A Window Into Oral Immunotherapy

Oral immunotherapy is still a relatively new “thing” in the food allergy world. To my knowledge, there are only two practices in Kansas City that offer this option. Oral immunotherapy (OIT) is a method of inducing your immune system to tolerate a food that it currently reacts to. It involves reintroducing the allergenic food to your system in gradually increasing amounts, with the goal of allowing you to eventually have exposure to the food without experiencing a reaction. 

I’m going to preface this blog post by saying that oral immunotherapy is not for everyone (and likely not possible for everyone). It has its pluses and minuses, and it’s not perfected (yet). My goal is simply to give you a window into what it’s like from the parent/family perspective, as that’s often what’s missing after a conversation with your provider.

Three weeks ago we started oral immunotherapy with our daughter for her peanut allergy after she failed an oral food challenge. Once she’s well established with that, we’ll start OIT for her pecan/walnut allergy as well. Our goal with all of this is simple: to arm her with everything we can to keep her safe (separate from just emergency medications), AND allow her to have as normal of a childhood experience as possible. If we’re being honest about it, food allergies can have a strong effect on the social side of life. If you’re afraid of going to a sleepover because you don’t know what food will be served, or can’t attend a birthday party because you’re allergic to shellfish and it’s at a seafood restaurant, it can hinder you from experiences.  And we want her to have those experiences. I’m not saying food allergy parents that choose not to undergo OIT don’t want their kids to have those experiences by any means, for some families it’s not a viable option (insurance coverage, too many allergies that can’t be desensitized, child refusal, etc.)

Not all allergens are possible with OIT yet, but luckily, nuts are pretty common practice. So here’s our journey and what it looks like:

It all starts at the allergist’s office:

DAY 1:

-       calm, quiet activities 30 minutes prior to dose

-       small dose of peanut flour is given, she’s watched for 1 hour at the office

-       we leave, and she’s monitored for 1 more hour

During OIT, it’s important that the patient do calm, quiet activities to keep from elevating the core body temperature or getting the immune system worked up. They’re also not allowed to sleep. It’s recommended that the patient take vitamin D and probiotics to support the gut and immune health. Depending on the severity of the allergen, the starting dose/how it’s administered orally may vary.

NEXT 2 WEEKS:

-       this same dose is given everyday, within a two hour window (with the same rules)

-       if the patient experiences symptoms, the dose may be extended for another week +

Typically after this two-week period, you go back to the allergist for an “up dose” and raise the amount of allergen administered orally so the immune system starts to build up a tolerance. Then you repeat the two weeks at home. In our experience, OIT will probably last 33 weeks for her peanut allergy. Depending on your allergy and how OIT is tolerated, the process could be shorter or longer.

So does this sound like a lot of effort? A bit. It’s about a 2.5-hour commitment everyday, with observations, supplements and trips to the doctor every two weeks. In my opinion is it worth it? Absolutely. Of course there are risks, for example she had a few hives after a dose last week and we had to administer Benadryl (not ideal). But for our family, the long-term reward outweighs the risk. Within one year she will be able to eat a few peanuts everyday, and not worry as much at restaurants. Someday restaurants may not be few and far between for her, but a regular outing. And who knows, her immune system may start to recognize peanuts as a friend instead of the enemy now that she’s eating them everyday—she may just outgrow the allergy.

Happy to discuss my experiences with anyone out there, and please share your own if you are going through OIT as well!

Until next time,

Meg