Other Topics

Overall Health

Why is the Rest of my Child's Health Important to the Success of Their Treatment?

Patients with a normal or steady immune system and anatomy have the best success in our program. Understanding how other medical conditions, injuries, or illnesses can effect your child child’s overall system and by extension their TIP™ treatment is important. Let your provider know if your child has any health changes.

Vaccines

What do I do I Need to Know About Vaccines?

Decision by parent with input from your pediatrician

Proceed with vaccinations and test for effectiveness of vaccinations when they reach remission. Hold vaccinations while in active treatment until they reach remission.

What to consider if you proceed with routine vaccinations

We have specific guidelines on vaccinations because your child’s immune system is adapting at a rapid rate during treatment. Therefore, we cannot guarantee the effectiveness of these vaccinations and do not want your child to be falsely labeled as vaccinated if their body has not fully mounted the proper response.

Patients who proceed with vaccinations will complete testing through their pediatrician once they reach remission. Your pediatrician can order the titers (blood test) and evaluate to determine if the immune system has responded effectively and if any adjustments in the vaccination cycles need to be made. In cases of an outbreak, it would be wise to proceed with vaccinations. Notify the office if your child is getting the vaccination, as we will make adjustments to their dosing plan on the day of and days following the vaccine administration. When notifying us, please provide information on which vaccination your child will be receiving.

What to know if you choose to hold vaccines

On January 1, 2021, the California Department of Public Health (CDPH) implemented a pair of laws (SB 276/SB 714) that affects the way medical exemptions for required school vaccinations are requested and effectively monitored.

To request a temporary medical exemption for required school vaccines from a physician, parents/legal guardians residing in California are now required to submit their request through the CDPH directly. Once the request has been submitted, physicians will approve/deny the request through the website. Schools have direct access to this website as well.

Once you have completed the medical exemption request for required school vaccinations, please submit the information we are required to obtain to complete your request through this link.

Please note that we approve requests for medical exemptions for required vaccinations on a case by case basis and each exemption is only good for one school year. We do not offer permanent medical exemptions for school required vaccinations. After completion of active treatment (upon remission or as determined by a TIP™ provider) we will not grant requests for medical exemptions for required vaccinations as it is no longer medically necessary for the Tolerance Induction Program.

What about the COVID vaccine?

As COVID vaccines are available to many of our patients 5 years of age and older, we want to review what this will mean for your child’s dosing in TIP™. Vaccines are a distraction to the immune system and can pose a risk to TIP™ dosing. Therefore, we are advising a conservative approach to dosing around the time you get your vaccine. We do not recommend dosing while your child is experiencing side effects from the vaccine. You will likely need to adjust your appointment during the dosing cycle when you receive your COVID vaccine. Please reach out to inform us when you have a vaccination appointment scheduled and which vaccine you will be receiving so we can plan your dosing adjustments.

Covid Vaccine FAQ:

We do recommend our patients receive the COVID vaccine as it becomes available to them as long as they do not have any other underlying immune conditions.

Because my child has food allergies, should they not get the vaccine?

Food allergic individuals are not excluded from getting the COVID 19 vaccine. If your child has a history of reactions to vaccinations, please consult your pediatrician prior to vaccinating your child. If your child has an autoimmune disease or immune system disorder, please consult your immunologist prior to vaccinating your child.

What should I do if my child has a fever after the vaccine?

If your child is experiencing side effects such as fever, you may treat with Motrin and Tylenol on a rotating schedule as needed to keep the fever under control. If your child has a fever that lasts over 24 hours you should follow up with your pediatrician.

How do I deal with medications, maintenance foods and treatment foods in TIP after getting the vaccine?

We have established the following adjustments to dosing schedules around the time of vaccination.

Your child may continue their daily anti-histamine and nasal spray if they are on one.
Your child may skip SLIT, maintenance, and treatment foods the day of the vaccination and the day following the vaccination
If your child does not have any residual symptoms or side effects, you may resume dosing where you left off.
It is best not to updose the day after skipping two days. Please plan the vaccination timing so you are able to complete at least two more doses on the current dose before updosing.

