Note: Before reading this article, if you do not know what Oral Immunotherapy is, check “Oral Immunotherapy: A True Lifesaver” under the “Treatments” section.
When I was ten years old, my life changed. As a person affected by peanut, cashew, and pistachio allergies, I was lucky enough to be offered a spot in a clinical trial for Oral Immunotherapy (OIT). My luck extended even farther, as my OIT journey was and continues to be a success. In this article, I will describe, in detail, the exact process that I underwent, to shed light on a truly incredible treatment.
The first step in my OIT adventure was to diagnose the exact nuts that I was most allergic to. To do so, I embarked upon a series of food challenges, each spaced apart by two weeks. In the food challenges, powdered versions of peanuts, cashews, almonds, and hazelnuts were placed into chocolate pudding, and I ate the pudding until I developed a reaction, or until it could be reasonably assumed that I was not very allergic to the nut in the pudding. Each nut was given to me during a different visit for obvious health reasons, and throughout the four challenges, I required an epipen once, when I had an anaphylactic reaction to cashews. I also had a mild reaction to peanuts, meaning I was treated for cashews and peanuts during my OIT. Since cashews and pistachios share the same protein that I was allergic to, I am also allergic to pistachios, but need only take cashews to expose my body to the protein and therefore also immunize myself to pistachios.
After the food challenge, I was given a shot of xolair, a medication that reduces the activity of one’s immune system. Since allergic reactions happen when one’s immune system overreacts, xolair lowered the possibility of such a reaction taking place, easing the OIT process. After the shot, I reported to the hospital to take my first, minute dose of peanuts and cashews. The powder, again, was mixed into pudding. After taking the dose, I had to stay in the hospital for the rest of the day in order to ensure that I did not have a delayed reaction. At the end of the day, I was discharged, and proceeded to eat the same dose every night for the next two weeks.
At the end of the two week mark, I went back to the hospital, where they gave me a slightly larger dose than the week before. Again, I had to stay there for the day, and then take this new dose daily for the following two weeks. The process was repeated for a year.
Although I was blessed to not have many difficulties (I never got a reaction to the nuts I was consuming), the taste of the nuts always disgusted me. I got so disgusted by the pudding that I began to mix the nuts into apple sauce instead, which, unfortunately, became equally nauseating in time. To this day, I cannot eat chocolate pudding or apple sauce, because they taste so awful. I now consume whole versions of the nuts instead of powdered versions, and although they are by no means appetizing, for some reason, I have never developed the same aversion to them. Another hallmark of OIT trials is that it is standard procedure that one cannot travel during the clinical trial, because only one’s allergy doctor can ensure that the participant is completely safe in the event of a reaction.
At the end of the clinical trial, I stayed on the same maintenance dose of 2 grams of peanuts and 2 grams of cashews for six weeks, with 3 visits to the hospital throughout. Almost six years later, I still continue with OIT, and, if all goes as planned, I will do it for the rest of my life to keep my immunity. However, there are a number of precautions that I need to take in order to prevent a reaction. First and foremost, those doing OIT cannot experience a significant change in body temperature 2 hours before or after consuming their allergens. So, one cannot exercise, take a hot shower, or do anything of that nature within that timeframe. The recommended timeframe has actually shortened, but I find that 2 hours is the best rule for me personally, and it is best to be safe when it comes to potential allergic reactions, in my opinion. Furthermore, when one turns 21, they cannot consume alcohol on the same day that they take their dose, because it makes one more likely to get a reaction. Obviously, before turning 21, one should not drink alcohol, but for reasons other than OIT (and even after turning 21, OIT should not be the only deterrent to drinking). For many, such as me, the allergens are consumed daily, meaning no alcohol whatsoever. Finally, I have personally found that it is best to not sleep during the 1 hour before the dosage or the 1.5 hours after; on some occasions, I have woken up having a reaction if I did not follow this rule or the body temperature guidelines.
Although OIT is a large commitment, it is, in my eyes, worth it. It’s easy for me to say, since I was blessed with not having to face much adversity in the OIT process. However, if you join some sort of clinical trial, or a trusted allergy doctor offers OIT, at least give it a shot; it could change your life.