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Table 2 Considerations to address before starting OIT

From: Eight tips for the implementation of the first licenced peanut allergy oral immunotherapy into clinical practice

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