The Tolerance Induction Program™ (TIP)

A safe and effective food allergy treatment that helps children and young adults overcome their severe food allergies, typically within 2.5 - 4 years.

Contents

How TIP Works

The Tolerance Induction Program (TIP) uses highly customized plans, supervised in-office visits at one of our California challenge clinics, and regulated at-home dosing to help patients achieve food freedom with a 99% success rate. Regardless of pre-existing conditions or the number of food allergies a patient has, TIP can help. TIP is available to patients from 18 months to 25 years of age.

By analyzing diagnostic data from thousands of food allergy patients, we effectively group patients based on their lab results and medical history. With this data, we discern the specific quantity of food allergen required to induce clinical anaphylaxis.

These findings provide an understanding of how your child's immune system reacts to 13 specific protein subgroups and help us develop the optimal treatment plan for your child.

Through the Tolerance Induction Program, patients will never begin by introducing their anaphylactic allergens but instead build tolerance through dosing biosimilar proteins. Biosimilar proteins are safe, non-allergic foods similar in molecular structure to a patient’s allergens.

The Snapshot

Using AI and machine learning, we analyze over a trillion data points to group or endotype your child's case and determine the severity and relationship of allergic proteins that affect your child. The snapshot is an individualized summary of this analysis and is the foundation for your treatment plan.

Snapshot

The snapshot consists of the following three categories of allergen sensitivity:

Anaphylactic
If your child eats a very small amount of food in the anaphylactic column, they have a 95% chance of suffering an anaphylactic grade 2 reaction. An anaphylactic reaction involves two body systems (i.e., hives and difficulty breathing, hives and vomiting, etc.).

Sensitized
Foods in the sensitized column will produce allergic pathways and proteins in your child’s blood if they eat a large amount of that food. Patients can likely consume foods on the right side of the sensitized column with no clinical reaction. However, foods on the left side of the column are more likely to cause a grade 1 reaction or a reaction involving one body system (i.e., hives, rash, stomach pain, nausea, etc.). 

Tolerant
If food falls into the tolerant column, it means that large, infrequent ingestion of that food will not elicit an allergic reaction from your child’s immune system. The goal of treatment is to move all foods to this column.

Why are some foods in both columns?
Columns are represented as a percentage. Based on your child's analysis, some foods may not fall into one group. For example, if “seeds” is 20% sensitized, the bar will be 20% in the sensitized column and 80% in the tolerance column.

The Stages of TIP

Pre-Treatment

Pre-treatment will include a recommended diet of foods, some of which your child likely already eats, in a set amount 3-5 times per week.

Conditioning

Conditioning involves passing a “high dose” of foods in the sensitized column on your child's snapshot. After safely passing challenges to these foods that contain key or biosimilar proteins, such as albumins, your child's “food cluster” is pulled toward the tolerant column. Treating these biosimilar proteins shifts anaphylactic proteins from the anaphylactic column to the sensitized column, making treatment of these proteins safer and more successful. 

 

Tolerance Induction

Using complex data analytics and statistics, your child will undergo tolerance induction for the proteins they are anaphylactic to. The first dose is introduced in the Food Allergy Institute clinic, and every subsequent dose is administered at home. Passing every up-dose predicts your child's ability to pass the next up-dose, eventually leading to a full challenge pass. No guesswork is done here. Your child's data analysis predicts their path to success. Once a challenge is passed, your child will eat a maintenance dose of that food for a period of time until their blood work reveals tolerance. At this point, daily dosing will become less frequent.

Remission

Remission is achieved when all food allergens are moved to the tolerant column. This means your child will only have weekly maintenance dosing and can eat food safely whenever they want without restrictions or the need to read labels.

a typical day in TIP

When you are not visiting the clinic it will be important to be following your plan at home. If indicated, patients will use SLIT in the morning after brushing their teeth. After the waiting period, patients will eat all maintenance foods for breakfast. Some patients will make these foods into cookies, bread, muffins, or pancakes. Give recommended foods for snacks or with lunch. Finally, give treatment foods around dinner time, followed by the rest period.

If your child participates in physical extracurricular activities like sports, it is generally better to do treatment foods after their activity. Your goal for successful treatment is 80-100% compliance. Missing a dose once in a while is acceptable. Missing doses regularly will impact the program and significantly increase the length of treatment. 

Recommended foods are preconditioned foods that are considered safe foods that your child can have at any time throughout the day and should be having at least 3-5 times a week. Most recommended foods include apples, pears, and stone fruits or pitted fruits. These fruits can be fresh, frozen, or dried. A serving size of these fruits should be an amount equal to your child's fist size. For the fruits to be useful, they may not be cooked, baked, or heated. The skins of the fruits are important to include. Although there are many stone fruits to choose from, the most useful ones for treating your child include cherries, apricots, peaches, nectarines, plums, and olives. Other pitted fruits, such as mango and dates, are not as helpful as the other choices for pre-treatment. Bartlett or Anjou are preferable choices for pears.

