OIT

Protocol Explanation 

Oral Immunotherapy Protocol

 

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Oral Immunotherapy

Oral immunotherapy explained 

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Peanut flour in apple sauce tastes good! 

Allergy & Asthma Institute of SE Michigan

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OIT Protocol

 

Desensitization has been used for medication and food allergy for over 100 years.

All desensitization protocols are built off the same back bone. The end dose is picked first (example. 500mg of amoxicillin, or 8oz of milk).  The first dose on a one day desensitization schedule is usually 1/1,000 of the final dose. For the food protocols most start at about 1/100,000 of the final dose.

Day One

The first day, induction day, or what is also called rush immunotherapy, is a day long procedure.  Therapy on this day can last 8 hrs.

You will be checked in, your vitals taken (blood pressure, pulse, weight, pulse ox, and if your asthmatic peak flow), and physical exam performed.

The starting dose will be given.  This is the food your allergic to diluted out in distilled water and usually flavored (Kool-Aid or analog).  Every 30 min you will have your vitals retaken and the next dose will be given.

For example with our protocol starting dose:

  • Peanut starting dose= 0.001mg of peanut protein; One peanut = 250mg of protein; End dose= 8 peanuts.

  • Egg starting dose= 0.0083mg; One egg = 4350mg; End dose one egg.

  • Milk starting dose = 0.1mg; 8oz of milk =8000mg; End dose 8oz of milk.

At the first sign of any reaction (mouth itching, GI discomfort, hives) the day is stopped. You will be monitored for at least one hour after the last dose.  Many patients make it up to the last planned dose of the day (varies from food to food- peanut for example is 6.25mg of protein).  What ever dose the patient has tolerated last with out any symptoms will be what they go home and take every day, twice a day.

The first day can be very long.  We have internet access (Wi-Fi), TV, Netflix, DVD's to help pass the time.  Lunch and snacks should be brought along (make sure the patient does not overeat through out the day, we do not want to have to end the protocol for a tummy ache caused by too many cookies).

Daily Dosing

  • Ever 24hrs (range 22-26hrs) the daily dose needs to be consumed.

Elevations

Every 7 days at home daily, you can return for elevation of the dose.  The number of elevations will depend on how far you make it through the first day.  In general most of the protocols have 18-22 elevations after the first day.

In the office the next dose on the protocol will be given. You will then be monitored for one hour.  If you are asymptomatic then you will go home on the twice/once daily dosing of the new amount of food.

No elevations are to be undertaken at home, for any reason!

If you are symptomatic at home, depending on the severity of the symptoms, the weekly elevation may be delayed.

  • Remember this is not a race to the top, it is a journey. 

  • There will be adjustments made along the way when needed to slow the progression. 

  • Delaying the weekly elevations will not cause you to have to decrease the dose.

  •  Most people with mild/moderate symptoms will show improvement over time and may need longer in-between some doses.

  • There is flexibility in dose elevations and some patients may need to delay an elevation because of vacations, special events etc. This delay will not harm progress (just slows it down a bit).

The End

After the maintenance dose is given in the office with in a short period of time (a week in most cases), you will no longer need to avoid the food allergen any longer.  You will need to continue taking the daily maintenance dose.

When will you be able to stop the daily dosing at home?  That question can not be answered at this time. It will be for at least 3-5 years, and most likely longer for some patients. 

 

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