Paul Detjen M.D.
Deborah Pockross M.D.
Kenilworth Medical - Adult and Pediatric Allergy and Asthma
534 Green Bay Road Kenilworth, IL 60043
847-256-5505
https://www.facebook.com/KenilworthAllergyAsthmaDetjenPockross/
Food Oral Immunotherapy FAQs
1. Q. How long will the entire process take?
A. The first day procedure will take 6-8 hours. If there are no reactions during the escalation
phase, you (your child) will be eating a full serving of the allergic food in 4-6 months.
2. Q. Should routine allergy medications be stopped before the first day procedure?
A. No. Patients should take all routine medications as they normally would during OIT.
3. Q. What is the timeline for the months after the first day?
A. The exact timeline depends on each individual and the specific food. If everything goes well,
some amount of the allergic food will be ingested during the second to third month and a whole
serving to the allergic food may be ingested by the fourth month.
4. Q. After the first day, can future dose increases be done at home?
A. No they cannot. The first day procedure and all escalating dose procedures must be done in
the physician office with medical treatment available. After the patient has completed each week
of directed home dosing, each dose increase must be done only under immediate supervision,
onsite, in the office.
5. Q. How often can the dose be increased?
A. Depends
Peanut and Tree Nut: The interval between dose increases is a minimum of 7 days.
Egg: Early in the process, there must be at least 4 full days of home dosing between office visits
for dose increases. For the last four doses, the interval between dose increases is 6 days.
Milk: Early in the process, there must be at least 4 full days of home dosing between office visits
for dose increases. When I (my child) begins drinking whole milk, the interval between dose
increases is 7 days.
Wheat: Early in the process, there must be at least four full days of home dosing between office
visits for dose increases. For the last nine doses, the interval between dose increases is six
days.
6. Q. What time of day should home dosing be given?
A. Doses should be given about 12 hours apart. Try to make the interval between doses no less
than 9 hours and no more than 15 hours.
7. Q. When dosing twice daily at home, morning and night, what should be done if the next
appointment for dose increase is midday?
A. Midday appointments should be avoided so that the dosing schedule will not be disrupted. Try
to schedule dose increase appointments for early morning or late afternoon so that doses may
continue to be given about 12 hours apart.
8. Q. How long should my child stay wake after the evening dose?
A. My child should be observed for at least one hour after the dose is given and should not be
allowed to go back to bedroom to sleep during this time.
9. Q. What about home dosing on the day of the office visit for dose increase?
A. There should be at least 9 hours and no more than 15 hours between doses. NEVER increase
the dose at home. If office visit is in the morning - Do not give the morning home dose. If office
visit is in the afternoon – Do not give the evening home dose.
10. Q. If there is a reaction at home, what should I do?
A. Treat the reaction the same way you would any food reaction; take antihistamine, get
epinephrine ready and call immediately if there is just minor rash or a few hives, Epi-Pen or other
epinephrine if there are any other symptoms of anaphylaxis perhaps developing. If there is only
oral itch, we may say hold antihistamine for the first hour to see if the reaction progresses, then if
the oral itch increases, give antihistamine. Call us after the appropriate immediate intervention.
We will give instructions on further dosing.
11. Q. What if we are traveling by airplane when the dose is due?
A. 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 upon request.
12. Q. At what point can we buy our own food?
A. Cashew, pecan, walnut, hazelnut, chickpea: When dosing escalates to whole food, patients
will be required to buy their own food. Cashew butter or cashew flour may be substituted during
cashew OIT. Pecan meal may be substituted in pecan OIT, walnut meal for walnut OIT, as well
as hazelnut flour for hazelnut OIT and Wheat Chex for wheat OIT. Families will obtain a scale
and will be responsible for weighing all doses.
Peanut: When doing OIT at the level of whole peanuts, patients will be required to buy their own
peanuts. Peanut butter or peanut flour may be substituted as directed by staff. Families will
obtain a scale and will be responsible for weighing all nut doses.
Egg: The last four doses of egg white powder and all maintenance doses will be provided by the
patient’s family. Egg white powder may be obtained from Barry Farm. The Barry Farm, 20086
Mudsock Rd., Wapakoneta, Ohio 45895 (www.barryfarm.com).
Milk: Once whole milk (undiluted) at full dose is being used, it can be prepared at home. Milk
should be Horizon Organic Whole Milk.
Wheat: When dosing with Wheat Chex cereal, patients will be required to buy their own Whet
Chex cereal and bring to each dosing appointment. Wheat bread may also be used ask staff
for details.
Sesame Seed: Unhulled sesame seeds or tahini for dosing should be provided by the family for
second half of OIT dosing.
Soy: Once undilated soy milk is being used, it should be purchased by the family for home
dosing. Soy milk should be Original Silk Soy Milk.
13. Q. Can whole eggs be substituted for egg white powder?
A. Egg white powder should be used for all dose increases and maintenance dosing. When the
child is on the maintenance dose of 1 tablespoon 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.
14. Q. At what point can the milk product be varied?
A. When the oral immunotherapy is complete, if everything goes well, maintenance doses may be
given with either 2% or whole milk and any brand of cow’s milk may be used.
15. Q. Does the food solution need refrigeration?
A. There are no preservatives in the food solution. It must be kept cold.
16. Q. What do I do if refrigeration is not maintained or if it smells or tastes different?
A. If the sample sits out for more than 1 hour or if it appears to have spoiled, the solution must be
replaced. Please call the office. If replacement is made during regular office hours, there may be
a charge. If replacement must be made at night or on a weekend or holiday, there will be a
charge of $50.00. This fee cannot be charged to your insurance.