Maintenance foods are foods that your child has challenged in the clinic and passed. These foods should be eaten every morning. The minimum amount of this food is noted in your maintenance foods list. Your child can have more than this minimum amount unless it is capped. Capped foods mean that your child should consume exactly the prescribed amount, no more and no less.

Treatment foods are foods in your child's food dosing strategy. Your child will be introduced to these foods in small amounts in a monitored setting at the clinic. You will then dose them at home in increasing amounts over the course of weeks between visits. While at home, these foods should be given in the afternoon or evening, at least 4 hours apart from Maintenance foods. After dosing these foods, your child will require a 60-minute rest period.

Visiting the Clinic

At the Food Allergy Institute, we have assembled a team of highly skilled providers dedicated to supporting your child on their path to food freedom. We prioritize the patient experience and ensure continuity of care by assigning each patient to a dedicated pod and a team of providers who will be there every step of the way during treatment. Having a familiar face who understands the unique aspects of your child's case is crucial for their success in our program.

Our institute offers specialized support from pulmonologists, allergists, immunologists, and gastroenterologists to cater to the specific needs of our patients. While we are more than happy to collaborate with specialists and primary physicians to advocate for our patients' best interests, please note that we do not serve as your child's primary care provider.

Treatment Zones

To provide convenience for our patients traveling to FAI, the frequency and number of challenges in your treatment plan may vary based on your location. The treatment plan will be customized to suit your child's needs and will be established during your initial appointments. Strict adherence to the treatment plan is crucial, as any deviation could potentially prolong the duration of the treatment. To better understand the frequency of clinic visits, please indicate your residing zone.

Pacific/Mountain Time Zones With convenient access to clinics in Long Beach and San Diego, local patients can easily take steps towards food freedom. Zone 1 patients visit the clinic in person every 6 - 8 weeks for 1 - 2 days of challenge appointments.

Central/Eastern Time Zones and Hawaii/Alaska With convenient proximity to  LAX, LGB, SNA, and SAN airports, our program is easily accessible to patients nationwide. Zone 2 patients visit the clinic in person every 9 - 12 weeks for 3 - 5 days of appointments. 

International With convenient proximity to  LAX, LGB, SNA, and SAN airports, our program is easily accessible to international patients. Patients visit the clinic in person 4 times per year, every 9 - 12 weeks for 3 - 5 days of appointments.

If you are traveling to our clinic, check out our travel guide page for discounts on allergy-friendly places to stay, allergy-friendly restaurants, and what to do in the surrounding areas during your visit.

Appointments

01 Tele-Boarding Virtual Call

Purpose
This first visit will be completed via a video call with one of our physicians to review your child's current food consumption, medical history, and to answer your basic questions about the program.


During Teleboarding, we will validate information from the Food Intake Questionnaire to ensure the accuracy of your child's food dosing strategy.
Additionally, this visit addresses medical questions, particularly around medications that may impact treatment and other medical conditions that may or may not be related to the lungs, GI tract, and skin.

Food Intake Questionnaire 
During enrollment, you will be asked to fill out a detailed history of your child's consumption. This is the most important first step in the program, understanding consumption patterns and food introduction is crucial to the creation of your child's medical plan. The foods that your child is currently eating will be recorded. You will be asked details about how much they eat and how often they are consumed.

Medical history
Collecting your child's medical history and evaluating them for potentially undiagnosed conditions is important at this stage. Although it may not seem applicable, almost any condition can potentially affect the success of their treatment plan. It is important for us to know as much about their medical history as possible, both regarding their allergies but also in all other areas such as gastrointestinal, pulmonary, cardiovascular, endocrine, and psychological.

02 Onboarding

Purpose
During this first in-person visit we will conduct extensive diagnostics to obtain a complete picture of your child's immune system and allergic profile.

All patients receiving TIP treatment will need a full evaluation of their system. This includes skin prick testing and blood testing that allows our medical team to evaluate over 300 biomarkers for your child. The result of the intake process is a molecular snapshot of how your child's immune system views allergens. These results will be presented at your Launch Visit.

Onboarding is the first direct interaction your child has with the program. This includes an interview process which is built on your Tele-Boarding Visit results. It also includes a physical exam, a skin prick test, and blood testing. The results from the diagnostic testing and other data analytics that we gather will help us determine the safest treatment plan for your child. These results will be presented at your next appointment, your Launch Visit.

Type of Testing During Visit
Blood Testing: Maximum blood laboratory testing is completed at our facility. We collect third-generation component-resolved diagnostic blood tests to identify IgE specific to individual proteins within an allergic food. This improves predictive clinical reactivity. Additionally, specific IgE blood testing (RAST or immunoassays) identifies IgE to whole allergens.

Skin Prick Test: Skin prick tests provide important information about IgE-mediated allergies, which are one of the many data points that help us design a custom treatment plan for each patient. This diagnostic tool utilizes a sharp prong to superficially break the skin and allow measurement of the histamine response to specific food allergens.

