30 December 2010

Peanut Oral Immunotherapy FAQ's - Frequently Asked Questions

My son Alexander is being successfully treated for his life threatening peanut allergy.
Click here to read more about his experience eating peanuts as part of his treatment.

Below - Links to each of separate Oral Immunotherapy FAQ pages for Peanut, Wheat, Milk and Egg published on the website of Dallas Allergy Immunology.

Following the links below I have copied a few of the 27 Frequently Asked Questions about Oral Immunotherapy for Peanuts as published on the website of Dallas Allergy Immunology www.dallasallergy.net (which is Dr. Wasserman's website). 

Links to the pages for the Oral Immunotherapy FAQ's. Each allergen has it's own page dedicated to questions for that particular food and its respective oral immunotherapy program.
PEANUT   http://dallasallergy.net/peanut-oral-immunotherapy-faqs
WHEAT    http://dallasallergy.net/wheat-oral-immunotherapy-faqs
MILK        http://dallasallergy.net/milk-oral-immunotherapy-faqs
EGG         http://dallasallergy.net/egg-oral-immunotherapy-faqs.

Below are a few of the PEANUT FAQ's I found most helpful. On the Dallas Allergy website there are 27 frequently asked questions and the relevant answers to each.
Question 1:  How long will the entire process take?
A. The first day procedure will take about 7-8 hours. If there are no reactions during the oral immunotherapy, you child will be eating a full serving of peanuts in about three months.
Question 3: What is the timeline for the months after the first day?
A. Exactly how it will go depends on each individual child. If everything goes well, some amount of the whole food will be eaten during the second month and a whole serving of peanuts may be eaten by the fourth month. By four months, if there are no reactions, two doses per day will be required to maintain desensitization.  After one year the dosing frequency will be reduced to once a day.

Question 5:  How often can the dose be increased?
A. The interval between dose increases is a minimum of seven days.
Question 6:  What time of day should home doses be given?
A. For twice a day peanut dosing, try to make the interval between peanut doses no less than 9 hours and no more than 15 hours.
Question 8:  How long should my child stay awake after the evening dose?
A. Children should be observed for at least one hour after the dose is given.  They should not be allowed to sleep during this time.

Question 10:  If there is a reaction at home, what should I do?
A. Treat the reaction the same way you would any food reaction; antihistamine if there is just rash, Epi-pen if there are other symptoms of anaphylaxis. If there is just one or a few hives, DO NOT give antihistamine for the first hour so we can see if the reaction progresses. If the hives are increasing, give antihistamine. Call us after the appropriate immediate intervention. We will give instructions on future dosing.

Question 16:  What if my child is sick and can’t take the doses on schedule?
A. If there is a gap of more than 15 hours between doses, call before giving the next dose. If it is less than 15 hours, pick up on the standard schedule.
Question 17:  When can foods containing peanuts be introduced into the regular diet?
A. Foods containing peanuts may be introduced into the diet at the end of the oral immunotherapy process
Question 18:  What is the goal of this process?
A. The number one goal is safety; to allow the patient to eat peanuts and foods that contain peanuts without thinking about it.
Question 21: Does my child need to avoid exercise during the oral immunotherapy process?
A. Exercise should be avoided for at least two hours after peanut dosing, but it is ideal to avoid exercise for four hours after dosing.  Exercise following peanut dosing increases the chance of a reaction. 
Question 23: How much peanut can/must my child eat following completion of the oral immunotherapy process?

A.Your child must ingest 8 peanuts twice daily as a maintenance dose for the first year following completion of the oral immunotherapy process.  The next year the dose will be reduced to 8 peanuts once daily.  Your child may also consume as much peanut as he/she would like in addition to the daily maintenance dose upon completion of the oral immunotherapy process.  We will have regularly scheduled follow-up appointments, and if the time comes when the frequency of the maintenance dose changes, we will let you know.  Until then, your child must continue the twice daily or daily maintenance dose

I hope you find this information to be helpful. For a complete list of the peanut FAQ's be sure to visit the relevant page on the Dallas Allergy website. Link provided above.

26 December 2010

Peanut Allergy Treatment #3 and #4

Appointment #3 December 16th

I was unable to take Alexander to his appointment so I enlisted the help of his grandmother Judy. She was great. Judy had to pick up Alexander (and his brother Dylan) at school and take them to the peanut appointment. All went smoothly yet to my surprise Alexander's came home with a "peanut pill".                                                                                     
No more peanut and grape juice cocktail. No more refrigeration. 
The pill turned out to be a much easier way to take his dose although according to Xander "the pill is a pain". 
The peanut capsule is teeny tiny
The peanut protein has to be dug out of the capsule with a toothpick to get every grain. Needless to say my son is looking forward to the capusule size increasing so he can eliminate digging for the peanut dust with a toothpick. 
Swallowing of the capsule is not allowed. 
I am not sure why. 

For his first at home dose Alexander mixed the peanut powder into yogurt. This worked "ok" but not great. Eventually he chose to mix the peanut flour into liquid. 

The instructions he received from the nurse were explicit when it came to mixing the peanut flour from the pill into liquids. His brother Dylan was quick to remind him of this fact.
The rule: Mix the entire capsule contents into a glass of liquid then swirl the powder to mix well. Drink. Next to be sure no peanut protein or traces are stuck on the sides of the glass, add more liquid to the same glass then swirl to mix and drink.

The remainder of the week proceeded normally and Alexander was very diligent to follow the dosing instructions and timing exactly. Another successful week!

Appointment #4 December 23rd

We arrive at the office and follow the same routine as outlined in an earlier post. 
Believe me I am so thankful that this process is becoming routine.
What a relief and a blessing the peanut desensitizing is going well thus far.

Alexander's dose is increased to 100 mg of peanut flour given twice daily as shown in our dosing instruction sheet picture below. 
Since it would be so much easier if the peanut pill could be swallowed I asked the Physician's Assistant why the dosing instructions did not allow swallowing of the pill. It turns out that no research has been done to determine if this capsule itself would be fully digested. If not then the peanut flour would not be fully absorbed either. 
Ok. Good rule. Makes sense. 
We wait the customary 1 hour after the dose is administered - no reaction and we are on our way home.

At home Alexander embarks on the project of digging the peanut flour out of the tiny capsule. 

This time the new increased dose of 100 mg is contained in what seems to Xander to be the same teeny size capsule. (to my eye it is slightly bigger).
This time the toothpick method of extracting the last bit of powder is traded for a new "improved" digging device pictured below. (I have cropped the photo for an up close look)
To Xander's delight indeed the new tool proves handy. 

The dosing method is a follows.
1) The capsule is opened and the peanut flour is added to a glass containing some liquid. Alexander uses gatorade or juice
2) Xander drinks the solution immediately. 
He does not like the peanut taste but the tried and true method of holding ones nose works like a charm. 
4) Again more gatorade is poured into the same glass and swirled around to ensure every single molecule of peanut flour is mixed into the liquid. 
5) Down the hatch!  
6) The current dose is successfully taken.