School and Daycare

What are concerns that I should have about my child starting school or daycare?

While schools work hard to keep our children safe, it is important to teach your child to protect themselves. Work with the school to designate a trusted adult who is well educated on food allergies that can be a point person for your child if they have questions about food throughout the school day.

Plan ahead with school nurses, teachers, and administrators to understand your child’s school’s policies around emergency protocol, storage of epi-pens, allergy-free snack and lunch areas, and food sharing during special events.

Where do I send in forms or letters for use of medications at school?

Prepare medical forms that outline your child’s allergens and the medications to take in case of a reaction. Remember, school medical forms take up to 10 business days for us to process, so please email them to us at Forms@tpirc.org at least two weeks before they are due.

Health Conditions

Eczema

What can I do to help my child’s eczema during in the TIP™ program?

SKIN CARE REGIMEN

Apply eczema care regimen in order: steroid first, followed by moisturizer, followed by aquaphor/vaseline.

Moisturize 2-3x/day with a moisturizer such as Vanicream or Eucerin (no scents or dyes), then apply Aquaphor over dry areas.
For chronic eczema, please ensure that you are applying moisturizing cream and emollient to areas where eczema is commonly found at least twice a day (preferably more).

MANAGING FLARES

For moderate flares, use a prescribed steroid ointment/cream such as triamcinolone for twice a day, for up to 7 days, and then as needed for spot treatment. If your child’s eczema continues to flare up during treatment please reach out, as we may need a stronger steroid or explore other treatment options such as wet wraps or bleach baths.

OTHER IMPORTANT ITEMS FOR MANAGING ECZEMA

1. Wear plant/cotton clothing.
2. Watch room temperature, keep your child’s room to 65-68 F°.
3. Use cotton sheets for covers at night.
4. Use topical agents such as Eucerin and Aquaphor/Vaseline as a barrier.
5. Use clear detergent.

BLEACH BATH INSTRUCTIONS: (TRY BATH TWICE PER WEEK)

Only use Dove unscented soap.
Lukewarm water + 1/4 cup** Clorox bleach (concentration for bleach must be 6 8.75%).
Sit for 10 minutes (supervised by adult).
** full tub = 1/2 cup, half tub = 1/4 Cover the face and neck with the water and cotton cloth.
After 10 minutes, rinse with dove soap only if skin doesn’t tolerate the bleach bath well.
Air dry or lightly pat dry, no vigorous towel use. Apply eczema care regimen in order: steroid first, followed by moisturizer, followed by Aquaphor.

What if my child’s eczema is severely out of control?

Send photos and information to our provider team at TIPhelp@tpirc.org.

Or schedule a visit with one of our Allergists, Dr. Vivian Aranez.

Stomach Problems

Experiencing Constipation?

Schedule a visit with one of our Allergists, Dr. Vivian Aranez.

HOW CAN I PREVENT CONSTIPATION?

1. Hydrate! Avoid dehydration by consuming adequate amount of water each day:
25 Pounds:4-5 Cups
50 Pounds: 6-7 Cups
75 Pounds: 7-8 Cups
100 Pounds: 8-9 Cups
125 Pounds: 9-10 Cups
150 + Pounds: 10 Cups
Add fiber to your child’s diet. Include at least 2-3 daily servings of fiber rich foods in your diet, if possible from an allergy standpoint (including beans, fruits, vegetables, whole grains/bran).
Get moving! Daily activity can help to increase motility. Children should have daily high-intensity activity.
Be aware that increasing antihistamines can contribute to constipation.
Set aside “toilet time” for your child 30 minutes after their largest meal of the day. Have your child spend 15 20 minutes on the toilet to ensure complete emptying.
Track bowel movements on the Bristol stool scale to ensure that your child is having daily type 3-4 bowel movements. Bristol stool scale Wikipedia
Send photos and information to our provider team at TIPhelp@tpirc.org.