Patients will have the skin prick test performed on their back at our clinic. The pricks are made with a sharp edge, not a needle. Results are collected and given to parents at their Onboarding Visit. While this test provides useful data, it is only one aspect of the patient's complete allergic profile.

Frequently Asked Questions
Although you will likely have lots of questions during the Tele-Boarding call regarding your child and TIP, we may not be able to answer all of them without having all of your child's data. This is our discovery call, learning about your child and collecting all of the information allows us to tailor the diagnostic testing and build their unique allergic profile. Once this information is collected and analyzed at your Launch Visit, we will be better equipped to answer all of your questions. 

How long will my program be?
There are a number of factors that determine the length of treatment. Age, severity of allergens, type of allergen, family history, health history, etc. are all considered when designing your child's unique protocol. The length of treatment will vary based on each child's individual plan.

Why do I have to test at/with TPIRC Diagnostics? 
TPIRC Diagnostics is a CLIA and COLA Certified, high complexity laboratory focused on supporting the diagnostic requirements for our treatment. Our lab is currently the only diagnostic facility that is able to perform the complete set of tests necessary to develop and maintain the treatment plans utilized in the Tolerance Induction Program. Our pediatric phlebotomists perform the blood draw at the clinic after you have completed your clinic appointment. 

When will I get the results?
You will receive a complete copy of your child's test results at your Launch Visit.

How often will my child need repeat blood testing? 
Generally, patients have repeat labs and a full analysis completed every 1-2 years. Like other medical conditions, therapeutic monitoring is key to safety and successful treatment.

Why does there need to be repeat lab testing?
Tests will be compared to the same tests that were obtained before starting treatment so we can evaluate changes in your child's immune system and see how it has responded to conditioning treatment in preparation for tolerance induction. The results will be analyzed to confirm the appropriate response of the immune system has occurred. TIP is based on mathematical data analytics, not guesswork. Tracking these changes over time ensures the safety of our patients. Adjustments to the treatment of anaphylactic food will be made based on these lab results.

Will I see the same physician throughout my treatment?
While in our program, your child will meet with many members of our team. Through our Pod Model, we use data analytics to assign your child to the pod that is best for them after their Launch appointment. The pod allows your child to see the same medical assistants and providers during each visit.

Will we get to meet Dr. Randhawa?
Though Dr. Randhawa is not able to see every patient, he is very involved in the program and creates the treatment plans for every patient. All of our providers are trained to execute and implement the treatment plans in a safe manner. 

Does my child have to stop eating certain foods during the program?
Generally, we recommend continuing your child's current diet. The physician may make recommendations based on your child's specific case, but we typically recommend to continue to eat the foods they have been consuming previously without symptoms. Remember that decisions made for treatment consider a combination of all data that is being collected.

When and Where Will My Onboarding Visit Be?
Your Onboarding Visit will occur 2 - 4 weeks after your Tele-Boarding Visit at one of our California clinics. 

Will my child need SLIT?
Pre-treatment may also include targeted treatment (specific to your child's case) of environmental allergies utilizing Sublingual Immunotherapy (SLIT). SLIT is a safe and effective approach that has been used to treat environmental allergies for over 60 years. Approximately 45% of our patients are required to go on SLIT to facilitate their food allergy treatment process. Your family will be instructed if your plan requires SLIT. This is generally discussed at your Launch Visit.

Do I have to stop all antihistamines prior to Onboarding?
Please stop using topical antihistamines and oral antihistamines 7 days prior to the skin prick test as these medications can interfere with the accuracy of results.

Next Visit
You will schedule your next visit, which is your Launch appointment at the conclusion of your Onboarding appointment:

Zone 1: This appointment is 2 days in length, approximately 8 weeks from your onboarding. 
Zones 2/3: This appointment is 5 days in length, approximately 12 weeks from your onboarding.

During your Launch Visit, a physician will review your child's results and TIP treatment plan with you.

03 Launch

Purpose
The Launch Visit allows our providers to collect your child's data, create their individualized dosing strategy, and make recommendations to prepare their system for food immunotherapy.

What will I receive at my Launch appointment?
  • Your child's blood test results
  • Your child's snapshot
  • Your child's food dosing strategy

Throughout your child's 2-5 day Launch Visit, your child will undergo a 24-hour patch test and meet with one of our physicians to review the results and their treatment plan, based on our analytics. Patients will also complete their first Food Challenge at this visit.

 

Zone 1: This appointment is 2 days in length, approximately 8 weeks from your onboarding. 
Zones 2/3: This appointment is 5 days in length, approximately 12 weeks from your onboarding.

Day 1: Patch Day
During day 1, a patch that contains physical food allergens will be placed on your child's back. This enclosed patch will remain on your child's back for 24 hours. This allows us to assess how your child's GI tract reacts to various allergens. Please keep the patch clean and dry, avoiding bathing and any heavy activity or sweating during the test. Children 7 years of age and older will have a Pulmonary Function Test (PFT). 

