showers just prior to and for 2 hours after each dose is important, since those activities increase the likelihood of developing an allergic reaction. If the dose is given in the evening, one should be awake for at least one hour prior to bedtime. For school age children, a good time to consume the daily peanut dose is once home from school, after eating a carbohydrate snack.
The specific time is not important, but doses should be given approximately at the same time each day.
It is important to consume a large carbohydrate meal or snack before doses are given. Appropriate foods include bagels, sandwiches, pancakes, waffles etc. Daily administration of a probiotic such as culturelle may prove to be beneficial and is advised.
In someone who has asthma, can a peanut allergic reaction manifest as an exacerbation of asthma, without any other symptoms, i.e., no rash/hives or stomach discomfort?
If asthma symptoms (cough/wheeze/chest tightness/shortness of breath) begin shortly after consuming the prescribed dose of peanut, this could be the manifestation of an allergic reaction to the peanut dose recently consumed. If the asthma symptoms are very minor, administration of the rescue asthma inhaler (albuterol/Xopenex) and a quick onset antihistamine such as Zyrtec or Benadryl may suffice. However, if symptoms are more than very minor, the epinephrine auto injector should be administered, in addition to administering the rescue inhaler.
The second visit occurs on the day after the initial visit. During this visit, the highest dose of peanut administered on Day #1 is repeated under medical supervision. The second visit usually lasts 1 ½ to 2 hours. During the next two weeks, the same dose of peanut administered in the office on Day #2 is self-administered at home under very specific instructions. An epinephrine auto-injector and quick onset oral antihistamine must be available at all times.
Routine medication should be continued. However, if one has asthma or other allergies, they should be well controlled during the initial visit and step-up dose visits.
Treat the reaction the same way that you would treat any food allergic reaction. If symptoms are mild, such a mild rash/hives, itchy mouth/throat or mild stomach ache, administer a quick onset antihistamine by mouth (cetirizine/Zyrtec or diphenhydramine/Benadryl). If mild symptoms are progressing, include difficulty breathing or anaphylaxis, administer the epinephrine auto-injector (such as EpiPen or Auvi-Q) and contact the rescue squad for transport to the emergency room. Please notify our office, since the peanut dose may need to be adjusted.
The most common symptoms are an upset stomach, nausea, and less frequently, vomiting. Itching of the mouth/throat may occur. Rarely anaphylaxis may occur. Some patients are found to have an increased number of cells known as eosinophils in their esophagus (Eosinophilic Esophagitis). It is unknown whether this is an incidental finding or caused by the peanut desensitization.
Initially the goal is for individuals to tolerate 2 ½ peanuts daily, which is equivalent to approximately 3 peanut M&M’s. Once this goal has been achieved and tolerated for a period of time, consideration will be given to raising the daily dose of peanut consumed. These decisions are individualized. The program requires approximately 16 oral immunotherapy/desensitization visits in the office, and takes 7-8 months to accomplish. In order to maintain the increased oral tolerance of peanut accomplished by Oral Immunotherapy, one must continue to consume one’s specified dose of peanut on a daily basis.
Every two weeks, a step-up dose is administered in the office under medical supervision. The individual is monitored for 1½ to 2 hours in the office after each step up dose. The dose of peanut is never increased at home. If someone is experiencing any peanut allergy symptoms, the peanut dose may not be increased, or may even be decreased.
The initial Oral Immunotherapy office visit lasts approximately 4-5 hours. At 20-30 minute intervals, increasing doses of peanut flour (mixed in either juice, pudding, yogurt etc.) are administered by mouth.
To participate in the peanut desensitization program, a child must be at least four years old and mature enough to notify the parent/physician of the onset of symptoms suggestive of an allergic reaction, during the desensitization process.
Allergy & Asthma services are available at our Danbury, New Milford, Norwalk and Ridgefield offices.