My daughter is allergic to peanuts and I feed them to her every day.
Yes, you read that right. My three-year-old daughter has a peanut allergy, yet in our house we do not avoid peanuts. We do not check ingredient lists on food labels. When dining out, we do not check with the server or cook to make sure that my daughter’s meals will be safe for her to eat. When we travel, we don’t bother to make sure that there will be safe restaurants available, and we don’t check for nearby stores to purchase safe food options. We don’t alert our airline of her peanut allergy or ask them to refrain from serving peanuts to the other passengers during the flight. We do not mind at all if the kid next to her at the playground is eating peanut butter. We don’t care if someone throws a handful of Reese’s into her bucket on Halloween — in fact, she will probably eat one of them when she gets home. And almost every day, I feed my daughter peanut butter because of a treatment called oral immunotherapy, or OIT.
When my daughter was ten months old, I fed her peanut butter for the very first time. It was just a thin layer spread onto a piece of bread. She hardly ingested any of it, but within minutes her face and chest were covered in hives. Her face was red and puffy, and one of her eyes had begun to swell shut.
Both skin and blood testing confirmed a peanut allergy. I still remember the nurse apologizing to me, telling me how sorry she was about the diagnosis, like my daughter had been diagnosed with some kind of horrible illness. It was because she knew from her own personal experience that the food allergy life is truly an awful, anxiety-ridden way to live. I was terrified, panicked, and grief-stricken for my daughter’s future.
Until you have a child with a food allergy, you truly don’t realize how dangerous it can be, and how even a microscopic amount of an allergen can trigger a reaction for the most sensitive individuals. In fact, one time after handling peanut butter, I washed my hands thoroughly not just once, but twice before helping my daughter to brush her teeth. Her whole face still broke out in hives from some tiny amount of peanut protein that I had somehow missed.
Peanuts have several allergenic proteins and a person can be allergic to one or several. Blood component testing showed that my daughter was specifically allergic to the ARAH2 protein, which is known to cause the most severe reactions and is also the least likely for an individual to outgrow. However, being so unlikely to outgrow her peanut allergy also made her a prime candidate for private practice oral immunotherapy, or OIT.
During this treatment, patients increase their tolerance to their specific allergen by starting with a microscopic amount of the food and slowly working their way up to a full serving of the allergen. Treatment requires daily dosing, with weekly trips to the allergist’s office for dose increases and monitoring. Treatment typically takes anywhere from six to twelve months to become desensitized and to reach what is called “maintenance.”
Once a patient reaches maintenance they continue dosing regularly to maintain their desensitization to their allergen. Unless a cure is developed, most who complete OIT will have to continue regular dosing for a lifetime. This, however, is similar to the recommendation for children who outgrow their allergies naturally because if they don’t continue to consume it once they outgrow, it is not uncommon for the allergy to return.
It’s important to note that OIT is not a cure. There is currently no cure for food allergies. Oral immunotherapy is simply a treatment that allows a patient to become desensitized to their allergen. It slowly helps their body to adjust and no longer view the allergen as a threat. After OIT a patient can usually eat as much of their allergen as they wish. However, if my daughter were to stop taking her doses regularly she would eventually lose her desensitization and begin reacting again. It is also still recommended to carry epi-pens as a precaution.
Though the FDA recently approved Palforzia, a drug derived from peanut powder, as part of OIT, it is important to note that OIT is still in relatively new, and some studies indicate that the protective properties may not last after OIT is discontinued. It isn’t right for everyone, so you definitely need to discuss in detail with your medical team.
But even though OIT is not a physical cure, it is definitely an emotional cure. Having a food allergy is not as simple as “just don’t eat peanuts.” Even items manufactured on shared lines with peanut products could pose a threat. A peanut-free meal in a restaurant prepared on a surface that had previously been contaminated by peanuts could pose a threat. A child who eats a food containing peanuts while sitting in a grocery cart could pose a threat for the severely allergic child who sits there next. For children as sensitive as my daughter, a tiny microscopic amount of peanut protein could easily have caused anaphylaxis prior to completing OIT.
Oral immunotherapy takes away the worry from grocery shopping and label reading. It takes away the worry from eating out, school cafeterias, family gatherings and birthday parties. I no longer worry about her starting school in a couple years. I won’t be worried about her when she starts to date and possibly kisses someone who may have eaten peanuts earlier in the day. I won’t be scared when she goes off to college and begins her life without me there to protect her. Because although she is still considered allergic from a medical standpoint, OIT allows us to live like we are allergy free.
My daughter has a peanut allergy and I feed them to her every day, without worry.