What is a Patch Test?
Patch tests are used to detect possible food allergies and gastrointestinal sensitivities. The patch test measures conserved, innate immune responses to food allergens via the closed (air-tight) application of food allergens to the skin, followed by measurement of the immune response 24 hours later.

The patch test allows FAI to assess how the patient's gastrointestinal tract reacts to various allergens, as the dendritic cells in the skin mimic those in the stomach. This test differs from ImmunoCap blood tests or skin prick tests, which are used to evaluate immediate reactions that may result in symptoms such as hives or anaphylaxis.

Combining patch testing and skin prick testing helps us identify foods that are causing allergic symptoms. This appointment lasts approximately 30 minutes. The enclosed patch will remain on your child's back for 24 hours, and the results will be ready the next day, at your Launch appointment.

What allergens are in the patch test?
The same allergens on the skin prick test are on the patch test. The patch test is testing for a different immune response than the skin prick test.

Has anyone had anaphylaxis due to the patch test?
We have placed thousands of patch tests and have never had a patient who developed anaphylaxis due to a patch test.

Can I give an antihistamine if it is itchy?
Yes, you can give Benadryl if your child is experiencing itching. This will not interfere with the test results.

Pulmonary Function Testing (PFT)

What is a PFT?
Pulmonary Function Testing (PFT) is a well-established modality of testing for evaluating lung volume, capacity, rates of flow, and gas exchange. An exhaled Nitric Oxide test (Fractional Concentration of Exhaled Nitric Oxide Oxide - FeNO) can assist with determining how much inflammation is present in the airways.

Why does my child need a PFT?
Children 7 years of age and older will have a Pulmonary Function Test (PFT) and exhaled Nitric Oxide (ENO) test completed. Children younger than 6 are generally not developmentally capable of completing the tests as they require a level of coordination. These tests are performed so that we can evaluate your child's airway reactivity and identify potential complications in an effort to maximize safety.

How often will my child need a PFT?
These tests will be performed periodically throughout treatment based on your child's specific needs.

Day 2: Launch Day
During your Launch day, your patch is removed and results are recorded while you meet with one of our physicians to review the results and your child's treatment plan. Our staff will thoroughly review your at-home dosing regimen with you, and your child will complete their first food challenge.

Day 3-5: Food Challenges
Zone 2/3 patients will have 3 additional days of food challenge appointments scheduled during their Launch Visit. 

With a complete diagnostic profile completed at the Launch Visit, our physicians are now able to better answer questions about your child and their individual plans. If you have any questions about the program, our physician will be happy to answer those for you at this visit.

Next Visit 
Once your Launch Visit is complete, you will enter the next phase of the program - Food Challenges.

04 Food Challenges

Purpose
The goal of a Food Challenge Visit is to appropriately cross-match your child's highest-risk food allergens to associated biosimilar proteins, which were measured during the intake process of the program.

If your child is successfully exposed to proteins at home, their chance of passing their calculated challenge is over 95%. However, safety is always our top priority. Your child's first exposure to any food will always occur in our center. Subsequent dose exposure will be graded and targeted against the amount of time it takes for your child's system to adapt.

At the end of a treatment cycle, your child will undergo a monitored, safe, comprehensive food challenge to a predetermined large amount of food protein, which then closes that cycle of treatment. Your child will repeat these cycles over months to years, ultimately reaching tolerance visits and remission.

What is a challenge? 
A food challenge is a monitored office visit where your child will consume a large amount of a sensitized allergen followed by exercise to ensure safe consumption at home. After each challenge, these foods will move into your child's maintenance plan.

What is an Introduction?
Introductions are monitored office visits where we will introduce a new conditioning food in small amounts. These allergens are always given in higher amounts in the office compared to at-home dosing and will be monitored for 15 minutes. Introduction foods will be taken home and built up over the treatment weeks before returning to the clinic to challenge larger dose amounts.

The Visit - Food Challenges
During Food Challenge Visits, your child will come into the clinic for a monitored consumption of an allergen they have been sensitized to with previous dosing.

After each successful challenge, these foods will move from dosing into your child's maintenance plan. We will also introduce new conditioning foods to your child during these visits, adding new allergens into your at-home dosing plan.

Each treatment plan requires a different number of visits to complete all Food Challenges. There will be a period of weeks (depending on zone) between each visit for your child to complete their at-home dosing plan before the next challenge.


Who will my challenge be with? 
Food Challenges are conducted by specialty, food allergy-trained Nurse Practitioners and Physician Assistants. Due to our specialty niches within allergy, our providers complete a specialized curriculum, training, and certification here at FAI.

How long are my visits? 
Challenge Visits are 60 minutes long. We can challenge a total of 3 foods safely. If your child is a slow eater or requires more time, please consider booking additional challenge days to complete these foods.


