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Instructions

Instructions

singlePatient Instructions for Sublingual /Oral Immunotherapy OAD (Oral Allergy Drops) Allergen Extracts

-The initial treatment kit comes in a box with 3 color-coded bottles of different

Strength, with a “dispenser” on the top.

-The 1st bottle is color-codes  Blue 

-The 2nd bottle is color- coded Green

-The 3rd bottle is color- coded Red , depending on the allergen strength available for any one allergen.

Keep the 1st dilute bottle in case you need to go back to it. 

How to take the allergen extracts

• The bottles are like a miniature soap dispenser and each bottle needs to be

“Primed” when first used by pressing down completely a few times.

• Parents should administer doses to their children.

• The dose is measured in FULL PRESSES.

• Take in the morning on an empty stomach

• Keep under tongue for at least 2 minutes, then swallow.

 

• The drops have a sweet taste it may be unpleasant for some. Children can suck a lollie/sweet at the same time

• Do NOT eat or drink anything for 15 minutes; the allergen is partially absorbed from under the tongue so if you eat/drink you may wash it away.

• Avoid crunchy cereals in the morning; they can cut the mouth lining & increase irritation. If you have had dental treatment or mouth ulcers, you may need to stop fora few days until it heals up, as broken mouth tissue may increase the risk of mouth irritation.

• If you forget to take them in the morning, take before bedtime instead.• If you are taking 2 separate extracts, it is best to separate them by 5-15 minutes if possible. Or you can take one in the morning and one in the evening if there are no significant side-effects in the first 2-3 weeks. If not possible, you can take them at the same time.

If you stop treatment temporarily

-­‐ If there has been less than a 1-week gap, go back to your usual dose.

-­‐ If you have stopped for more than a week,go back to the beginning of the protocol

and build up to the maintenance dose again.

Side-effects of oral immunotherapy:

• Irritation or itching or swelling inside the mouth (common).

• Stomach upset, stomach or chest pain (uncommon)

• Throat swelling, tight chest, asthma, rash (rare)

Mild side-effects can usually be controlled by temporarily reducing the dose or by taking anControlling Side-effects

Anti-histamine the night before. The itchy mouth usually settles after 4-6 weeks so feel

free to take a daily antihistamine the night before if needed. Local itch can also by

directing the liquid to under the side of the tongue if under the front of the tongue causes

bad irritation. If more severe side-effects occur (e.g. throat swelling, difficulty

breathing, bad stomach/chest pains), seek medical attention, stop treatment and contact

Dr Shahid for further advice.

Ongoing bad side-effects

• Let Dr Shahid know.

• If local itch and swelling does not settle, change the location of administration to behind the lower lip in front of the teeth,hold 2 minutes, then swallow.

• If nausea/stomach upset is bad, then hold in the mouth for 2-3 minutes, then spit outthe allergen into the sink (not swallow).

This may reduce effectiveness but is better than not being able to tolerate the treatment at all.

• The above advice is based on theoretical aspects, the distribution of cells in the mouth that trigger side-effects compared to immunotherapy benefit, one small trial presented at a European meeting in 2012 and expert advice.

 

Delivery takes 1week by courier

This will require forward planning by patients and their doctors

to ensure that there are no gaps in treatment schedules due to extracts “running out”. Make

sure you order more allergen no later than when you are on the second-last bottle of your

current supply. Keep the 1st dilute bottle in case you need to go back to it.

 

INITIAL PROTOCOL

The allergen is taken DAILY :-

Bottle # 1 , 1st 1 Press daily for 5 days then  2 Presses daily for 5 days then 3 presses daily for 5 days

Bottle # 2 , 1st   1 Press daily for 5 days then  2 Presses daily for 5 days then 3 presses daily for 5 days

2weeks (#1 & #2 for two weeks each), until Maintenance dose reached.

DAYS PROTOCOL FOR BOTTLE #1 (WEEK 1 &2 or First 15 days) (4)

(1 PRESS)      DAYS 1    2    3    4    5

(2 PRESSES) DAYS 6    7    8    9  10

(3 PRESSES) DAYS 11 12 13  14  15

DAYS PROTOCOL FOR BOTTLE #2 (WEEK 3&4 or Second 15 days) (3)

(1 PRESS)      DAYS 1    2    3    4    5

(2 PRESSES) DAYS 6    7    8    9  10

(3 PRESSES) DAYS 11 12 13  14  15

DAYS PROTOCOL FOR BOTTLE #3 (WEEK 5, 6, 7, 8 or 28days) (2) (3.0ml)

(1 PRESS)      DAYS    1      2        3     4      5       Day  6NO Oral Drops          Day 7NO Oral Drops 

(1 PRESSES) DAYS     8     9      10     11    12      Day 13NO Oral Drops          Day 14NO Oral Drops     

(2 PRESSES) DAYS     15   16    17     18    19     Day  20NO Oral Drops           Day 21NO Oral Drops     

(2 PRESSES) DAYS    22   23   24      25    26     Day  27NO Oral Drops           Day 28NO Oral Drops     

BOTTLE #4 (WEEK 8  to 12 weeks onwards (2) 4.5ml

(1 PRESS)      DAYS    1      2        3     4      5       Day  6NO Oral Drops          Day 7NO Oral Drops 

(2 PRESSES) DAYS     8     9      10     11    12      Day 13NO Oral Drops          Day 14NO Oral Drops     

(2 PRESSES) DAYS    15   16    17     18    19     Day  20NO Oral Drops           Day 21NO Oral Drops     

(2 PRESSES) DAYS    22   23   24      25    26     Day  27NO Oral Drops           Day 28NO Oral Drops     

2 presses/day, Mon-Fri. If no benefit after 4 months, increase dose to 3 presses/day,every day. (Note: this will increase cost and mean you will need to order allergen more often).

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Important dates

Your initial allergen order will last 12 WEEKS

Allergen will run out in about 12 weeks ___________

You should order more allergen in 10th week with details about ur progress _______

Suggest review _________________

Your referral expires __6months_______________

Planned treatment (if works) is 3-5 yrs.

If ineffective, options are those of:

• Medication;

• Higher oral doses; or

• Switching to immunotherapy injections

 

Estimated costs are provided as a guide

Estimates are per allergen extract. Estimates are approximate since technique may

determine actual allergen volume dispensed,and cost estimates are based on calculations

based on manufacturer and distributor costs that may change without notice.

Each bottle contains sufficient to last for about one month or 28days but one loses some volume (~ 2 doses) when priming the

device for initial use or accumulation of air in the device so IT IS STRONGLY RECOMMENDED THAT THE CAP SHOULD BE LOSENED AND TIGHTEN AGAIN AFTER EVERY USE.

The cost for one month is about AED 700.00 INCLUDING

Important Note:-

-THE FREIGHT INITIALLY BUT THE MAINTENANCE DOSE WILL BE AED 850 PER MONTH INCLUDINT THE FREIGHT. FREIGHT WILL BE PAID BY THE COMPANY IF ORDERED FOR 3 MONTHS.

-IF ORDER LESS THAN 3 MONTHS THEN FREIGHT WILL BE PAID BY THE PATIENT

-AMOUNT WILL BE PAID IN ADVANCE AND ORAL ALLERGY DROPS WILL BE SHIPPED WITH IN ONE WEEK OF THE CONFIRMED ORDER