1. Q. How long will the entire process take?
A. The first day procedure will take about 7-8 hours. If there are no reactions during the oral immunotherapy, you child will be eating a full serving of peanuts in about four months.
2. Q. Should routine allergy medications be stopped before the first day procedure?
3. Q. What is the timeline for the months after the first day?
A. Exactly how it will go, depends on each individual child. If everything goes well, some amount of the whole food will be eaten during the second month and a whole serving of peanuts may be eaten by the fourth month. By four months, if there are no reactions, two doses per day will be required to maintain desensitization. After 3 months the dosing frequency will be reduced to once a day.
4. Q. How often can the dose be increased?
A. The interval between dose increases is a minimum of seven days.
5. Q. What time of day should home doses be given?
A. Peanut doses should be given about 12 hours apart, try to make the interval between peanut doses no less than 9 hours and no more than 15 hours.
6. Q. When doing the peanut oral immunotherapy and taking two doses a day at home, morning and night, what should be done if the next dose appointment 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.
7. Q. How long should my child stay awake after the evening dose?
A. Children should be observed for at least one hour after the dose is given. They should not be allowed to sleep during this time.
8. Q. What about home dosing on the day of the office visit for dose increase?
A. There should be at least nine hours and no more than 15 hours between doses. NEVER increase the dose at home.
9. Q. If there is a reaction at home, what should I do?
A. Treat the reaction the same way you would any food reaction; antihistamine if there is just rash, Epi-pen if there are other symptoms of anaphylaxis. If there is just one or a few hives, DO NOT give antihistamine for the first hour so we can see if the reaction progresses. If the hives are increasing, give antihistamine. Call us after the appropriate immediate intervention. We will give instructions on future dosing.
10. Q. What if we are flying 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. If there are scheduling conflicts while traveling, give a dose just before leaving and just after returning.
11. Q. At what point can we buy our own food?
A. When dosing with whole peanuts you will be required to buy your own peanuts. Peanut butter or peanut flour may be substituted.
12. Q. Does the peanut solution need refrigeration?
A. There are no preservatives in the peanut solution. It should be kept cold.
13. Q. What do I do if refrigeration is not maintained or if it smells or tastes different?
A. If it appears to have spoiled, the peanut solution must be replaced. Please call the office. If replacement is made during regular office hours, there is no charge. If replacement must be made at night or on a weekend or holiday there will be a charge of $50. This fee cannot be charged to your insurance.
14. Q. What if I need additional doses and I am out of town?
A. Call as soon as you know you need more. You must be able to tell us what the concentration and amount of the current dose is. We can ship doses to you on ice via FedEx. If this is done during regular office hours, there will be a charge of $25 plus the FedEx charge for this service. If a staff member needs to come in at night, on a weekend or holiday, there will be an additional charge of $50 (I.E., $75 plus the FedEx charge). This fee cannot be charged to your insurance.
15. Q. What if 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. If it is less than 15 hours, pick up on the standard schedule.
16. Q. When can foods containing peanuts be introduced into the regular diet?
A. Foods containing peanuts may be introduced into the diet at the end of the oral immunotherapy process.
17. Q. What is the goal of this process?
A. The number one goal is safety; to allow the patient to eat peanuts and foods that contain peanuts without thinking about it.
18. Q. What is the follow up schedule when a full portion of the food is being eaten?
A. When the full dose has been reached, there should be follow up at one week, one month and then three months after that.
19. Q. When dosing is reduced to once a day, is the time of day important?
A. Peanut doses will be reduced to once daily after three months of maintenance dosing. 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 peanut protein being in the system at all times. You should try to give the once a day dose at the same time every day (24 plus or minus two hours).
20. Q. Does my child need to avoid exercise during the oral immunotherapy process?
A. Exercise should be avoided for at least two hours after peanut dosing, but it is ideal to avoid exercise for four hours after dosing. Exercise following peanut dosing increases the chance of a reaction.
21. Q. Can two oral immunotherapy foods, one on maintenance dose and one on increasing dose be given at the same time?
22. Q. How much peanut can/must my child eat following completion of the oral immunotherapy process?
A. Your child must ingest 8 peanuts twice daily as a maintenance dose for the first 3 months following completion of the oral immunotherapy process. The dose will be reduced to 8 peanuts once daily. Your child may also consume as much peanut as he/she would like in addition to his daily maintenance dose upon completion of the oral immunotherapy process. We will have regularly scheduled follow-up appointments, and if the time comes when the frequency of the maintenance dose changes, we will let you know. Until then, your child must continue the twice daily or daily maintenance dose.
23. Q. How soon after completion of the oral immunotherapy process can a food challenge be done for another food?
A. May do a food challenge for a different food 1 week after completing oral immunotherapy.
24. Q. How soon after completion of the oral immunotherapy process can a second oral immunotherapy be performed for another food?
A. Your child may begin a second oral immunotherapy program after he/she has been stable on a maintenance dose for one month.
25. Q. How is the food oral immunotherapy billed and what does it cost?
A. The procedure is separate from office visits. The day one procedure is billed as desensitization. Subsequent doses are billed as a challenge (significantly lower cost than desensitization). The actual reimbursement varies by insurance plan.