What will my challenge visit look like?
At the beginning of the visit, your provider will review your child’s progress, illnesses, and issues. Your provider will perform a physical exam to make sure he/she is ready for the visit. Your child will challenge foods you have been dosing at home in higher amounts and introduce new foods while our providers monitor how your child’s system responds. After the challenges and introduction are complete, your provider will review your child’s plan for the next dosing cycle.

Gummy Dosing
While your child is building on small, milligram amounts of doses, they will be provided in gummy form until your child is ready to start larger doses. The Tolerance Induction Program fee will include the food dosing for at-home dosing and in-house food challenges. We provide our patients with pharmaceutical-grade gummy doses for their at-home regimens for all doses that cannot be measured on a traditional measuring spoon set. 

What is a TIP Gummy?
TIP gummies are a fun and tasty way to fight food allergies! Each of our gummies contain a milligram amount of a nut, grain, seed, or legume. They also come in a variety of colors, shapes, flavors, and sizes so our patients can easily know what they're eating! In total, we have 143 unique gummy products that we provide our patients! Each of these products were developed specifically for our patients by our TIP specialized Food Laboratory Scientists.

Why a gummy?
Safety is our top priority. Through the use of mathematics and predictive analytics, we use each child's data to devise a treatment process that is specifically tailored to his or her immune system -- down to the milligram of food protein for each dose throughout the program. As we expand, it is vital to the program that we continue to produce these doses with near-zero error and that we continue to automate the process in order to meet the growing demand as we increase access to more families. The gelatin process allows for accomplishing each of these objectives.

What is in the gummy?
Aside from the specific nut proteins, which are sourced from organic companies and prepared to avoid cross-contamination, they are beef gelatin-based and required for the program. Gummies contain beef gelatin, sugar, food coloring, and safe preservatives (ingredients are consistent with those found in Jello brand gelatin found at grocery stores). These ingredients are used to differentiate each nut, provide the appropriate doses, and extend the gummies' shelf lives. Gummies are required for the program. 

Do I have to use the gummy?
Certain allergy doses are required to be given in gummy form. Gummy dosing is not optional. Gummy doses are a component of quality control and part of the TIP program. Preferences to avoid sugar and/or food dyes are not approved exceptions.

Please be advised that all gummies are beef gelatin based, no exceptions. If the consumption of animal products is necessary to ensure the patient safely reaches tolerance, we may ask the patient to consume animal products.  For religious purposes, patients are asked to request an exemption from their religious leader. 

In some cases, patients with severe beef allergy will not be given gummies until successfully clearing their beef allergy with microdosing of the actual protein. This is determined on a case by case basis.
How long will I be on gummy dosing?
When dosing small milligram amounts, your child will be treated with gummies. Once your child successfully progresses to large protein amounts, you will no longer dose with gummies and instead measure these proteins in teaspoon amounts.

Next Visit
You will repeat Food Challenge cycles over months to years of time. Once you have successfully challenged and moved each allergen to Tolerant on your snap shot, you will schedule your first of two Tolerance appointments. 

05 Tolerance

Purpose
Tolerance is defined as an immunological state where your child can consume previously anaphylactic foods at large dose exposures without any clinical reactivity or negative immunological responses.

The process of tolerance is measured from the beginning of the program, through analytics and lab results, to Tolerance Visits. At this time, the immune system is put through a state of stress, preparing it for remission.

During this phase of your program, your provider will encourage you to try something new one day of every week! Stop reading food labels, eat cross-contaminated foods, and enjoy the final step towards food freedom.

Tolerance Challenges ramp up your child's most allergic protein or proteins followed by a scheduled day to stress the immune system with a variability of protein exposure. This is an important step in long-term Remission success.


Tolerance Visit 1 
Tolerance Visit 1 is generally the last “visit” listed on your child's food dosing strategy.

Tolerance Visit 2 
Tolerance Visit 2 is the following visit and the visit prior to reaching Remission.

Why are there Tolerance Visits?
During the challenge cycles, your child needs daily exposure to proteins. In the next stage of TIP, your child will undergo a systematic transition away from daily protein exposure and will reduce their frequency of maintenance foods. This crucial transition phase prepares their immune system for successful sustained immune unresponsiveness during Remission. Routine exposure is key in keeping the tolerance your child has built up during the program.

The end of recommended foods
With a successful transition into Tolerance, the good news is that recommended foods will be a thing of the past! Although we always encourage a healthy snack, these foods will no longer be an important part of your TIP journey.

Next 
You will then come for your Remission Visit, the final visit before achieving Food Freedom! 

06 Remission

Purpose
Remission is a scientific and immunologic term defined as sustained unresponsiveness. Remission is signaled by a seven-day period between which your child ingests a very large serving of a previously anaphylactic food without any clinical or immunologic reaction. Seven days later, the same ingested amount results in the same response without any exposure in between the seven-day period.

