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Food Allergy Oral Desensitization1. 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, your child will be eating egg in
about four months.
2.
2. Q. Should
routine allergy medications be stopped before the first day
procedure?
A.
No.
3.
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, egg
white powder will be eaten by the second month and whole egg will be
eaten by the fourth month. By five months, if there are no
reactions, only one dose per day will be needed
4.
4. Q. After the first day,
can future dose increases be done at either office?
A.
The first day
procedure must be done in the
5.
5. Q. How often can
the dose be increased?
A.
Early in the
process there must be at least four full days of home dosing between
office visits for dose increases. For the last four doses the
interval between dose changes is six days.
6.
6. Q. What time of
day should home doses be given?
A.
Doses should be
given twice daily, about 12 hours apart.
Try to make the interval between doses no less than 9 hours
and no more than 15 hours.
7.
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.
8. Q. What about
home dosing on the day of the office visit for dose increase?
A.
There should be at
least 9 and no more than 15 hours between doses. NEVER increase the
dose at home.
9.
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.
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.
A letter explaining the procedure and need for food solutions for
the Transportation Safety Authority is available on request
11.
11. Q. At what point can we
buy our own food?
A.
Once whole egg is
being used, it can be prepared at home. Eggs should be “Large”.
12.
12. Q. Can egg
powder be substituted for whole eggs?
A.
After the 1/4 egg
dose has been completed, egg white powder can be substituted for
eggs. Egg white powder can be obtained from Barry Farm. The Barry
Farm,
13.
13. Q. At what
point can the products be varied?
A.
When the oral
immunotherapy is complete, if everything goes well, you can use any
egg product.
14.
14. Q. Does the egg
solution need refrigeration?
A.
There are no
preservatives in the egg dilutions. They MUST be kept cold.
15.
15. Q. What do I do
if refrigeration is not maintained or if it smells or tastes
different?
A.
If the sample sits
out for more than 30 minutes or if it appears to have spoiled, the
food dilutions 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.
16.
16. 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.
17.
17. 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.
18.
18. Q. What about
masking the taste of the egg solution?
A.
Taste is personal;
experiment. Try drink powder (Kool-Aide, Crystal Light), chocolate
or another beverage. Small volumes could be mixed with a semi-solid
food such as apple sauce or mashed potato but it is important that
the entire dose of oral immunotherapy mixture be taken. If the total
amount gets too large, it will be hard to get it all down.
19.
19. Q. How can we
make whole egg more varied and attractive? A Scrambled eggs can be flavored by adding ingredients to the scrambled mixture or to the finished product before serving. You will have to experiment. Everybody’s taste is different and you know your child best. Suggestions to add to the scrambled egg.
i)
Sweet - sugar,
cinnamon, maple syrup, fruit slices or berries
ii)
Savory - ketchup,
salsa, peppers, cooked bacon bits, salami.
iii)
Other forms -
soufflé, flan, egg custard, French toast, quiche.
iv)
Do not rely on
egg baked into foods. Baking changes the allergic features of the
egg and make it a less suitable method.
20.
20. Q. How about
Egg Beaters TM?
A.
Egg Beaters are not
permitted because they are not complete eggs.
21.
21. Q. When can
foods containing egg be introduced into the regular diet?
A.
Foods containing
egg may be added to the diet once the oral immunotherapy process is
complete.
22.
22. Q. What is the
goal of this process?
A.
The number one goal
is safety; to allow the patient to eat the problem food without
thinking about it.
23.
23. Q. What is the
follow up schedule when a full portion of egg 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.
24.
24. Q. When dosing
is reduced to once a day, is the time of day 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 egg
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).
25.
25. Q.
Does my child need to avoid exercise during the oral immunotherapy
process?
A.
Exercise
should be avoided for at least two hours after egg dosing, but it is
ideal to avoid exercise for four hours after dosing. Exercise
following egg dosing increases the chance of a reaction.
26.
26. Q.
Can two oral immunotherapy foods, one on maintenance dose and one on
increasing dose, be given at the same time?
A.
Yes.
27.
27. Q. How much egg
can/must my child eat following completion of the oral immunotherapy
process?
A.
One egg or egg
white must be eaten daily as a maintenance dose, but your child may
also consume as much egg as he/she would like in addition to that.
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 daily maintenance
dose.
28.
28. Q.
How soon after completion of the oral immunotherapy can a
food challenge be done for another food?
A.
A challenge may be
done for a different food 1 week after completing oral
immunotherapy.
29.
29. Q. How soon
after completion of the oral immunotherapy can a second oral
immunotherapy be performed for another food?
A. May
do oral immunotherapy for a different food 1 month after completing
oral immunotherapy.
30.
30. 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 oral immunotherapy). The
actual reimbursement varies by insurance plan.
Frequently Asked Questions:
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Egg FAQ
Food Allergy Treatment
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