The number one goal is safety: to allow you to eat or drink food without thinking about it.
People with a history of reacting to food ingestion and having positive allergy tests. If the story is not clear cut, a food challenge may be necessary to confirm an allergy. Peanut and tree nut OIT is being offered as young as nine months old. Egg and milk allergy can often resolve naturally by age six, so OIT is often put off until that age for these foods.
The typical patient can finish OIT in 5-6 months. It could take longer if we have to slow down due to food reactions, infections, or scheduling conflicts on your end.
Sure, we do Multi-food OIT with up to 4 foods. If you have been told you are allergic to more than 4 foods, you may wish to seek a 2nd opinion. Simply having a positive skin or blood test does not mean you are allergic.
When it comes to tree nuts, rarely will you need more than cashew and walnut. These two ‘dominant nuts’ share allergenic proteins with other nuts. That means, once you are tolerating cashew and walnut, you will be protected against pistachio, pecan, hazelnut, and less common nuts. This is important because instead of having to eat a handful of 5-6 different nuts, you’ll only be eating 2-3 cashews and 1-2 walnuts.
Prior to starting OIT, you will come to the office for a mini-challenge of five very dilute doses of food over a four hour visit. If all doses are well tolerated, you only have 12-15 weekly/biweekly buildup doses to go. On the other hand, if you do react to one of the challenge doses, you will back up one dose and then finish the remaining doses as part of the buildup phase. Once completed, you will be safely eating a small serving of the food you were previously allergic to on a daily basis.
The dose is only increased in the office. Patients typically return every 1-2 weeks for the next updose. There is no maximum time between visits, as long as you stay on the home dosing of food once a day.
We will ask you to return to the office after you’ve been on your maintenance dose for 1-3 months for a single dose challenge to three times your daily dose.
Following your high dose challenge, we would like to see you in six months and then annually. We will do blood and skin tests each year to see if you’re losing your allergy. After a few years, some patients can cut back to dosing 2-3 days a week. We ask that you continue to keep epinephrine on hand until your tests turn normal, if they ever do.
Great question – we truly don’t know. Right now we are asking patients to eat their top dose of food 5-6 days a week. Each year we will reassess your allergic status by blood and skin tests. As the testing improves, we will reduce the frequency of dosing to 2-3 days a week.
In research studies, the food was totally stopped after a year or more and then the patients challenged to the food, checking for what has been termed, sustained unresponsiveness. About 10%/year would pass, so in 5 years ~50% of people are thought to no longer be allergic.
In practice, most patients don’t want to stop and risk a positive challenge and restarting OIT, so they just continue on with dosing a few days a week. With egg and milk, that may involve just normal intake of these foods in your regular diet.
Food challenges are sometimes the only way to know for sure if you are allergic to a food. Most cases are clear cut: the ‘real deal’ of reacting to a food and having strongly positive allergy tests, or ‘no way’ with no past reaction to the food and weakly positive testing. It is those questionable cases in the middle that can only be solved by doing a careful and safe food challenge.
Some clinics do too many challenges, wasting your time and money on foods that could be introduced at home; while other don’t do enough, leading you to avoid foods or go on OIT to foods you aren’t truly allergic to.
Food challenges are covered, so the mini-challenge series of doses will be billed to your insurance. Beyond that day, however, OIT is considered a non-covered medical service. You will be charged a start-up fee based on the number of foods being used and each updose visit has a cash charge to be collected at the time of the visit.
The average out-of-pocket cost for treatment can run between $3,000-$5,000.
Over time we expect payers to reevaluate this highly successful form of treatment and we’ll be able to bill insurance in our usual fashion.
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