This model of weekly dose exposure at high amounts inducing sustained unresponsiveness is critical to the Tolerance Induction Program. Your child will be reevaluated on an annual basis to review their state of remission.

What is TIP Remission?
Remission is the absence of signs or symptoms of a disease process. TIP Remission is a state of immune unresponsiveness with once-weekly protein exposures. This simply means that your child will essentially eat like a non-allergic person.

Remission Visit 1
This visit is your first Remission Visit. This is a large challenge to your child's highest allergen or allergens. Once your child successfully completes this challenge, all of the maintenance foods move to once weekly. The Remission Visit is essentially a stress test of your child's immune system. We are testing its ability to handle normal variations of exposure in your child's regular diet. Once your child has successfully completed the challenge and monitoring period, they are in Remission and free to eat whatever they want!

Maintenance Changes
Your provider will go over any additional maintenance and plan changes. They will review how to handle changes in your day-to-day routine. Since this will be the last time we see you until next year, we want to ensure you have the information you need.

What's Next?
Remission is the final TIP phase. This is when your child reaches food freedom! Once you have reached Remission, your child can eat like a non-allergic person. We do require annual visits and diagnostic testing so we can continue to monitor your child's system and adjust their maintenance plan as needed.

Annual Remission Visits
Like all other medical conditions, it is important to have annual checkups to ensure that your child's tolerance levels are on the right track. These visits ensure that all of your hard work, time, and investment into food freedom lasts a lifetime. If consuming your child's prior allergen weekly is going well, there is a good chance we can space out your dose intervals to every two weeks and beyond once their body is ready. 

Once in Remission, it is still important for your child to continue consuming their dosing/allergens, since we want them to maintain their state of immune unresponsiveness. 

Lifelong Remission
We are committed to lasting Food Freedom for all of our patients. We understand the amount of time and effort that went into reaching Remission. Our journey with you doesn't end there. We are committed to keeping our patients in Remission for life. That means we will continue to follow patients for the rest of their lives to ensure that they stay in Remission.

 

Program Cost

While in Active Treatment, you will be financially responsible for three distinct aspects of the Tolerance Induction Program™: 

1. TIP Fee - $4,800 annually (may be paid monthly in $400 installments or quarterly in $1,200 installments)
2. Clinical Fees (clinical visits and procedures, quantity will vary per individual plan) $7,740 per year 1, $5,220 annually thereafter
3. TPIRC Diagnostic Services fees (a minimum of one annual comprehensive laboratory visit every 1.5 years) $2,500 

Average program costs are $1,100 monthly for the duration of the program, which is billed separately: Portions of Clinical and TPIRC Diagnostic Services fees may be covered by your insurance. We are in network with most major PPOs. Kaiser and most HMOs are out of network plans.Fees-02

 

Please contact your insurance company directly to determine if the Food Allergy Institute is within your network and considered a participating provider under your plan.  To assist you with this verification, please see the Billing Entity, Service List, and Fee Schedule below.

Each plan is tailored to the individual patient, with 8-12 in-clinic food challenges annually. Visit cadence and length varies by zone. Please select your zone below for a breakdown of visit types and costs:

  • Zone 1: Pacific / Mountain Time Zones
  • Zone 2: Central / Eastern / Hawaii / Alaska Time Zones
  • Zone 3: International
Zone 1 Service & Fee List

To obtain details about insurance coverage, we recommend reaching out to your insurance provider by using the contact number provided on the back of your insurance card. Please provide them with the CPT codes listed and the information below.

Zone 1 patients visit the clinic in person every 6 - 8 weeks for 1 - 2 days of challenge appointments.


TPIRC Medical Foundation, Inc.
701 E. 28th Street, Suite 419 Long Beach, CA 90806-2759
NPI: 1225611312
Tax Id: 86-3638185

 

Estimated cost of  TIP year one

YEAR ONE

CPT Code

Total Fee

01 Teleboarding 

   

Virtual Visit

99442

$95

 

Visit Cost

$95

02 Onboarding

 

 

Office Visit (New)

99205

$450

Skin Prick Test (19 Allergens)

95018

$950

TPIRC Diagnostic Services (Lab Test)

-

$2,500

 

Visit Cost

$3,900

03 Launch 

   

Office Visit 

99215

$240

Patch Test (25 Allergens)

95044

$625

PFT

94010

$120

ENO Test

95012

$40

Challenge Visit (Office + Food Visit 1 Days)

99215 + 95076

$435

 

Visit Cost

$1,460

04 Food Challenges Remission & Tolerance Visits 

Challenge Visit (Office + Food Visit)

99215 + 95076

$435 ea

*In clinic every 6 - 8 weeks, 

11 Visits / $435 per Visit

Yearly Cost of Visits

$4,785

Annual TIP Fee 

   

Tolerance Induction Program Fee

 

$4,800

 

Year 1 Total 

$15,040

 

Estimated cost of  TIP years 2 +

YEAR 2 +

CPT Code

Fee

Diagnostic Test (every 1.5 yrs)

