Food Oral Immunotherapy: Home Dosing Instructions

  1. Continue to avoid the treatment food, other than for the treatment dose of that food.
  2. An epinephrine auto injector and quick onset oral antihistamine such as levocetirizine/Xyzal, cetirizine/Zyrtec or diphenhydramine/Benadryl must be available at all times.
  3. It is best to administer the treatment dose of food at approximately the same time each day, for example when returning home from school.
  4. It is important to consume a carbohydrate meal or snack prior to administering the treatment dose of food. Suggestions include sandwich, bagels, toast, pretzels, goldfish crackers, etc. Never administer the oral immunotherapy dose on an empty stomach.
  5. Daily administration of a probiotic such as Culturelle may prove to be beneficial and is advised.
  6. Avoid sports/exercise/hot showers/becoming overheated for one hour prior to and two hours after each treatment dose. These activities increase the likelihood of developing an allergic reaction to the treatment dose.
  7. If the treatment dose is given in the evening, one should be awake/monitored for at least one hour prior to bedtime.
  8. Illness may increase the risk of developing an allergic reaction to the treatment dose. Withhold the dose and notify the allergy office if fever, nausea/vomiting/diarrhea, or other illness occurs. Very minor “colds” without fever may not require a dose adjustment. After illness, doses should be withheld until one is feeling well and has been free of fever for 24 hours.
  9. For some individuals, one’s menstrual cycle may be associated with an increased risk of developing an allergic reaction to the treatment dose. If allergy symptoms to the treatment food are associated with one’s menstrual cycle, notify the office for advice regarding a dose adjustment.
  10. 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.
  11. If one has asthma and/or allergic rhinoconjunctivitis (hayfever) these conditions should be well controlled while undergoing oral immunotherapy. Daily asthma/allergy medication should be continued. Please notify the office if symptoms are uncontrolled.
  12. If any new blood pressure medications are started, you should notify our office immediately.
  13. On the day of a step-up office visit, do not administer the daily food oral immunotherapy dose at home. That day’s dose will be administered in the office.
  14. An allergic reaction to the home treatment dose may occur. If symptoms are very mild, such as a minor rash, few hives, mild itching of the mouth/throat or mild stomach discomfort, administration of a quick onset antihistamine by mouth (levocetirizine/Xyzal, cetirizine/Zyrtec or diphenhydramine/Benadryl) may be adequate to treat the symptoms. If mild symptoms are progressing, or if there is any difficulty breathing, speaking/swallowing, or if anaphylaxis occurs, immediately administer the epinephrine autoinjector, contact the rescue squad/911 for transport to the emergency room and then administer the quick onset antihistamine by mouth.

Note: An epinephrine auto-injector when administered properly has very few side effects. For the great majority of people, administration of epinephrine, when in retrospect it may not have been needed, will not cause harm.