Review lifestyle | • Competitive sports and other extracurriculars | • May not increase heart rate for any reason including sports or other activity for 3 hours after dosing every day |
• School schedule | • Will need to be carefully monitored by caregiver to ensure dose is taken daily | |
• Vacations and travel | • Up-dosing may be delayed by one or more weeks to accommodate travel or schoolwork | |
• Caregiver monitoring | • Will need to be carefully monitored by caregiver for any reaction after every dose | |
• Transportation | • Legally authorized caregiver should provide transportation to clinic; adolescents should not attend alone | |
Clarify timing of daily dose | • Early morning before school | • May require 5am wakeup |
• Immediately following school dismissal | • activity, even when weather is nice | |
• Dinnertime | • Must remain awake for monitoring for 3 hours after dos | |
Understand goals | • Bite-safe | • Life-long daily dosing is required to remain bite safe |
• Free eat | • Free eating peanut containing foods may be possible for some but requires a monitored challenge in clinic before starting as well as careful explanation of risks | |
• Remission | • No evidence currently exists that OIT induces remission, i.e. if daily dosing is stopped; protection may be lost | |
Review options for Mixing | • Yogurt | • Consider other food allergies |
• Ice cream | • Consider particular tastes of child | |
• Guacamole | • Have multiple options available | |
• Pudding | ||
• Applesauce | ||
• Smoothie | ||
Review risk factors for systemic reactions | • Exercise (or any activity that increases heart rate) | • Heart rate may not be elevated for 3 hours after each dose |
• NSAID use | • OIT is likely not possible for those on chronic NSAIDS | |
• Menstruation | • Consider avoiding up-dosing appointments | |
• Hot showers | • Drinking water throughout the day, particularly on up-dose days is crucial | |
• Dehydration | • Each dose should be taken with a meal or substantial snack | |
• Empty stomach | ||
Review medications that treat side effects | • Second generation H1 blocker | • Patient should have at least one of each that is tolerated |
• H2 blocker | • Family should have on hand prior to starting | |
• Correct dosing should be provided |