Christina Schwindt, MD
“Asthma and allergies significantly impact the lives of those who suffer from them. Yet, with the right treatment, they can live healthy, active lives. I went into this field to make a difference in the lives of those who suffer from these disorders. The considerable impairment of these diseases to health and quality of life should not be discounted – and the expertise of an allergist can make all the difference.
My dedication to improving patient care includes understanding the environmental factors that influence asthma and allergies. I am the Principal Investigator on many research projects, including from the National Institutes of Health (NIH), National Institute of Environmental Health Sciences (NIEHS) and South Coast Air Quality Management District (SCAQMD) and have published in numerous scientific journals.
I am very understanding and patient. I recognize the importance of treating the person, not just the disease. People need to feel comfortable enough with their treatment plan and their physician to ask questions. The more a patient understands about their care, the happier and healthier they will be.”
Board-Certified: American Board of Allergy & Immunology, American Board of Pediatrics
Fellow: American Academy of Allergy, Asthma & Immunology
Fellowship Training: St. Louis University School of Medicine, St. Louis, MO
Residency: Pediatrics, St. Louis University School of Medicine, St. Louis, MO
MD: St. Louis University School of Medicine, St. Louis, MO
BSc: Biochemistry, University of California at Los Angeles (UCLA), Los Angeles, CA
Member: American Academy of Pediatrics; American College of Allergy, Asthma & Immunology; American Academy of Allergy, Asthma & Immunology; International Child Health; American Thoracic Society; American College of Sports Medicine; Orange County Society of Allergy & Immunology
Volunteer: Medical missions to St. Vincent and the Grenadines (developed asthma 27800 Medical Center Road, Suite 244 clinic and HIV/AIDS program)
A review from their Facebook page:
“I have been a patient since November 1987 and can clearly say Dr. Berger changed my life. Wonderful care, delightful staff, many family and friends have been referred here as well.”
QUESTIONS (AND ANSWERS) CONCERNING ORAL IMMUNOTHERAPY (OIT)
You or a family member may be starting treatment for food allergy, also known as oral immunotherapy (OIT). This handout is designed to help answer the most common questions about OIT. Please feel free to speak with one of our staff members if you have additional questions, or if new questions or problems arise. By working together on your treatment plan, we will have the best opportunity for good control of your allergy symptoms.
How long will the first visit take?
The first-day procedure will take between three to six hours. If there are no reactions during the escalation phase, your child may be eating a full serving of the allergenic food in six months or less.
Should routine allergy medications be stopped before the first-day procedure?
No. Patients should take all routine medications as they normally would during OIT.
What is the projected treatment protocol after the first day of OIT?
Progression of treatment is dependent on each individual patient’s reaction to the allergens. If everything goes well, the amount of the allergenic food ingested during the second to third month will increase, with a whole serving of the allergenic food possibly being ingested between the fourth to sixth months.
How often can the dose be increased?
The interval between dose increases is a minimum of seven days but may be longer if needed.
What time of day should home doses of the allergenic food be given?
We prefer doses are given in the morning, allowing monitoring of the effect all day. However doses can be given in the evening as long as the patient is observed for at least 2 hours. Doses should be given approximately 24 hours apart.
How long should my child stay awake after the evening dose?
Children should be observed for at least two hours after the dose is given. They should not be allowed to sleep during this time.
What should be done at home, on the day of the office visit for dose increase?
NEVER increase the dose at home. On the day of dose increase, hold the normal dose given at home.
If there is a reaction at home, what should I do?
Treat the reaction the same way you would any food reaction; give an antihistamine if there is just itching and administer the Epi-Pen® if there are other symptoms of anaphylaxis such as swelling or shortness of breath. Call us after the appropriate immediate intervention. We will give instructions on future dosing.
What if we are flying when the dose is due?
Do not administer the dose while flying. If you can administer the dose at least two hours before leaving for the airport, that will allow enough time to determine any reaction to the food before your flight. A letter explaining the procedure and need for food solutions for the Transportation Safety Authority is available upon request.
Does the food solution need refrigeration?
