OIT rules after a dose: what clinics tell families
This guide only reports what recognised sources and clinics tell families, and every health statement in it is attributed to a named source. Your allergist's instructions always come first.
Your own clinic's rules for the time after an OIT dose come before anything you read here. This guide gathers the rules that allergy clinics and organizations publish for families about the time after an OIT dose, so you know what to ask about. It covers what oral immunotherapy clinics ask families to avoid after a dose, and what they say about sick days, medicines, sleep and missed doses.
Why clinics give rules for the hours after a dose
A review in Frontiers in Allergy says that patients starting OIT are given precise instructions to minimize the impact of cofactors around their doses.5
The same review lists physical exertion, infections, extreme heat, poorly controlled asthma, alcohol, ibuprofen and other NSAIDs, sleep deprivation and menstrual cycles among these cofactors.5
The American Academy of Allergy, Asthma & Immunology (AAAAI) describes a home monitoring period after dosing as one of the precautions that come with OIT at home.3
Which of these apply to your child, and for how long, is for your allergist to tell you.
What clinics say about the first hours after a dose
The Children's Hospital of Philadelphia (CHOP) asks families to keep to calm activities for two hours after a dose.1
CHOP explains that anything that raises the heart rate can bring the protein in too quickly and trigger symptoms.1
CHOP asks families to avoid hot showers or exercise for 30 minutes before a dose and for two hours after it.1
Among the activities CHOP lists to avoid in the two hours after a dose are running around, climbing, going to the gym and playing sports.1
A review in the Journal of Food Allergy describes avoiding vigorous exercise around the time of the dose, typically one hour before and two hours after, as one of the most important precautions.4
The same review notes that some patients may need a rest period of up to four hours after the dose.4
FARE says that people on OIT typically schedule their doses for a time when they won't be very active afterwards.2
Whether your child needs a quiet time after a dose, and for how long, is for your clinic to tell you.
Body temperature
CHOP lists baths, showers, hot tubs, saunas and swimming among the things to avoid in the two hours after a dose.1
CHOP also lists going outside on extremely hot days.1
The AAAAI describes avoiding a rise in body temperature, for example from exercise or hot showers, for two to four hours after dosing.3
FARE names hot showers, exercise and infection among the factors that can make a reaction affecting the whole body more likely.2
Ask your allergist which of these your clinic wants you to avoid, and for how long.
Medicines
CHOP asks families to avoid medicines not prescribed by the CHOP team during the two hours after a dose.1
CHOP says ibuprofen must be avoided for two hours before or after the dose.1
FARE names nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen among the factors that can make a reaction affecting the whole body more likely.2
The review in the Journal of Food Allergy lists NSAID use among the things that can be risk factors for reactions during OIT.4
Ask your clinic about any medicine your child takes on a dosing day.
Sick days, fever and illness
CHOP asks families to contact the OIT team if a child develops a cold, a fever or another illness, to discuss whether the dose needs to change.1
CHOP asks families to contact the OIT team for advice if a child is vomiting or has diarrhea.1
The review in the Journal of Food Allergy lists avoiding dosing when ill, in particular with a fever, among the most important precautions.4
On a sick day, your clinic decides what happens with the dose, so call them rather than deciding at home.
Tiredness and sleep
The review in Frontiers in Allergy includes sleep deprivation among the cofactors that can influence the reactivity threshold of patients undergoing peanut OIT.5
The review in the Journal of Food Allergy suggests making sure that patients on OIT get adequate sleep for their age.4
The same review notes that sleep deprivation has been identified as a risk factor for food anaphylaxis, although not specifically in OIT.4
If your child has slept badly or seems very tired before a dose, ask your clinic what they want you to do.
Missed doses
CHOP asks families to call the OIT team before the next dose if a child misses a dose for any reason.1
CHOP says the child's doctor will then advise on the best course of action.1
The review in Frontiers in Allergy says families should be given guidance for situations such as missed doses or illness.5
What to do after a missed dose is your clinic's decision, so contact them before you give the next one.
If something happens
CHOP tells families to follow the child's anaphylaxis plan if the child has a significant reaction to OIT at any time.1
The review in Frontiers in Allergy says patients should have a personalized action plan for managing adverse effects before starting OIT.5
The review in the Journal of Food Allergy stresses that parents need a ready way to contact their OIT providers outside office hours in case of a serious reaction.4
The action plan your own clinic gave you is the one to follow.
Questions to ask your allergist
- How long is our observation window after each dose?
- Which activities should our child avoid before and after a dose, and for how long?
- Does our clinic have rules about body temperature after a dose?
- Which medicines may our child take on a dosing day, and which should we ask you about first?
- What should we do with the dose when our child has a cold, a fever or a stomach bug?
- Should we change anything after a night of poor sleep?
- Who do we call about a missed dose, and how do we reach you outside office hours?
- Can we have all of these rules in writing, as part of our action plan?
Whatever any guide says, the rules your own clinic gave you are the ones that count.
Sources
- Oral Immunotherapy Fundamentals for Families · Children's Hospital of Philadelphia · Accessed
- Oral Immunotherapy (OIT) · FARE (Food Allergy Research & Education) · Accessed
- The Current State of Oral Immunotherapy · American Academy of Allergy, Asthma & Immunology · Accessed
- Risk factors for reactions and adverse effects during oral immunotherapy · Journal of Food Allergy · Accessed
- Transitioning peanut oral immunotherapy to clinical practice · Frontiers in Allergy · Accessed