Egg Oral Immunotherapy FAQs
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, you child will be eating egg in about four months.
2. Q. Should routine allergy medications be stopped before the first day procedure?
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. Q. After the first day, can future dose increases be done at either office?
A. The first day procedure must be done in the Dallas office. After that, dose increases may be done at either office. Patients must choose between the offices so that the appropriate dose will be at the proper location.
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. 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. 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. 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. 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. 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. 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. 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, 20086 Mudsock Road, Wapakoneta, Ohio 45895. www.barryfarm.com.
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. Q. Does the egg solution need refrigeration?
A. There are no preservatives in the egg dilutions. They MUST be kept cold.
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. 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. 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. 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. 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. Q. How about Egg BeatersTM?
A. Egg Beaters are not permitted because they are not complete eggs.
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. 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. 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. 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. 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. Q. Can two oral immunotherapy foods, one on maintenance dose and one on increasing dose be given at the same time?
27. Q. How much egg can/must my child eat following completion of the oral immunotherapy process?
A. One egg 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. 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. 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. 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 a desensitization. Subsequent doses are billed as a challenge (significantly lower cost than oral immunotherapy). The actual reimbursement varies by insurance plan.