Frequently Asked Questions (Food OIT) - Once Daily

1.  Q.     How long will the entire process take?  
A.     The first day procedure will take about 3 hours. Visits 2 and 3 will be about 2 hours,     with subsequent visits about an hour. If there are no problems during the escalation phase, the patient will be eating a full serving of the allergenic food in 4-5 
  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.    How often can the dose be increased?  
      A.    There must be a minimum of 7 days between dose increases (7 doses given), but patients 
    may decide to go longer between dose increases if they so choose. 
 
4.   Q.    What time of day should home doses be given? 
      A.    Doses should be given 21-27 hours apart.   
 
5.   Q.    What if my child does not get immunizations or is behind on scheduled immunizations, 
    can he/she start the OIT program? 
      A.    No. Your child must be up-to-date on all scheduled immunizations before starting any of 
    the oral immunotherapy programs. 
 
6.  Q.    How long should my child stay awake after the dose is given? 
     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. 
 
7.  Q.    What about home dosing on the day of the office visit for dose increase?  
A.    There should be at least 21 hours and no more than 27 hours between doses. NEVER increase the dose at home. If the updose office visit is scheduled more than 27 hours since the last dose, give one additional dose about 12 hours before the scheduled updose visit. 

8.   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/hives, Epi-pen or Auvi-Q if there are other symptoms of anaphylaxis. If there 
    are only mild hives or oral itch, DO NOT give antihistamine for the first hour to see if the 
reaction  progresses. If the hives/oral itch are increasing, give antihistamine. Please see the additional information sheets regarding fever, nausea, and vomiting. Call us after 
    the appropriate immediate intervention. We will give instructions on future dosing. 

 
9.   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. 
 
10. Q.    At what point can we buy our own food? 
      A.    When dosing with whole foods. Specific brand and type recommendations will be given.
      
11. Q.    What if my child is sick and can’t take the doses on schedule? 
      A.    If there is a gap of more than 27 hours between doses, call before giving the next dose. If 
    it is less than 27 hours, pick up on the standard dosing schedule. 

12. Q.    What about masking the taste of the food powder? 
      A.     Taste is personal; experiment. Try drink powder (Kool-Aide, Crystal Light), chocolate or 
another beverage. The food powder 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. 

13. Q.    May Egg Beaters® be used for dosing in egg OIT? 
      A.    Egg Beaters are not permitted because they are not complete eggs. 
 
14. 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. 
 
15. 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.  
 
16. 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. 
 
17.  Q.    With once daily dosing, is the time of day that the dose is given 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 (21-27 hours between doses). We recommend morning dosing. 
 
18. Q.    Does my child need to avoid exercise during the oral immunotherapy process?  
      A.    Exercise should be avoided for at least two hours after dosing and doses should not be 
    given immediately following exercise.  Exercise around the time of dosing increases the 
    chance of a reaction.  Exercise restriction applies to both escalation and maintenance 
    dosing. 
 
19. Q.    Can two oral immunotherapy foods, one on maintenance dose and one on increasing dose 
    be given at the same time?   
      A.    Yes. 

20. Q.     How much of the allergenic food can/must my child eat during the maintenance phase of 
    the oral immunotherapy process?  
       A.    In most cases the food may be freely added to the diet after reaching the maintenance
phase of Food OIT treatment. Cashew, Hazelnut, Almond, Pistachio, Macadamia, and 
Peanut: 8 nuts  Walnut and Brazil nut: 3 ½ nuts  Pecan: 7 pecans Egg: 2 tsp egg white 
powder or 2 T of liquid egg white Milk: 240ml (8 oz) whole or 2% milk Wheat: 75 
Wheat Chex (3/4 cups) or 1 slice of whole wheat bread  Chickpea: 16 chickpeas Soy: 
240ml (8 oz) soy milk Sesame: 5.6 grams of sesame seeds Sunflower seed: 8 grams of 
sunflower seeds or 7 grams of Sunbutter.
If the time comes when the frequency of the maintenance dose changes, we will let you know.  Until then, the patient should continue the daily maintenance dose as directed. 
 
21. 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. 

 22. Q.    If 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 provider for more specific information for treating multiple food 
    allergies. 
 
23. Q.    How soon after completion of the oral immunotherapy process can a second oral 
    immunotherapy program 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. 
  
24. Q.    How is the oral immunotherapy program billed and what does it cost?  
A.    The first 3 visits/procedures will be billed as an Oral Challenge and visit. Subsequent dosing     office visits are billed as an office visit. The actual reimbursement varies by insurance plan. As this procedure is not FDA approved your insurance will not cover the actual materials and time used to make the capsules. You will be responsible for $1000 before we start and 3 payments of $500 at 3, 6 and 9 weeks of the program. Additional foods will be charged at 50% off each set of capsules.

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