So You Want to Do Oral Immunotherapy?
When I was in fourth grade, I got the incredible opportunity to be part of an Oral Food Challenge, where I was essentially a subject in an Oral Immunotherapy test. For those of you who may not have heard of Oral Immunotherapy, it’s the only remedy for food allergies today (even if it definitely does not cure you of the allergies, as you will see later). It works by you ingesting a tiny amount of your allergen until your body builds tolerance to that amount and then increasing that amount until you get to a maintenance dose, which can be a decent-sized portion of your allergen (I am allergic to peanuts, cashews, and pistachios, and my maintenance dose is about 2.5 peanuts and 1.5 cashews).
Obviously, there’s no cure for food allergies right now, but what Oral Immunotherapy does is ensure that if you are to accidentally eat an allergen, you will probably not have to use epinephrine and go to the hospital as a result of the reaction. The catch to Oral Immunotherapy (OIT for short) is that, to maintain immunity, you have to eat a certain amount of your allergy every day (hence the term “maintenance dose,” which is how much of your allergen you consume every day), and must follow restrictions around the time of the day that you eat your allergen.
In this article, you will hear my experience with OIT; how much of a commitment it was, how difficult it was, and how successful it was and is to this day. So, after confirming that I would be part of the trial (which took place at Children’s Hospital Los Angeles), I first had to go through a series of double-blind food challenges to see exactly which nuts I was most allergic to (double-blind food challenges are basically where you don’t know what allergen you’re eating until afterward). At each one, I felt a little sick, and when I had cashews (each of these nuts were ground up and mixed into chocolate pudding), I actually started vomiting and had to use an EpiPen; luckily, these food challenges occurred in a hospital, so I was already in the perfect place (do NOT attempt to do food challenges or OIT by yourself and not in a hospital; it is extremely dangerous, for obvious reasons). Anyway, it transpired that I was most allergic to peanuts, cashews, and pistachios; however, because the components of cashews and pistachios that I was allergic to were actually the same component, I only needed to be immunized to cashews.
And so, I embarked on my journey of OIT. First, I was given Xolair, a medicine injected into you at the hospital, to calm down my immune system. Then, my parents were given little packets of nut powder - just the nuts I was being immunized to all ground up. Every night, my mom would mix the nut powder into chocolate pudding, and I would eat it. During this year-long trial, I was not permitted to do any traveling in case I had an allergic reaction to my dosage; it would be much safer to stay near CHLA, the hospital with which I was doing OIT.
Every two weeks, I would have to miss one day of school (always a Monday for me) so that my dosage could be increased at the hospital, and I could be monitored in case I had a reaction from this increased dosage. And so, every day, I would have some nuts, and every two weeks, I would go into the hospital. Eventually, I got so sick of the taste of chocolate pudding that I didn’t want to eat my nuts with it every day; I switched to applesauce instead. Even now, I HATE the taste of nuts, so they really ruined chocolate pudding and applesauce for me; I won’t touch either product now.
I was very lucky in that the trial went very well for me; I never had a serious reaction, though I would notice some itchiness around my mouth after doing OIT every night (this itchiness was especially prevalent if I had something super sour that day, like a Warhead candy, so I would recommend food that doesn’t irritate your mouth). Eventually, I was brought all the way up to maintenance dose, which was two grams of peanuts and two grams of cashews every night. I continued to attend the hospital every other week for six weeks, and then, finally, I was free.
Now, of course, I still had to eat the maintenance dose of nuts every night and still do, five years later. However, instead of eating the nut powder mixed into something, I was just eating straight nuts, which was much easier. Of course, you can also eat some sort of candy or other food that has nuts or whatever your allergen is within it, as long as it’s the correct amount of your allergen, but I would caution against foods that could remain stuck in your throat (such as peanut butter), as this could lead to continual inflammation of the throat, which may require procedure.
What is very important to remember is that you may not experience a significant change in body temperature two hours before or after consuming your allergen. Exercise, showers, and being in a really hot environment cause a change in body temperature, so you must NOT do these things within the four-hour time frame of your OIT. Even if you accidentally do something like this and are fine that night, it does not mean you can make a habit of it, as you may very well eventually see yourself reacting more frequently. I would also recommend, if you have environmental allergens, to limit time spent outside or take an antihistamine if you know you will be spending a couple of hours or more (time could depend on the severity of your environmental allergens) outside, as increased exposure to an allergen, even if you don’t feel it at the time, can lead to a worse OIT experience later. Furthermore, it is inadvisable, given my own experience, to consume your allergen on days that you are on an airplane (planes kind of throw off your whole body) or to sleep within an hour before or after doing your OIT.
With all those things said, it really is quite manageable to do OIT; if I know my friend is coming over and we’re going to be outside for a long time, I simply take a Zyrtec, and I am fine. I am careful not to exercise two hours before doing OIT (which I do at night) and to make sure that I don’t go to bed unless it has been over an hour since my OIT. It is very important to note that OIT doesn’t mean you can all of a sudden eat your allergen anytime you want; if I were to eat a ton of peanuts, I would most likely get a reaction. The benefit lies in that I don’t have to worry about accidentally eating an allergen; I can have a candy bar that may contain nuts and be fine whenever I go out to eat. However, carrying EpiPens and probably a Zyrtec or Benadryl at all times as well is still very, very important because you really never know what might happen.
Anyway, I hope that you enjoyed my article about what OIT is and my experience with it. If you are doing an OIT trial or looking to do one, I wish you luck!