TPIRC Diagnostic Services (Lab Test)

Attached

$2,500

 

Visit Cost

$2,500

04 Food Challenges Remission & Tolerance Visits 

Challenge Visit (Office + Food) 

99215 + 95076

$435 ea

*In clinic every 6 - 8 weeks, 

12 Visits / $435 per Visit

Yearly Cost of Visits

$5,220

Annual TIP Fee 

Tolerance Induction Program Fee

 

$4,800

 

Year 2 + Total 

$12,520

 

Estimated cost of TIP during remission 

REMISSION

CPT Code

Fee

Annual Visit

Office Visit

99215

$240

Skin Prick Test (19 Allergens)

95018

$950

TPIRC Diagnostic Services (Lab Test)

-

$2,500

Telehealth Visit

99443

$240

 

Visit Cost

$3,930

Annual TIP Fee 

Tolerance Induction Program Fee

 

$375

 

Remission Total 

$4,305

*Number of in-clinic food challenges may vary depending on the individual patient and their plan; patients can expect 8 - 12 in-clinic food challenges per year.

Additional Out-of-Pocket Costs

Some patients will require the use of SLIT (Sublingual Immunotherapy) during the course of treatment; the cost of SLIT averages $300 per quarter / $1200 per year.  

 

Zone 2 / 3 Service & Fee List

To obtain details about insurance coverage, we recommend reaching out to your insurance provider by using the contact number provided on the back of your insurance card. Please provide them with the CPT codes listed and the information below.

 Zone 2/3 patients visit the clinic in person every 9 - 12 weeks for 3 - 5 days of appointments. 

 

TPIRC Medical Foundation, Inc.
701 E. 28th Street, Suite 419 Long Beach, CA 90806-2759
NPI: 1225611312
Tax Id: 86-3638185

 

Estimated cost of TIP year 1

YEAR ONE

CPT Code

Total Fee

01 Teleboarding 

   

Virtual Visit

99442

$95

 

Visit Cost

$95

02 Onboarding

 

 

Office Visit (New)

99205

$450

Skin Prick Test (19 Allergens)

95018

$950

TPIRC Diagnostic Services (Lab Test)

-

$2,500

 

Visit Cost

$3,900

03 Launch 

   

Office Visit 

99215

$240

Patch Test (25 Allergens)

95044

$625

PFT

94010

$120

ENO Test

95012

$40

Challenge Visit (Office + Food Visit 4 Days)

99215 + 95076

$1,740

 

Visit Cost

$2,765

04 Food Challenges Remission & Tolerance Visits 

Challenge Visit (Office + Food Visit)

99215 + 95076

$435 ea

*Zone 2 In clinic every 9 - 12 weeks, 12 Visits / $435 per day

*Zone 3 In clinic every 9 - 12 weeks, 12 Visits / $435 per day

Yearly Cost of Visits

$3,480

Annual TIP Fee 

   

Tolerance Induction Program Fee

 

$4,800

 

Year 1 Total 

$15,040

 

Estimated cost of TIP year 2 +

YEAR 2 +

CPT Code

Fee

Diagnostic Test (every 1.5 yrs)

TPIRC Diagnostic Services (Lab Test)

Attached

$2,500

 

Visit Cost

$2,500

04 Food Challenges Remission & Tolerance Visits 

Challenge Visit (Office + Food) 

99215 + 95076

$435 ea

*In clinic every 9 -12 weeks

12 Visits / $435 per Visit

Yearly Cost of Visits

$5,220

Annual TIP Fee 

Tolerance Induction Program Fee

 

$4,800

 

Year 2 + Total 

$12,520

 

Estimated cost of TIP during remission 

REMISSION

CPT Code

Fee

Annual Visit

Office Visit

99215

$240

Skin Prick Test (19 Allergens)

95018

$950

TPIRC Diagnostic Services (Lab Test)

-

$2,500

Telehealth Visit

99443

$240

 

Visit Cost

$3,930

Annual TIP Fee 

Tolerance Induction Program Fee

 

$375

 

Remission Total 

$4,305

*Number of in-clinic food challenges may vary depending on the individual patient and their plan; patients can expect 8 - 12 in-clinic food challenges per year.

Additional Out-of-Pocket Costs

Some patients will require the use of SLIT (Sublingual Immunotherapy) during the course of treatment; the cost of SLIT averages $300 per quarter / $1200 per year.
In-network PPO plans
Dependent on your exact plan, Food Allergy Institute clinical services is typically in-network with the following carriers:
  • Aetna 
  • Meritain Health (Aetna)
  • Cigna
  • Health Partners (Cigna)
  • Blue Shield of California
  • Anthem Blue Cross of California
  • United Healthcare
  • Oxford Health 
  • UMR
  • Healthnet of California
  • Multiplan
  • First Health 
  • Blue Cross Blue Shield (Outside of CA)
  • Tricare
Services Your Insurance Will Cover  

The following information has been prepared to help you understand how we work together to make sure you have the information you need to meet your financial responsibilities for the care and services you receive. 