There are no preservatives in the food solution, thus it MUST be refrigerated.
What do I do if refrigeration is not maintained or if it smells or tastes different?
If the sample sits out for more than 30 minutes, or if it appears to have spoiled, the solution must be replaced. Please call the office. If replacement is made during regular office hours, there is no charge. If replacement must be made at night or on a weekend or holiday, there will be a charge of $150. This fee cannot be charged to your insurance and must be paid when you pick up the new solution.
What if I will be out of town and will need additional doses?
Call as soon as you know you will need more doses. You must be able to tell us the concentration and amount of the current dose. If a staff member needs to come in at night or on a weekend or holiday, there will be an additional charge of $150. This fee cannot be charged to your insurance.
What if my child is sick and can’t take the doses on schedule?
Call us immediately if your child becomes ill. The dose should not be given if he/she is sick. We will typically reduce the dose or hold it until there are at least two full days when there is no illness. After that, the provider will determine how to resume dosing.
What can I do to mask the taste of the food solution?
Taste is personal, so feel free to experiment. The peanut solution may be mixed with Crystal Light® or cranberry-grape juice; please let us know the flavor your child would prefer at their first appointment. Try to give the dose in one bite to ensure that the entire dose of oral immunotherapy mixture is taken. Once your child is on solid peanuts, dark chocolate can help mask the taste.
What is the goal of this process?
The number-one goal is safety; to allow the patient to ingest foods that contain the allergenic without reactions or worry.
What is the follow-up schedule when maintenance dosing is reached?
It will take several months of weekly visits until you have reached the maintenance dose. When the full dose has been reached, there is a follow-up at one month (with lab) and then every three to six months. Food-specific IgE levels will be drawn before starting OIT and early in maintenance dosing.
Does my child need to avoid exercise during the oral immunotherapy process?
Exercise should be avoided for at least two hours after dosing and doses should not be given immediately following exercise. Exercise around the time of dosing increases the chance of a reaction. Exercise restriction applies to both escalation and maintenance dosing. If exercise cannot be avoided during this time, then your child is not a candidate for OIT.
Can two oral immunotherapy foods, one on maintenance dose and one on increasing dose, be given at the same time?
Yes.
If my child is allergic to multiple foods, will completing OIT for one food help treat other food allergies?
Each OIT program is food-specific. Completing one program does not treat other food allergies. Ask your provider for more specific information for treating multiple food allergies.
How soon after completion of the oral immunotherapy process can a second oral immunotherapy program be performed for another food?
Your child may begin a second oral immunotherapy program after he/she has been stable on a maintenance dose for one month.
What if my child does not get immunizations or is behind on scheduled immunizations? Can he/she start the OIT program?
No. Your child must be up-to-date on all scheduled immunizations before starting any of the oral immunotherapy programs.
What age can a patient start?
We prefer to treat ages 4 and above for now.
How is the oral immunotherapy program billed and what does it cost?
The cost to you will depend on your insurance coverage. The very first visit with the doctor is billed as a new consult and any skin testing that is needed may be done at that time. In addition, any lab work that is needed will be ordered at that time. All of the desensitization visits are billed as a follow-up visit with rapid desensitization (95180). The actual reimbursement varies by insurance plan. We strongly advise you to contact your insurance carrier to understand what your insurance coverage is and what your actual cost will be prior to the desensitization visits. Our office will be happy to assist you if needed.
Contact
Dr. Christina Schwindt
Allergy & Asthma Associates of So Cal, Food Allergy Center
OIT Contact: Chante’ Phan (949) 364-2900 x1879
27800 Medical Center Road, Suite #244, Mission Viejo, CA. 92691
15785 Laguna Canyon Road, Suite #100, Irvine, CA 92618
https://www.facebook.com/allergyandasthmaassociatesofsoutherncalifornia/
Allergy & Asthma Associates of So Cal: Dr. William Berger, Dr. Warner Carr, Dr. Christina Schwindt
OIT Details
State: California
Treats single/multi allergens at once: Single
Offers SLIT for food allergens: No
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