Patients with known or suspected food allergies are evaluated and managed. The primary focus is on the diagnosis and treatment of IgE-mediated food allergies, which are immediate, potentially life-threatening reactions to various foods, including milk, egg, peanut, tree nuts, and sesame. IgE-associated diseases, which include eosinophilic gastrointestinal disorders and atopic dermatitis, and other food antigen associated diseases, such as food protein induced enterocolitis and celiac disease, are also addressed. Common symptoms, typical allergens, and triggering events are explained. Attention to distinguishing immune related food allergy from non-immune related food intolerances may play a role in appraisal and education.
Patient evaluation involves detailed history and exam as well as testing procedures. Skin prick tests with extracts and fresh foods, blood tests, graded food challenges, and pulmonary function tests may be utilized to achieve a diagnosis. Proximity food challenges and trace food challenges are offered to define the degree of individual patient sensitivity, help reduce fear and anxiety regarding food allergy, and have the potential to vastly improve patient and parent quality of life.
Commitment to impacting food allergy through oral immunotherapy and other effective treatments is a primary component of the food allergy center. Education is the foundation for a shared relationship with the patient and family members and sets the stage for optimal outcomes. Available methods for evidenced based modification of the immune system are explained. Risks, benefits, side effects, administration and costs of avoidance, pharmaceutical treatment and oral immunotherapy (OIT) are discussed.
OIT, or oral desensitization for food allergies, is a medical treatment guided by Dr. Schiffman, during which the immune system is re-trained to tolerate food proteins or allergen through regular eating of small amounts of food. The outcome is protection from accidental exposure to a known food allergen. Some patients are able to freely consume formerly allergic foods at will. During OIT, the food allergen is administered slowly, in small but steadily increasing doses, until the patient is desensitized.
The first day of treatment is a build-up day, during which multiple doses of very small amounts of allergen are administered. This procedure may take up to 5 hours. The patient continues to eat a “safe dose” at home, once daily. Dose increases occur in the office, every 1-2 weeks, after assessment by the physician. After each dose there is a 1 hour observation period. Instructions on home dose administration, when to avoid dose increases, and treatment of side effects are reviewed at each office visit. The timeline for achieving the target dose depends on each individual patient. If everything goes well, some amount of the allergenic food will be ingested during the 4th – 6th month, and a whole serving of the allergenic food may be ingested by the 8th month. The allergenic food must continue to be consumed on a daily basis to maintain the ability to eat it safely.
At Boca Raton Food Allergy Center, we understand that some patients need extra time for questions, explanations, and reassurance. For these patients or family members, Dr. Schiffman offers the opportunity for private consultations. This allows both the physician and patient to set aside adequate time to address all concerns. Consultation fees are above and beyond any insurance compensation, and provide the added benefit of concierge type service.
OIT involves substantial preparation and follow up time, that is not always reimbursed adequately by insurance. Prior to starting OIT insurance benefits will be verified, and additional private pay allergen preparation fees will be determined.
|Initial Visit Consultation Fees|
|Initial consultation up to 60 min||$250|
|Initial consultation up to 90 min||$375|
|Initial consultation up to 120 min||$500|
|Follow up Consultation Fees|
|Follow up consultation up to 30 min||$100|
|Follow up consultation up to 60 min||$225|
|Follow up consultation up to 90 min||$350|
|OIT Food Preparation Fee|
|Initial Build up day||$200|