Portions of Clinical and TPIRC Diagnostic Services fees may be covered by your insurance. Food Allergy Institute is in network with most major PPOs. Kaiser and most HMOs are out of network plans and will not be covered, you will be billed at cash pay rates.

Know Which Services Your Insurance Will Cover  
Insurance may cover portions of your clinic fees and lab draw. The TIP Fee will always be an out of pocket expense. To determine your clinic and lab financial responsibility in advance of your consultation, please submit your insurance card using the link provided. You can also use the list of CPT codes to contact your insurance company directly.

Health insurance coverage is a contract between you and your insurance company. It is best if you know which services your insurance will cover before you receive care. If you’re not sure of your coverage, please ask your insurance company. Please refer to the information on the back of your insurance card for the contact number to member services.    

Insurance Billing

Contracted coverage: FAI contracts with several national insurance companies in the California region. If we are in your health plan’s network, our billing office will submit claims to your insurance company for the care and services you receive from us. You will be expected to pay any cost shares at the time of service.  

Non-contracted: You are responsible for the full cost of the care and services you receive. If you owe a balance, or if your insurance company does not pay your claim within 45 days, the balance will be billed to you. 

Copayments, Deductibles and Other Patient Cost Shares: Please plan to pay your copayment at the time you receive care or services. The amount charged will be based on your specific insurance plan. We may also ask you to pay any money owed for non-covered services, and any other cost shares at the time of service. If you are not able to pay these amounts at the time you receive care or services, you will receive a bill. The total amount you owe might change after your appointment, depending on the actual care or services you receive. You are responsible for all or part of the charges, based on your coverage and insurance plan. It is important to know that even if a service is covered, your insurance plan might not pay the charges in full.    

Care or Services Not Covered by Your Insurance Plan  
Not every service is covered by every insurance plan. Some or all the care or services you receive might not be covered or might not be considered medically necessary by your insurance plan. If that is the case, you will be responsible for the full cost. If you receive a service that is not covered, we will expect payment in full at the time of your visit.

Publications & Webinars

Published Evidence - Based Food Allergy Articles

Long Term Efficacy and Safety of Cow’s Milk Anaphylaxis Specific Immunotherapy: Allergen Unresponsiveness via the Tolerance Induction Program
https://www.jaci-global.org/article/S2772-8293(24)00081-X/fulltext

Food anaphylaxis diagnostic marker compilation in machine learning design and validation
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0283141

Demographic, clinical and diagnostic correlation of almond allergy in a cohort of nut allergy patients
https://doaj.org/article/ba7d1a7b606c4de7b8c966173a056c9f

Experimental evaluation of the importance of colonization history in early-life gut microbiota assembly
https://elifesciences.org/articles/36521

Correlation of negative skin-prick test results for tree nuts and successful tree nut challenges among children with peanut allergy
https://pubmed.ncbi.nlm.nih.gov/30401323/

Allergy Evaluation During Hospitalized Asthma Improves Disease Management Outcomes
https://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2018.197.1_MeetingAbstracts.A1427

Tolerance Induction Program Effect Explains Variation in Wheal Size, sIgE, andIgG4 in Peanut Allergic Children
https://www.researchgate.net/publication/335755783_Tolerance_Induction_Program_Effect_Explains_Variation_in_Wheal_Size_sIgE_and_IgG4_in_Peanut_Allergic_Children

Evaluating the potential allergenicity of dietary proteins using model strong to non-allergenic proteins in germ-free mice
https://pubmed.ncbi.nlm.nih.gov/32437892/

Tolerance Induction Program Q&A May 30, 2024 - Dr. Inderpal Randhawa

 

What is TIP Q&A April 20, 2024 Dr. Inderpal Randhawa
Exploring the Tolerance Induction Program Q&A March 23, 2024 - Dr. Tracy Clark

 

A Founders Call to Action - Dr. Inderpal Randhawa

 

Treating Food Allergies with the Tolerance Induction Program - Dr. Tracy Clark

 

Data Science and Food Allergy Treatment - Data Scientist Herman Sandhu

 

Evolving Perspectives on Food -Allergies Nathan Marsteller, PHD

Get Started Today

The Path To Food Freedom Is Simple: Appointments Available as Early as Next Week.
1. Pay your TIP Program Deposit
2. Submit the Food Intake, & Financial Acknowledgement forms.
3. Once received our team will schedule your onboarding visits.
4. Visit our lab for diagnostic testing.
5. Begin treatment at one of our Southern California clinics with your custom plan.
6. Build tolerance with at-home dosing.
7. Food Freedom: Eat Whatever, Whenever you want!

Click Submit Deposit below, call, or email us!

(562) 490-9900 option 2

enrollment@foodallergyinstitute.com

Have questions?  Request more information or schedule a call.