17. Q. What if I need additional doses and I am out of town?
A. Call as soon as you know you will need more. You must be able to tell us the concentration
and amount of the current dose. If a staff member needs to come in at night, on a weekend or
holiday, there will be an additional charge of $50.00. This fee cannot be charged to your
insurance. A compounding pharmacy may be able to ship capsules out of town, if necessary.
You will be responsible for the applicable charges.
18. Q. What if I am (my child is) sick and can’t take the doses on schedule?
A. If there is a gap of more than 15 hours between doses, call before giving the next dose.
19. Q. What about masking the taste of the food solution?
A. Taste is personal; experiment. Try drink powder (Kool-Aid, Crystal Light), chocolate or another
beverage. The food powder or small solution volumes could be mixed with a small amount of a
semi-solid food such as apple sauce or mashed potato. Try to give the dose in one bite to ensure
that the entire dose of oral immunotherapy mixture is taken. If the total amount gets too large, it
will be hard to get it all down.
20. Q. May Egg Beaters
TM
be used for dosing in egg OIT?
A. Egg Beaters are not permitted because they are not complete eggs.
21. Q. When can foods containing the allergenic food be introduced into the regular diet?
A. Foods containing the allergenic food may be introduced into the diet at the end of the entire
oral immunotherapy escalation process as instructed by your provider.
22. Q. What is the goal of this process?
A. The number one goal is safety; to allow the patient to ingest the allergenic food and foods that
contain the allergenic food without thinking about it.
23. Q. What is the follow up schedule when maintenance dosing is reached?
A. When the full dose has been reached, there is a follow-up at 1 month (with lab) and then every
6 months. Food specific IgE levels should be drawn yearly on maintenance dosing.
24. Q. When dosing is reduced to once a day, is the time of day important?
A. Time of day is not important but the amount of time between doses is important. We have
achieved a delicate balance that depends on a certain amount of the allergenic protein being in
their system at all times. You should try to give the once a day dose at the same time every day
(24 hours plus or minus two hours).
25. Q. Do I (does my child) need to avoid exercise during the oral immunotherapy process?
A. Exercise must be avoided for at least 2 hours after dosing. Exercise around the time of
dosing increases the chance of a reaction. Exercise restriction applies to both escalation and
maintenance dosing.
26. Q. Can two oral immunotherapy foods, one on maintenance dose and one on increasing dose be
given at the same time?
A. Yes, depending.
27. Q. How much of the allergenic food can/must I (my child) eat following completion of the oral
immunotherapy process?
A.
Cashew, Hazelnut, Pecan and Peanut: Must ingest 8 nuts once daily as a maintenance
dose, may also consume as much of the allergenic nut as desired in addition to the daily
maintenance dose upon completion of the oral immunotherapy process.
Walnut: Must ingest 5 nuts daily as a maintenance dose and may also consume as many
walnuts as desired in addition to that.
Egg: One tablespoon of egg white powder must be eaten daily as a maintenance dose, but
may also consume as much egg as desired in addition to that.
Milk: Must ingest 240mL of milk daily as a maintenance dose, but may also consume as
much milk as desired in addition to that.
Wheat: Must ingest 125 Wheat Chex (1 1/4 cups) or 1 slice of whole wheat bread daily as a
maintenance dose following completion of the oral immunotherapy process, but may also
consume as much wheat as desired in addition to that.
Chickpea: Sixteen chickpeas must be consumed once daily during chickpea maintenance
dosing, but additional chickpeas may be consumed if desired.
Sesame Seed: 5.6 grams of unhulled sesame seeds or 1¼ tsp of tahini must be the minimum
amount of sesame ingested every day while on maintenance dosing, more if desired.
Soy: Must ingest 240mL of soy milk daily as a maintenance dose, but may also consume as
much soy as desired in addition to that.
If the time comes when the frequency of the maintenance dose changes, we will let you
know. Until then you (your child) must continue the daily maintenance dose as directed.
28. Q. How soon after completion of the oral immunotherapy process can a food challenge be done
for another food?
A. A food challenge for a different food can sometimes be performed 1 week after completing oral
immunotherapy.
29. Q. If I am (my child is) allergic to multiple foods, will completing OIT for one food help treat other
food allergies?
A. Each food OIT Program is food specific. Completing one program does not treat other food
allergies. Ask your physician for more specific information for treating multiple food allergies.
30. Q. How soon after completion of the oral immunotherapy process can a second oral
immunotherapy program be performed on another food?
A. You (your child) may begin a second oral immunotherapy program after stable on a
maintenance dose, sometimes sooner.
31. Q. What if I do not (my child does not) get immunizations or is behind on scheduled
immunizations, can I (he/she) start the OIT program.
A. No. You (your child) must be up-to-date on all scheduled immunizations before starting any of
the oral immunotherapy programs.
32. Q. How is the oral immunotherapy program billed and what does it cost?
A. The Day #1 procedure and escalation doses are billed as Ingestion Challenge Desensitization
Procedure along with the office visit which is designed to address separate but potentially
confounding issues such as active asthma, rhinitis, viral URI, eczema, etc. These procedures are
commonly performed procedures by allergists and covered generally by most if not all insurance
plans. The actual reimbursement varies by insurance plan and guarantor component can depend
on deductible. We strongly advise you to check with your insurance to obtain an estimate of
coverage.