Food Oral Immunotherapy: FAQ
- Q. How old must one be to participate?
A. To participate in the treatment program, a child must be mature enough to notify the parent/physician of the onset of symptoms suggestive of an allergic reaction during the desensitization process, which usually corresponds to about age 4 years.
- Q. How long does the initial office visit last?
A. The initial Oral Immunotherapy office visit lasts approximately 4-5 hours. At 20-30 minute intervals, increasing doses of the treatment food (mixed in juice, pudding, yogurt etc.) are administered by mouth. The purpose of the multiple doses administered at the initial visit is to assess one’s sensitivity to the food allergen and establish the dose to be administered at the second visit.
- Q. What happens at the second visit?
A. The second visit occurs on the day after the initial visit. During this visit, the starting dose established at the previous visit is administered under medical supervision. The second visit usually lasts 2 hours. During the next two weeks, the same amount of treatment food administered in the office at the second visit is self-administered at home under very specific guidelines. An epinephrine auto-injector and quick onset oral antihistamine must be available at all times.
- Q. What happens after the second visit?
A. Every two weeks, a step up dose is administered in the office under medical supervision. The individual is monitored for 90 minutes in the office after each step up dose. If no adverse reactions occur, at some point during the oral immunotherapy process, the monitoring time may be reduced to 60 minutes. The dose of the treatment food is never increased at home. If someone is experiencing any allergy symptoms thought to be related to the treatment food, the dose may not be increased, or may even be decreased.
- Q. What is the end point of the Oral Immunotherapy program?
A. The endpoint depends on the treatment food. For most individuals, the program will take between 20 to 25 visits to complete. In order to maintain the increased oral tolerance to the treatment food accomplished by Oral Immunotherapy, one must continue to consume one’s specified dose of treatment food on a daily basis.
- Q. What are the most common symptoms during build-up?
A. 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 oral immunotherapy.
- Q. What should I do if there is a reaction at home?
A. If symptoms are mild, such a mild rash/hives, itchy mouth/throat or mild stomach ache, administer a quick onset antihistamine by mouth (levocetirizine/Xyzal, 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 food treatment dose may need to be adjusted.
- Q. Should routine allergy or asthma medication be stopped before the first Oral Immunotherapy visit?
A. 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.
- Q. In someone who has asthma, can a food allergic reaction manifest as an exacerbation of asthma, without any other symptoms, i.e., no rash/hives or stomach discomfort?
A. If asthma symptoms (cough/wheeze/chest tightness/shortness of breath) begin shortly after consuming the treatment dose of food, this could be the manifestation of an allergic reaction to that treatment dose. 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 other than very minor, the epinephrine autoinjector should be administered, in addition to administering the rescue inhaler.
- Q. Should the food treatment dose be administered on a full or empty stomach?
A. It is important to consume a large carbohydrate meal or snack before doses are given. Appropriate foods include bagels, sandwiches, pancakes, waffles etc. Never administer the Oral Immunotherapy dose on an empty stomach.
- Q. Are probiotics helpful during Immunotherapy?
A. Daily administration of a probiotic such as Culturelle may prove to be beneficial and is advised.
- Q. What time of day is best for the home treatment doses?
A. The specific time is not important, but ideally doses should be given approximately at the same time each day.
- Q. Are there specific precautions relating to home dosing?
A. Yes, there are several precautions. Avoiding sports/exercise and hot showers for one hour prior to and for two 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 treatment dose is once home from school, after eating a carbohydrate snack.
- Q. Does illness affect the peanut dosing schedule?
A. 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. After illness, doses should be withheld until one is feeling well and has been free of fever for 24 hours.
- Q. For how many days can doses be skipped at home without the necessity of decreasing the next dose?
A. Although it is important to follow the protocol, occasionally one may miss a dose. Home doses can be missed for a maximum of 3 consecutive days (3 doses), without the need to contact the office on how to proceed. The recent dose may be repeated on the 4th day. If last dose was 4 days or greater, phone the office to discuss the next dose, since one may need to have the next dose administered in the Allergy office.
- Q. What is the success rate?
A. While there are some individuals who are unable to complete the desensitization, studies report that the vast majority of individuals are successful.
- Q. At what point will we buy our own food?
A. The exact timing depends on the food, but typically as one completes the treatment protocol.
- Q. What is the cost of the Oral Immunotherapy/Peanut Desensitization?
A. 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.