About Dr. Randhawa
Dr. Inderpal Randhawa is the Founder and CEO of Food Allergy Institute (formerly known as SoCal), a food allergy treatment center located in Long Beach, California, and the creator of the Tolerance Induction Program™, commonly known as TIP. He is a leading clinical academic scientist with five board certifications in transplant immunology, allergy, pulmonology, pediatrics, and internal medicine. Dr. Randhawa’s experience in lung transplant immunology inspired him to question if some of the same principles and methodologies could be applied in the food allergy community as a treatment option, ultimately leading to the creation of TIP. Watch our Insta Live Q+A with Dr. Randhawa to learn more!
What is the Tolerance Induction Program™?
The Tolerance Induction Program™, or TIP retrains a patient’s immune system to tolerate their allergens. TIP is a one-of-a-kind food allergy treatment program that enables children to freely eat their allergens and allows their families to go from strict avoidance to the freedom of no longer fearing an allergic reaction—we call this “Food Freedom”.
Patients begin treatment by building tolerance to proteins similar to their allergens, which prepares their immune system for the introduction of their actual allergens. We introduce the least sensitive allergen first and work through other allergens in order of sensitivity to lower their IgE numbers in preparation for their final and most sensitive allergen. This approach ultimately results in patients developing tolerance to all of their allergens.
What makes TIP unique?
Our program is unlike any others in many ways. To start, the goal of our program is to not only be safe in the event of an accidental exposure but to actually be able to freely eat your allergens. Each patient has a customized plan specific to their immune system which we also use to precisely predict the length of their treatment. Our approach incorporates a concept unique to our program that we call “protein matching”, which involves the use of proteins that are similar to a patient’s allergens to prepare their system for consumption of their actual allergens—our patients do not start consuming their allergens at the start of treatment. Our program allows us to treat multiple allergies at the same time and up-dosing is conducted in-home, resulting in fewer office visits. We also have a customer call center available 24/7 and have created gummies for dosing to make the program easier.
Is it safe?
Our program has an unmatched safety record and while reactions are very rare, we are prepared at all times. All of our patients are provided with an anaphylaxis plan kit and we have a call support center available 24/7. In over 50 million home doses, only 0.004% of our patients have administered epinephrine. Likewise, epinephrine has only needed to be administered at a very low rate during our in-office food challenges. 40% of our patients complete the program without a single symptom. The remaining 60% will have one to two episodes of Grade 1 symptoms (itching, flushing, small hives, swelling) that will either resolve on their own or may require an antihistamine.
Who is TIP right for?
We treat children ranging in age from 18 months to 21 years old and welcome all cases, regardless of the severity of their allergies or other conditions. While our offices are located in Long Beach, California, our patients come from as far away as Australia, Chile, and Malaysia. We’ve treated patients from across the U.S. and from 13 countries around the world.
Treatment overview
The goal of treatment is “food freedom”, or the ability to freely eat allergens without fear, restriction, reaction, or limitation. After completing the virtual enrollment process, patients will begin moving through the 5 stages of treatment: Onboarding, Pre-Treatment, Interface, Tolerance Induction, and Remission. During treatment, patients in the Pacific and Mountain time zones will visit our center every 6-8 weeks on average and patients located outside of these time zones, including international patients, will visit our center every 8-10 weeks on average.
Onboarding
The first step of treatment is a 90 minute in-person onboarding appointment that includes data collection and a consultation with a physician. The data we collect from testing during this appointment allows us to obtain a complete picture of each patient’s immune system and create their customized treatment plan. All patients will undergo blood work and skin testing during their first appointment, and other tests may also be performed depending on the individual.
Pre-Treatment
The Pre-Treatment phase begins with your second in-person appointment, a 2 day visit that will take place approximately 10 weeks after your lab work. We call this your Launch Visit. The first day will focus on patch placement, which takes approximately 10-15 minutes. Patch testing is done to assess how a patient’s gastrointestinal tract will react to various allergens.
The second day of your appointment typically takes 3-4 hours and includes removal of the patch, a food challenge of a food your child has tested negative for or never been exposed to, an overview of your child’s customized treatment plan, which includes the approximate length of their time in treatment and their Food Dosing Strategy, which will explain the order in which their allergens will be treated and challenged, as well as your child’s at-home dosing protocol.
Interface
The Interface phase involves our team finding foods with similar proteins to a patient’s allergens that they can eat without reaction to help them pass food challenges during the Tolerance Induction phase. The goal of Interface is to make Tolerance Induction safe, efficient, and as convenient as possible.
