Peanut FAQ

A. The first day procedure will take about 7-8 hours. If there are no reactions during the oral immunotherapy, you child will be eating a full serving of peanuts in about three months.

A. No.

A. Exactly how it will go depends on each individual child. If everything goes well, some amount of the whole food will be eaten during the second month and a whole serving of peanuts may be eaten by the fourth month. By four months, if there are no reactions, two doses per day will be required to maintain desensitization. After one year the dosing frequency will be reduced to once a day.

A. The interval between dose increases is a minimum of seven days.

A. Peanut doses should be given about 12 hours apart, try to make the interval between peanut doses no less than 9 hours and no more than 15 hours.

A. Midday appointments should be avoided so that the dosing schedule will not be disrupted. Try to schedule dose increase appointments for early morning or late afternoon so that doses may continue to be given about 12 hours apart.

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.

A. There should be at least nine hours and no more than 15 hours between doses. NEVER increase the dose at home.

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.

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.

A. When dosing with whole peanuts you will be required to buy your own peanuts. Peanut butter or peanut flour may be substituted.

A. There are no preservatives in the peanut solution. It MUST be kept cold.

A. If the sample sits out for more than 30 minutes or if it appears to have spoiled, the peanut solution 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.

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.

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.

A. Foods containing peanuts may be  introduced into the diet at the end of the oral immunotherapy process.

A. The number one goal is safety; to allow the patient to eat peanuts and foods that contain peanuts without thinking about it.

A. When the full dose has been reached, there should be follow up at one week, one month and then three months after that.

A. Peanut doses will be reduced to once daily after one year of maintenance dosing.  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 peanut 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).

A. Exercise should be avoided for at least two hours after peanut dosing, but it is ideal to avoid exercise for four hours after dosing. Exercise following peanut dosing increases the chance of a reaction.

A. Yes.

A. Your child must ingest 8 peanuts twice daily as a maintenance dose for the first year following completion of the oral immunotherapy process. The following year the dose will be reduced to 8 peanuts once daily. Your child may also consume as much peanut as he/she would like in addition to his daily maintenance dose upon completion of the oral immunotherapy process. 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 twice daily or daily maintenance dose.

A. May do a food challenge for a different food 1 week after completing oral immunotherapy.

A. Your child may begin a second oral immunotherapy program after he/she has been stable on a maintenance dose for one month.

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 desensitization). The actual reimbursement varies by insurance plan.