Oral Immunotherapy


Instructions for Oral Immunotherapy (OIT)

Pre-therapy instructions:

  1. If you have asthma, please continue your daily inhaled steroid medications for asthma (Flovent, Advair, Pulmicort, Symbicort, Asmanex) and/or Singular.
  2. If you use albuterol, Xopenex or any bronchodilator medication more than two times (except prior to exercise) in the week before the oral immunotherapy, please contact our clinic.
  3. You can continue inhaled steroid nasal sprays (Flonase, Nasonex, Rhinocort)
  4. To minimize reactions to oral immunotherapy, please take an antihistamine the night before and the morning of Day#1, #2 and each 2-week visit.
  5. Please inform the nursing staff if you have recent illness prior to the OIT. We might need to put the OIT on hold for safety reason.

What can you expect on your first day of the Oral Immunotherapy (OIT)?

The first day is called the “dose-escalation day”. Therapy can last for up to 8 hours. Please bring something to occupy yourself such as a laptop, book, tablet, etc. We request you arrive at our clinic on time at 8 am.

It is recommended that you do not have an empty stomach during the OIT. Bring plenty of healthy snacks throughout the day. Drink plenty of water and avoid dehydration.

Every 15 min you will have your vitals retaken and escalating doses will be given according to pre-determined protocol. We will also ask you to note any symptoms that you observe and report them immediately to us.

You will be carefully monitored for potential reactions. Your vital signs, oxygen saturation, breath sounds, and skin will be continuously monitored.

Please bring your auto-injectable epinephrine (Epi-Pen, Auvi-Q, or Twinject) to the appointment, to have it available after you have left the clinic. This is a precaution in case a delayed reaction occurs after leaving the clinic.

You will be given specific individualized recommendations depending on the outcome of day 1 treatment. If day 1 goes well, you will be asked to come back on the following day for 1 more oral challenge. The day 2 visit usually last 2 hours.

What to do after Day #2?

The dose you have tolerated on Day #2 without any symptoms will be the dose you go home with and take every day until your next visit with us in 2 weeks. Every 24hrs (range 22-26hrs), the daily dose needs to be consumed. You do not need to take antihistamines for this 2 week.

Do not consume any other brand of protein other than what we prescribe!

Dose Escalations: What to expect in subsequent visits?
  1. Every 2 weeks, you will return to the clinic for elevation of the dose. Dose escalation must only be performed and supervised by Dr. Leung. It is too dangerous to do it at home without medical supervision. Please take a dose of antihistamine the night before and the morning of the visit.
  2. In the clinic the next escalated dose will be given. You will then be monitored for one hour.  You can expect to stay in the clinic for a total of about 2 hours. If you are asymptomatic then you will go home on the daily dosing of the new amount of peanut.
  3. Please bring your auto-injectable epinephrine (Epi-Pen, Auvi-Q, or Twinject) to the appointment, to have it available after you have left the clinic. This is a precaution in case a delayed reaction occurs after leaving the clinic.
  4. If you develop any reactions to the escalated dose, we will hold the dose, and continue the dose previously tolerated for 2 weeks at home. We will again give you the escalated dose after 2 weeks.
  5. No escalations are to be undertaken at home, for any reason!
  6. If you are symptomatic at home, please notify us immediately. Administer epinephrine for anaphylaxis as indicated. Do not wait for call back from Dr. Leung’s office in case of medical emergency and call 911.

Maintenance:

After serial dosing elevations in the build-up phase (usually takes 18-34 weeks), maintenance dose will be reached. Dr. Leung will determine the optimal maintenance dose on a case to case basis. You will need to continue taking the daily maintenance dose for at least 3-5 years or may be longer. Research Studies have suggested that patients on a longer duration of OIT are more likely to achieve sustained unresponsiveness, which is a state of permanent tolerance to peanuts, i.e., no recurrence of clinical allergy upon reintroduction of peanuts in a person not on the maintenance dose.

Please do not hesitate to call our clinic for any questions or concerns: 617-804-6767.


Oral Immunotherapy Consent Form