Experiencing choking or difficulty swallowing?

Schedule a visit with one of our Gastroenterologists.
Dr. Roy Nattiv and Dr. Leon Chen

Asthma, Cough or Wheezing

My child has a history of asthma or reactive airway disease and I am having more symptoms

OR

My child doesn’t have a history or asthma but has symptoms of regular cough, easy fatigue, or shortness of breath.

If you have either of the following, please reach out to one of our providers at TIPhelp@tpirc.org. If you haven haven’t had a lung function test done recently please schedule one for evaluation. You can or may be recommended to see a specialist.

Schedule a visit with one of our Pulmonologists.

Acute Illness

TIP™ treatment is intended for patients with a healthy immune system, any changes can put them at risk of experiencing symptoms when dosing

We all know that illnesses happen, especially in the winter time. Please make sure to monitor your child closely for signs and symptoms of illness. During high viral seasons consider checking the temperature of your child before dosing. For your child’s safety we may need to make appropriate adjustments to their food dosing plan if they get sick or injured.

In general, for fever, vomiting, lethargy, and poor appetite we recommend holding all dosing (including SLIT, maintenance and treatment foods) for 24 hours after these symptoms have resolved. If you are taking your child to their primary medical doctor for evaluation, Urgent care, emergency room, keeping them home from school due to illness, or giving your child Tylenol or Ibuprofen for illness, this would also be an appropriate time to hold dosing. If you are not sure what to do, it is alright to skip that day of dosing and please email us at TIPhelp@ytpirc.org for further instruction. We are available 8am-8pm PST on email to answer these types of questions.

Generally, your child can miss 1-2 days of dosing in a row. If your child misses more than 2 days of dosing for any reason, please email us at TIPhelp@tpirc.org to let us so we can make dosing adjustments as needed for the safety of your child when they resume.

If your child has a fever lasting more than 72 hours please take your child to their primary medical doctor for evaluation. Your child is considered to be febrile if they have a fever greater than 100.4. They are still considered febrile until their fever is less than 100.4 without any antipyretic, such as Tylenol or Ibuprofen in their system for 24 hours. Viral illnesses in general can have 3-5 days of fever, after 3 days of fever they need evaluation for secondary bacterial illnesses. Fever that resolves but returns within a week should also be evaluated for secondary bacterial infection. If your child looks very ill no matter how many days of fever it has been, they should be evaluated by a physician.

If your child is having symptoms with dosing, requiring you to deploy any scenario in your anaphylaxis plan, we want to know about it! We are available by phone if you are need to deploy scenarios for symptoms. Please call our 24/7 emergency line for scenario 2 or 3 symptoms or concerns (562-490-9900, then press 7). If these events occur please deploy appropriate scenario medications and call our reactions line. Although we do not replace the need for calling 911 should that be your child child’s case, we are here to support patients and families should this occur.

Remember that all patients dosing in the afternoon or evening require a rest period, that includes anything that will increase their temperature or heart rate. For example, if the patient has itching after dosing please avoid exposure to a hot bath as this can increase their heart rate. Cool wipes are a safer option to use if there is any concern that there was topical exposure. If your child develops respiratory symptoms after dosing please give scenario medications first and avoid Albuterol if able. Albuterol does increase heart rate and therefore circulation of allergen. Although we realize that it is often impossible to control your child, other activities such as excessive laughing and or crying also increase their cardiovascular state.

Other Health Conditions

How can other health conditions effect my TIP™ treatment?

Any other medical conditions that affect or stress your child’s immune system can put them at risk for symptoms with dosing. Insufficient amount of sleep, dehydration, bodily injuries, fractures, bacterial and viral infections, constipation, dental work, oral injury and oral ulcers, the use of certain medications (narcotic pain medications, albuterol), can negatively affect your child’s treatment. If your child develops any medical condition, starts new medications, or medical treatment during TIP™, it is important that you notify us at TIPhelp@tpirc.org so that we can make the notes on your child’s chart, since changes in your child’s health can affect treatment responses and safety.