The Nitty-Gritty

I was on the phone the other day with my best friend in the whole wide world.  Obviously, she’s aware of our Oral Immunotherapy journey, but when we started talking it became clear that she didn’t have a clue about the exact details of the therapy.  I had told her WHAT we’d be doing, but I hadn’t explained HOW we’d be doing it.  If my best friend didn’t completely understand, I’m going to go out on a limb, and guess that you’re probably also wondering how this whole OIT thing works.  

So, here’s the nitty-gritty:

Oral Immunotherapy involves feeding a child tiny amounts of a food that he’s allergic to and then slowly increasing the dose until the child can tolerate the food.  There are several different protocols out there, so although the idea is the same, it can look a little different in each doctor’s practice. (**NOTE for any crazies reading this:  Please don’t try this at home.  That’s a good way to put your kid into the hospital—or worse.**)

We’ll be starting with eggs.  We chose egg for a couple of reasons: 1) Getting eggs into Brendan’s diet will open up a ton of new foods, especially since he can’t even tolerate egg in baked goods right now.  2) Nuts are scary.  We’re gonna do scary last.

On our first day, they will start with micrograms of egg, and feed him increasing amounts every 15 minutes.  We’ll be at the doctor’s office ALL DAY.  That oughta be fun.  Thank God for iPads.

That first day, they will keep increasing his dose until he starts to show early signs of an allergic reaction, or until they get to their day one maximum (I’m not even sure how much that is!), whichever comes first.  He’ll then be sent home with the last dose that he tolerated without a reaction.

Over the next six months, Brendan will move from eating micrograms of egg
to eating a tablespoon of egg white powder (15 grams).

He’ll have to take the dose twice a day, as close to 12 hours apart as he can (we can go as little as 9 and as much as 15 hours between doses).  After each dose, he’ll have a 2 hour rest period, where he can’t do any aerobic activity.  They’ve found that exercising right after a dose can bring on a reaction.  I’ve already thanked God for iPads in this post, right?!

Once a week, if all goes well and he tolerates the dose, we’ll head back up to Dallas to “updose.”  They’ll increase his dose and watch him for an hour.  Then, we’ll drive back home that same day.  iPad = gift from God (are you seeing a theme here?).

He’ll take the dose twice a day for another week, and then we’ll rinse and repeat.  If he tolerates all the doses well, it should take him about 6 months to be eating the max dose of egg, which is a tablespoon of egg white powder.  At that point, he’ll go on “maintenance” where he’ll dose once a day, possibly for the rest of his life.  That last part is the realm of the unknown.  No one has done this long enough to know if eventually he’ll be able to stop taking his maintenance dose and still be able to eat egg. 

At any rate, once he’s on maintenance, he should be able to eat as much egg as he wants to.  Cookies.  Cakes. French toast.  Boiled Eggs. Scrambled Eggs. Omelets.  At the risk of sounding like Forrest Gump, I’ll stop there, but you get the idea J.

So, that’s the Nitty Gritty.  We’re set to start in two days.  We've got the iPad charged and ready.  Bring on the egg!