Frequently Asked Questions about Food Desensitization
Q. How long will the entire process take?
A. The first day procedure will take about 2-5 hours. If there are no reactions during the desensitization, you child will be eating a full serving of peanuts in about three months.
Q. Should routine allergy medications be stopped before the first day procedure?
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, 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.
Q. How often can the dose be increased?
A. The interval between dose increases is a minimum of seven days.
Q. What time of day should home doses be given?
A. For twice a day peanut dosing, try to make the interval between peanut doses no less than 9 hours and no more than 15 hours.
Q. When doing the peanut desensitization and taking two doses a day at home, morning and night, what should be done if the next dose appointment is midday?
A. With ALL food desensitization it is important keep dosing the food at a relatively close interval. If the office appointment for the next dose is more than three hours after or before the next scheduled dose, give the regularly scheduled doses. For example if the appointment is at noon and dosing is normally done at 8 AM and 7 PM, there should be three doses that day. If the appointment is at 9 AM, there can be only two doses.
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.
Q. What about home dosing on the day of the office visit for dose increase?
A. There should be at least three hours between doses. NEVER increase the dose at home.
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.
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.
Q. At what point can we buy our own food?
A. When dosing with whole peanuts you will be required to buy your own peanuts. Peanut butter or peanut flour may be substituted.
Q. Does the peanut solution need refrigeration?
A. There are no preservatives in the peanut solution. It MUST be kept cold.
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 peanut solution must be replaced. Please call the office.
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.
Q. When may foods that contain peanuts be introduced into the regular diet?
A. Foods containing peanuts may be introduced into the diet at the end of the desensitization process.
Q. What is the goal of this process?
A. The number one goal is safety; to allow the patient eat peanuts and foods that contain peanuts without thinking about it.
Q. What is the follow up schedule when a full portion of the food 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.
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 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).
Q. Can two desensitization foods, one on maintenance dose and one on increasing dose be given at the same time?