Milk 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, your child will complete the oral immunotherapy in 22 weeks.
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, your child will be drinking small amounts of whole milk in 5 weeks and will be drinking full servings of milk in 5 months. At that point, the frequency of dosing will be weaned to once a day.
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. When the child begins drinking whole milk, the interval between 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 spacing 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 milk (undiluted) at full dose is being used, it can be prepared at home. Milk should be Horizon Organic Whole Milk.
12. Q. At what point can the milk product be varied?
A. When the oral immunotherapy is complete, if everything goes well, you can use any milk product.
13. Q. Does the milk solution need refrigeration?
A. There are no preservatives in any of the milk dilutions. They MUST be kept cold.
14. 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 milk 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.
15. 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.
16. 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.
17. 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.
18. Q. What is the goal of this process?
A. The number one goal is safety; to allow the patient to eat or drink milk without thinking about it.
19. Q. What is the follow up schedule after the oral immunotherapy is complete?
A. When the full dose has been reached, there should be follow up at one week, one month and then three months after that.
20. 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 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).
21. 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.
22. Q. Can two oral immunotherapy foods, one on maintenance dose and one on increasing dose be given at the same time?
23. Q. How much milk can/must my child eat following completion of the oral immunotherapy process?
A. Your child must ingest 240mL of milk daily as a maintenance dose following completion of the oral immunotherapy process, but your child may also consume as much milk 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.
24. Q. How soon after completion of the oral immunotherapy process can a food challenge be done for another food?
A. A food challenge for a different food may be done 1 week after completing oral immunotherapy.
25. Q. How soon after completion of the oral immunotherapy process can a second oral immunotherapy be performed for another food?
A. May do a oral immunotherapy for another food 1 month after completing a oral immunotherapy.
26. 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.