Milk FAQ

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 complete the oral immunotherapy in 22 weeks.
2. Q. Should routine allergy medications be stopped before starting oral
immunotherapy ?
A. No
3. Q. When it is expected for my child to drink a full serving of milk after starting the
procedure?
A. Exactly how it will go depends on each individual child. If everything goes well, it
is expected to tolerate small amounts of whole milk in 5 weeks and a full serving of milk
in 5 months. At that point, the dose frequency will be weaned to once a day.
4. Q. How often can the dose be increased?
A. Early in the process you must continue daily doses for at least four full days
between office visits for dose increments. When whole milk is tolerated, the interval
between dose changes will be six days.
5. Q. What time of day should home doses be given?
A. Home doses can be given twice daily, about 12 hours apart. The doses should
be given no less than 9 hours and no more than 15 hours apart.
6. 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.
7. 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.
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, Epi-pen if there are other symptoms of anaphylaxis (reviewed in
office prior to start of procedure). 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.
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. 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.
10. Q. At what point can we buy our own food?
A. Once whole milk (undiluted) at full dose is being used, it can be prepared at
home. Milk should be the Horizon Organic Whole Milk brand.
11. Q. At what point can the milk product be varied?
A. When the oral immunotherapy is completed, if everything goes well, you can use
any milk product.
12. Q. Does the milk solution need refrigeration?
A. There are no preservatives in any of the milk dilutions. They MUST be kept cold.
13. Q. What should I do if refrigeration is not maintained or if the sample smells or
tastes different ?
A. If the sample sits out for more than 30 minutes or if it appears to be spoiled, the
milk dilution 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 milk be introduced into the regular diet ?
A. Foods containing milk may be added to the diet after the oral immunotherapy
process is complete. No additional milk should be ingested during the oral
immunotherapy.
17. Q. What is the goal of oral immunotherapy for milk?
A. The number one goal is safety; to allow the patient to eat or drink milk without
thinking about it.
18. Q. What is the follow up schedule after the oral immunotherapy is complete?
A. When the full milk dose has been reached, there should be follow up at one
week, one month and then three months after that.
19. Q. When the dose is reduced to once a day, should the dose be given at a certain
time during the day?
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 milk 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 milk dosing, but it is ideal
to avoid exercise for four hours after dosing. Exercise following milk 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?
A. Yes.
22. Q. How much milk can/must my child drink following completion of the oral
immunotherapy process?
A. At the end of oral immunotherapy process your child must ingest 240ml
(approximately 8 ounces) of milk daily as a maintenance dose. In addition to the
maintenance dose he/she may also consume as much milk as your child would like.
Regularly scheduled follow-up appointments will be needed and during those visits it
may be recommended to change his/her maintenance dose. You will be provider with
detailed time or frequency changes on the maintenance dose, until then, your child
must continue the daily maintenance dose.
23. Q. How soon after completion of the oral immunotherapy process can a food
challenge is done for another food?
A. A food challenge for a different food may be done 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 oral desensitization). The actual reimbursement varies by insurance plan.

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