Pediatric Allergist, Peachtree City, Fayetteville, Marietta, Georgia, Peanut Oral Immunotherapy
Starting Young – Breckan’s OIT Journey
Written by Deborah C.
At just over a year old we did what most parents do – give their child peanut butter for the first time. His older brother isn’t allergic and we had no reason to think he would be. Breckan’s first two small bites were uneventful and I thought we were in the clear. I made him a peanut butter and honey sandwich and he LOVED it!! Fifteen minutes later that sandwich would lead to the most terrifying trip to the ER to date. My little boy looked as though he had been attacked by a swarm of bees from head-to-toe and was screaming to breathe. That pivotal day is ingrained forever in my mind, and from that point onward I searched for any sign of hope or treatment for his anaphylactic food allergy.
When Breckan was 18 months old, I came across a Facebook group where someone mentioned Oral Immunotherapy (OIT). I honed in on it immediately. It just made sense, and I knew it was the treatment best suited for Breckan’s deadly allergy. I hit the jackpot, because at the same time I learned of OIT, I heard there was a doctor opening up a private practice in the Atlanta area and I tracked him down and called him immediately. It sounds cliche, but when Dr. Agrawal picked up the phone he changed our family’s life forever! We watched Breckan’s peanut IgE numbers with hope over the next year, but when they shot up and his skin test exploded at 2.5 years old we decided to start OIT asap under the direction of Dr. Agrawal.
Breckan began his OIT journey on October 5, 2015 at 2 yrs, 9 months old. Personally, I find beginning OIT at a young age provides so many benefits! Some of these being little or zero anxiety, being completed before starting kindergarten, earlier protection, and at this age such a young child really hasn’t had to feel much, if any, exclusion due to their allergy. Many parents who are interested in starting their child younger ask “what about communicating symptoms?” I can assure anyone that communication is both verbal and non-verbal. Your child doesn’t have to speak every word perfectly and know a vast vocabulary to complete OIT. You are watching and observing (more like hawk-eyeing) and you will know if there are any symptoms or reactions. Without a doubt, you will know. A parent knows their child better than anyone and even the slightest change in expression can tell you if something is “off.” We had zero issues with communicating symptoms throughout our experience and we did have a handful of them along the way, but nothing that couldn’t be worked through and overcome. I also found that starting young made it easier to control and shape that this is just how things are now. Period. Meaning when it comes to dosing and then the observation period after for Breckan, I just made it into “this is what we do and this is just part of life.” He is one of the most stubborn kids I have met, but by treating this as “peanut medicine” to him it was that – medicine – he ate a meal, he took his medicine, and he knew that meant “calm play” after. Anyone who knows Breckan knows that calm and him do not go hand-in-hand. Active is an understatement. However, I think the term “rest period” with OIT is mis-labeled. Kids do not have to sit still and not move! They can do so many things!! MagnaTiles, Legos, color, paint, use their imaginations to build cities or anything for that matter, play with dinosaurs or their favorite current toy, Star Wars themed toys, and the list goes on and on for all the things Breckan could do during his calm play time. That list doesn’t even include video games or apps on his tablet which we’d sometimes do too. We even dosed during vacations, like on our family winter ski vacation which was very active. Breakfast, dose, calm play in condo, drive to mountain, and by the time he was skiing we were good to go! OIT adapts to your life and you adapt to OIT.
Even being young, it amazed me throughout this process how much Breckan just “got it.” One example was back in February 2016, in an instance that reminded me why we were doing this. We had picked up Panda Express (not for the kids), and to our surprise, Breckan wanted to try the entree. At this point he wasn’t “cleared” to eat any cross-contaminated food yet. We obviously didn’t get any items that contained peanuts, but there was still too much of a risk for him to eat it when it’s a place that serves peanuts like that. We hadn’t brought that food into our house at all in a couple years, but we felt ok doing it now with where he was at with OIT. Unfortunately, we had to explain to him that he couldn’t try the entree. I wasn’t expecting his reaction or I would have never brought it home. He got teary-eyed and very upset that he wasn’t allowed to try it because of his allergy. He kept saying, “but I take my peanut medicine” through a quivering lower lip. My heart just broke for him. I explained that this is why we are doing it, that this is why he is eating more and more peanuts and when he can eat even more, which will be soon, that he’ll be able to try new foods like this. He understood, smiled, and was happy then and said, “I want to see Dr. Agrawal tomorrow.” It probably seems so small to so many, but the exclusion to things like this and gaining freedom to have choices are some of the reasons we went through OIT.
On August 16, 2016, Breckan completed OIT and is now in maintenance! Dr. Agrawal has given him the gift of protection and life insurance in its truest form. I never thought this was possible when my head was swirling after that fateful ER trip 2.5 years ago. Our lives were changed forever that day after being sealed with an anaphylactic peanut allergy diagnosis, but because of OIT we are able to give him the most “normal” life possible without the usual limitations of a deadly allergy. He will never know what an allergy table is like at school, he’ll be able to eat the same birthday cake with all the other kids at parties, he can try new restaurants and new foods (and without having to investigate them first), we don’t have to worry about all the food recalls that are totally out of our control, we have no worries about mistakes made at the hands of others in food service industries, no more reading labels with a magnifying glass, he won’t have to leave a playground because a kid comes with a peanut butter sandwich and I can see it on their fingers as it smears everywhere, he’ll be able to go to overnight camps and field trips without his mom hovering over him (or maybe I still will)…and the list goes on and on. It is really the simple day-to-day things that mean so much and one of the reasons we did OIT! The biggest reason is accidental exposure and preventing a possible life-ending anaphylactic reaction… I would do anything to protect him to the best of my ability from that, but I also want him to be able to live the fullest life possible and thanks to Dr. Agrawal, his staff, and OIT, he can do just that!
If you’d like to read more about our OIT journey, please refer to our blog, “conquering peanut: Breckan’s OIT journey” at http://coxfamilyconquers.blogspot.com
First peanut OIT dose!
Eating peanut M&M’s with Nurse Danielle!