Oral Immunotherapy – The First Appointment
Oral Immunotherapy – The Second Appointment

For those who are still following along, you know that we are still in the early stages of our oral immunotherapy treatment.  So far we have not seen any reactions to the foods we’ve been assigned (pine nuts and chickpeas). We are still in the “prepping” stages to get her body strong and “ready for battle”. However, I know I will get increasingly nervous as we move into her more serious allergens.

After our second “two day” appointment, we were left with a detailed plan of care.  Going forward, this was what was expected from us at home:

  1. Daily dosing of allergy medications – 5 mg of Xyzal, and Flonase.
  2. Eat 3-5x per week – 1 apple, 1 pear, 1 stone fruit, 1/2 tsp wheat germ, and 1/4 tsp tahini sauce.
  3. Daily maintenance food – pine nuts (2o) << this will change with each appointment
  4. Daily treatment food – none yet << this will be added in subsequent appointments, but we’re not there yet.

This is a breakdown of Lil’ Miss Louboutin’s plan as we move forward:

  • Pine nut challenge (6 g) – in-office – done
  • Visit 1 – Chickpea challenge – in-office – done (and we’ve been continuing to dose both pine nuts and chickpeas daily at home until our next in office challenge, which is coming up soon)
  • Visit 2 – Brazil nut challenge
  • Visit 3 – Dosing for Almonds
  • Visit 4 – Dosing for Hazelnut
  • Visit 5 – Dosing for Soy
  • Visit 6 – Dosing for Coconut
  • Visit 7 – Dosing for Pecan
  • Visit 8 – Dosing for Walnut
  • Visit 9 – Dosing for Macadamia
  • Visit 10 – Dosing for Pistachio
  • Visit 11 – Dosing for Cashew
  • Visit 12 – Dosing for Peanut (80 mg)
  • Visit 13 – Dosing for Peanut (400 mg)
  • Visit 14 – Dosing for Peanut (2 g)
  • Visit 15 – Dosing for Peanut (10 g)

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We dose at home in-between visits, then at our next appointment, we’ll do an in-office food challenge under monitored conditions to ensure Lil’ Miss Louboutin “passes” before she’s allowed to move on and “dose up”.

As for logistics, we make sure to give her the maintenance foods (right now she has to eat 20 pine nuts and 12 chickpeas) first thing in the morning with breakfast because once they introduce treatment foods (we haven’t been assigned any yet), they require you to dose treatment foods in the afternoon. There also needs to be a 4 hour window between maintenance and treatment foods.

As for the foods she has to eat 3-5x a week, we usually give half a piece of fruit at breakfast (we don’t have that much time in the morning and half is about all we can get in), half with her school lunch, and the rest of the fruits when she comes back from school. Then after dinner, we’ll give her the tahini and wheat germ. All we do with these is get a spoonful of jam and mix in the tahini and wheat germ. The sweetness of the jam helps mask the taste and texture of tahini and wheatgerm.

We explored different ways to give her these foods before settling on this approach. At first we were mixing all of it in a smoothie, but it was a lot of smoothie to drink all at once, and it took her upwards of an hour to drink it. We also tried to mix the wheat germ and tahini in oatmeal, or in a sandwich with jam (like a mock PBJ), but she wasn’t a fan of any of those approaches. As for the medications, those are usually given to her right before bed. We’re glad we finally found a system that works for us, even though it required some trial and error.

Some questions people have asked that I will answer here:

  1. Is there a minimum age requirement to enroll in the program?  I asked Dr. Randhawa, and his response was that it really depends on the child’s ability to communicate and eat, which makes sense. I’m sure younger toddler-aged children can go through this, but it would pose some challenges with getting them to eat the necessary foods, and it would be a concern if they can’t communicate well that they are feeling symptoms like itchiness, tummy aches, and such.  Plus some of the longer office visits can make it hard too.
  2. Were Lil’ Miss Louboutin’s results what you expected based on your prior knowledge?  Honestly, no. We knew she was allergic to peanuts because of an actual reaction, confirmed through bloodwork. The blood panel we had done in the past also indicated that she had a slight walnut allergy, but it did not test for every single nut. Because of her peanut allergy, we had always just avoided ALL nuts. So we knew about her peanut and walnut allergies, but did not know about pistachio and cashew, and that she was even more allergic to those than walnuts.
  3. Can she do OIT for more than one allergen at a time? As you can see in the dosing schedule above, she is only doing one allergen at a time. However, in a sense they are tackling more than “one allergen” at a time because they are looking for the common denominator and protein profiles between allergens. So she is already indirectly building immunity to peanuts as she goes through this dosing schedule because it shares similar proteins with some of the other foods.
  4. How long will she be in the program for?  There are 15 challenge visits plus the first few intake visits, so it’s going to take us roughly 20 months if everything goes smoothly and she passes all in-office challenges as expected.

What do you think about this whole process so far? Any other questions?