Tolerance Induction
The Tolerance Induction phase involves introducing the first dose of each new food at an in-clinic appointment where patients are fully monitored. These appointments are followed by at-home dosing. After a period of at-home dosing, patients will come in for a food challenge in the clinic. To reach maintenance for an allergen, a patient must pass a food challenge of an adult-sized dose. This process is followed for each of a patient’s allergens. Once a patient has passed their in-office food challenges, they’ve completed the program and graduate to the post-treatment maintenance phase, Remission.
Remission
In Remission, patients return for yearly follow-up appointments and keep up with a maintenance dose of their former allergens to remain tolerant. After eating the maintenance dose, your child can safely eat as much or as little of their former allergens as they want. There is no need to read labels or restrict their diet.
How long does treatment take?
Treatment will take 18-24 months on average but will vary based on a patient’s age, severity of their allergies, types of allergens, family history, and health history. Each patient will have a clear idea of how long their treatment will take at the end of their second visit and you can learn more about our average treatment cycle here.
Gummy dosing
To help make at-home dosing as safe, easy, and effective as possible we’ve created gummy dosing, a dosing method where allergens are consumed in flavored gummies. We know eating your allergens can be difficult and we think gummies are a game changer. Each allergen has its own flavor and comes in several different sizes and shapes of gummies for different dosing amounts. We currently have gummies available for 21 proteins including Tree Nuts (Almonds, Brazil Nuts, Cashews, Chestnuts, Hazelnuts, Macadamia Nuts, Pecans, Pine Nuts, Pistachios, and Walnuts), Seeds (Chia, Flax, Mustard, Sesame, and Sunflower), Legumes (Chickpea and Pea Protein), and Grains (Barley and Rye). Breaking news: we will be launching Peanut gummies next month! Gummy dosing is included in the TIP program fee.
How much does TIP cost?
There are 3 main fees involved in the program: the Tolerance Induction Program™ Fee, testing, and office visits. The Tolerance Induction Program™ fee is $1,125, per quarter or $4,500 per year. Each patient’s personalized treatment plan predicts how long their treatment will take to provide transparency upfront regarding the total cost. The program fee includes the work of the facility, analytics, research, food protein extraction, food preparation, challenge safety and much more. The first office visit will cost $450 and subsequent office visits will cost $435 each, which includes the $240 Office Visit Fee and a $195 food challenge fee. Testing costs include the skin testing and patch testing conducted during your first appointment, plus additional tests if any are required. Skin testing will cost approximately $2,000 and patch testing will cost approximately $1,000. If SLIT is part of your treatment plan, there may be additional fees. You can see a full cost breakdown for the program here.
Insurance coverage
Insurance coverage varies but we work directly with insurance companies to get as much of the treatment cost covered as possible. We accept various HMO insurances and most PPO insurances but it’s best to contact your insurance provider directly to verify coverage.
Financial support
We strive to make TIP accessible for as many patients as possible. Prospective patients can seek financial support through our medical grants or our Diversity Grant Fund, which aims to close the gap in severe food allergy care for Black children and their families.
FDA approval
We are currently in the process of submitting for FDA approval.
Plans to expand?
We will be opening a second location in San Diego early in 2022 and have a goal of opening additional locations in the Midwest and East Coast as well.
Can adults be treated?
Patients are able to start the program up to the day before they turn 21. We hope to be able to increase this age limit in the future.
Waitlist
While in the past our waitlist has exceeded a year or more, we’ve recently expanded our facilities and our current waitlist is now 2 months. You can sign up for our waitlist here.
What to expect while waiting
We’ll send you 1-2 emails weekly that aim to educate you about our program so you’re well informed by the time you reach the top of the waitlist.
Enrollment
Once you’re at the top of the list, your place will be reserved for 2 weeks and an enrollment specialist will reach out to help you enroll and schedule your onboarding appointment. If it’s not the right time for you to begin treatment, you’ll have the option to delay your decision by 30 or 60 days.
What’s next
We have some really exciting launches coming next month including long-awaited peanut gummies and an app for our patients. We know TIP can be time consuming and we’re always listening to our patients and trying to find ways to make any part of the process easier. We know a lot of patients will have to source foods for their treatment that can at times be hard to find and add to the expense of the program. With that in mind, we’re working on a co-op to provide a resource for patients that could make ordering these foods easier and hopefully provide discounts as well.
Stay connected
Learn more about the Food Allergy Institute on their website and find answers to any other questions about TIP in their FAQ. To keep up with the latest Food Allergy Institute news and events, sign up for their newsletter and follow Food Allergy Institute on Instagram and Facebook. See Dr Randhawa’s Spokin reviews and share your own on the Spokin app.
*Enrollment in TIP is required to be eligible to win.
