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Learn more about this Once Daily Dosing process by clicking the questions below to view the answer.
Food OIT is a desensitization therapy. Food OIT is a method of retraining the immune system to tolerate food proteins to which it is currently sensitized (allergic). It involves the regular administration of small amounts of allergen (food) by mouth. The process introduces incrementally larger amounts of precisely measured food protein through the gastrointestinal tract on a regular basis for an extended time period. This creates an increase in IgG4 blocking antibody and a decrease in IgE antibody, shifting the balance in the body from hypersensitivity to tolerance.
The first day procedure lasts about 4-5 hours. If there are no problems during the escalation phase, the patient will be eating a full serving of the allergenic food in 5-6 months.
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. A secondary goal is to reach a daily dosing schedule where the patient does not have too avoid the allergen and can eat it on a regular basis (ideally to consume a full serving of the allergen without experiencing any adverse reaction).
Clinical trials show that Food OIT has an 85%-90% success rate. However, at this time, the US Food and Drug Administration has not approved Food OIT.
As much as OIT has evolved and gained prevalence within the allergy community, it is a relatively new treatment. There is not yet a designated OIT procedure code to bill insurance companies. KCAA has developed a new pricing package that will allow patients to receive these services for the treatment phase. This billing policy only affects services directly related to OIT. Contact our Billing Manager at 913-491-1830 to discuss this package in more detail.
Food OIT works for both adults and children. For children, our current minimum age is 5 years old. However, we would like to see the patient as soon as possible to begin discussion and planning.
No. In fact, the highly allergic patients are the ones with the greatest need of Food OIT due to the high risk of a reaction in daily life.
Each Food OIT Program is food specific. Completing one program does not treat other food allergies. Ask us for specific information for treating multiple food allergies.
The most common side effects are gastrointestinal. Symptoms include abdominal pain, nausea, and/or reflux. It is possible to experience a typical allergic reaction or anaphylaxis during the course of escalation and maintenance dosing. About 10% of patients develop eosinophilic esophagitis EoE) during the escalation phase, which slows down the process but does not stop it.
Your child must be up-to-date on immunizations before starting Food OIT.
Patients should continue to take routine medications during OIT.
The timeline depends on the individual patient. If everything goes well, some amount of the allergenic food will be ingested during months 3-4. An entire serving of the allergenic food may be ingested during months 4-6.
There is a minimum of 7 days between dose increases. However, a patient may decide they wish to have longer intervals between dose increases.
Doses are given 21-24 hours apart.
Children should be observed for at least 1 hour after the dose is given. They should not be allowed to sleep during this time.
There should be at least 21 hours BUT no more than 24 hours between doses. NEVER increase the dose at home. If the up-dose office visit is scheduled more than 24 hours since the last dose, give one additional regular dose about 12 hours BEFORE the scheduled up-dose visit. We will give you specific instructions at the time we increase the dose.
Treat the reaction the same way you would any food reaction: antihistamine for rash/hives, epinephrine autoinjector for other symptoms of anaphylaxis. If there are only a few hives or oral itch, DO NOT give antihistamine for the first hour to see if the reaction worsens. If the hives/oral itch increase, give an antihistamine. Call or text us with any reaction to a dose for instructions on future dosing.
Do not administer the dose less than one hour before boarding, i.e., be sure there is at least an hour prior to boarding when the dose is administered. Do not administer the dose while flying. Upon request, we can provide a letter explaining the procedure and need for food solutions for the Transportation Safety Authority.
Peanut, Tree Nuts, Chickpea: When dosing with whole food, patients will buy their own food. Nut butters and flours may be substituted for the peanut or tree nut during escalation dosing. We can discuss allowable food substitutes upon request.
Egg: Patients can purchase liquid egg white or egg white powder for home dosing after completing the dosing with KCAA provided solutions.
Milk: Patients can purchase whole milk for home dosing after completing the dosing with KCAA provided solutions.
Wheat: When dosing with Wheat Chex cereal, patients are required to buy their own Wheat Chex cereal and bring it to each dosing appointment. Wheat bread may also be used.
Liquid egg white should be used for all escalation doses. Patients may dose with either egg white powder or liquid egg white during the maintenance phase, and egg may then be freely added to the diet. Whole egg should never be used in place of liquid egg white or egg white powder for the daily egg dose.
When the escalation is complete, if everything goes well, maintenance doses may be given with either 2% or whole milk. Any brand of cow’s milk may be used.
Yes, it MUST be kept cold. There are no preservatives in it.
If the sample sits out for more than 30 minutes or if it appears to have spoiled, the solution must be replaced. Please contact us for replacements.
Call as soon as you realize you are running short. Be ready to tell us the concentration and amount of the current dose. You might keep this information on your phone so you have access to it.
If there is a gap of more than 24 hours between doses, contact us before giving the next dose. If it is less than 24 hours and one dose was missed, don’t try to make up the dose. Just restart the standard dosing schedule.
Taste is personal; feel free to experiment. Try drink powder (Kool-Aide, Crystal Light), chocolate, or another beverage. The food powder or small solution volumes can 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 might be difficult to get it all down.
Foods containing the allergenic food may be introduced into the diet at the end of the entire oral immunotherapy escalation process as instructed by KCAA.
When the full maintenance dose is reached, there is a follow-up at 3 months and then every 6 months. This allows us to draw food specific IgE levels every 6-12 months on maintenance dosing.
Time of day is not important. However, the AMOUNT OF TIME between doses is important. A delicate balance has been achieved that depends on a certain amount of the allergenic protein being in the patient’s system at all times. Try to give the once-a-day dose at the same time every day (21-24 hours between doses).
Exercise around the time of dosing increases the chance of a reaction. Exercise should be avoided for AT LEAST 2 HOURS after dosing. Doses should NOT be given immediately following exercise. Exercise restriction applies to both escalation, maintenance dosing, and any other time the allergenic food is eaten above and beyond the maintenance dose.
In most cases the food may be freely added to the diet after reaching the maintenance phase of treatment.
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.
NEVER. Currently, there is a lack of evidence on long-term tolerance. Studies are ongoing to determine if therapy will include long-term tolerance, where daily doses will no longer need to be given. For now, the maintenance dose MUST be maintained.
A food challenge for a different food can be done 1 week after completing Food OIT for the first food.
The patient may begin a second oral immunotherapy program after being stable on a maintenance dose for at least one month.
For further questions, contact Jennifer at (913) 491-5501, Ext. 112
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