FOOD (OIT) ORAL IMMUNOTHERAPY FAQ’s
Q. What is an allergy?
A. An allergic reaction occurs when your body’s immune system overreacts and releases chemicals into your blood. These chemicals can then affect different tissues in your body, such as the skin, eyes, nose, airways, intestinal tract, lungs, and blood vessels.
Q. Are allergies serious?
A. Many allergens are harmless and do not affect most people. If a person is allergic to a substance, such as pollen, their body reacts to the substance as if it was foreign and harmful, and tries to destroy it.
Severe allergic reactions can cause rashes, hives, low blood pressure, nausea, vomiting, and include swelling that can spread to the throat and lungs. This can lead to breathing trouble, allergic asthma or a serious condition known as anaphylaxis. Anaphylaxis can cause death if not treated immediately.
Q. What are the most common food allergies?
A. Eight things cause about 90% of food allergy reactions:
- Milk (mostly in children)
- Tree nuts, like walnuts, almonds, pine nuts, Brazil nuts, and pecans
- Wheat and other grains with gluten, including barley, rye, and oats
- Fish (mostly in adults)
- Shellfish (mostly in adults)
Q. What is OIT (Oral Immunotherapy Treatment)?
A. OIT is a medical treatment guided by a board-certified allergist where your body is re-trained to tolerate food allergens. This is done through regular dosage of small amounts of food.
Q. What is the goal of this process?
A. The number one goal is safety. We want to allow the patient to eat the allergenic food and foods that contain the allergenic food without worrying about reactions.
Q. How long does OIT take?
A. Exactly how long treatment lasts depends on each individual patient. If everything goes well, some amount of the food you are allergic to will be eaten between around the 4th or 5th month of treatment. A whole serving may be eaten by the 8th month.
Q. Will I be able to stop taking my allergy medications?
A. No. Patients should take all routine medications as they normally would during OIT.
Q. What if my child does not get immunizations or is behind on scheduled immunizations, can they start the OIT program?
A. No. Your child must be up-to-date on all scheduled immunizations before starting any oral immunotherapy treatment program.
Q. Will we need special food?
A. Patients will be required to buy their own food during OIT. Your doctor will explain exactly which foods will be required, based on the allergy and treatment.
Q. When can foods containing the allergenic food be introduced into our 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 doctor.
Q. What happens then?
A. When the full dose has been reached, there is a follow up at 1 month (with labs) and then every 6 months. Food specific allergy levels will be drawn yearly once you reach maintenance dosing.
Q. What if I’m allergic to more than one food? Can I be treated for two (or more) foods on OIT?
A. Each food OIT program is food specific and each one must be completed separately. Completing one food program does not treat other allergies to other foods. Patients may participate in OIT for other foods after they have been on maintenance dose for one month with no problems.
Ask your doctor for more specific information for treating multiple food allergies.
Q. How much does OIT oral immunotherapy treatment cost?
A. We strongly advise you to contact your insurance company to discuss whether OIT is covered under your plan. Our office provides you with an estimate of insurance coverage as well. Additionally, a $200 supply fee per food will be collected at the start of immunotherapy. You are responsible for this fee. It cannot be charged to your insurance.
Food Oral Immunotherapy (OIT) Procedure
Before OIT Begins:
- About 2-3 weeks before treatment begins, patients are evaluated to see whether or not their asthma and/or allergy is stable.
- Spirometry is performed if the patient has asthma. Spirometry a common office test used to figure out how well your lungs work. It measures how much air you inhale, how much you exhale and how quickly you exhale.
- Parents sign a consent form for a child.
- All the patient’s routine medications stay the same.
OIT Day 1:
- Patient arrives at 9:00 am. A physical exam is performed before dosing begins. Active illness or unstable asthma are both reasons to postpone Day 1 dosing.
- Doses are given every 20 minutes under staff supervision. There is a one hour observation time after the last dose.
- Emergency medications and equipment will be available in case of allergic reaction.
- Any sign of reaction, no matter how small, is a reason to stop treatment for the day. Patient will continue dosing at home with the last tolerated dose.
- After Day 1 there are 17-22 dose increases, depending on the food schedule.
- Patient takes last tolerated dose on Day 1 at home once daily until their next appointment. Each increase in dose will take place during an office visit with 45 minutes of observation.
- There must be a minimum of 7 days between dose increase. There is no maximum time between dose increase.
- If reactions occur during OIT, the dose will be reduced to the last tolerated dose. Following Day 1 increases, there should be no more than one dose increase per office visit. The protocol will be adjusted by the doctor if necessary.
- Active illness and exercise within a few hours of dosing increases the likelihood of a reaction. There are no dose increases during active illnesses or during asthma flares. Patients are instructed to avoid exercise for 2 hours after dosing.
- Maintenance doses are continued for a minimum of three years.
- Patients may freely add the tolerated food to their diet during the maintenance phase.
- Patients are instructed to continue to avoid exercise for 2 hours after dosing and to continue to carry an epinephrine autoinjector.
- Patients may participate in OIT for other foods after they have been on maintenance dose for one month with no problems.