Being able to live a safer and fuller life, thanks to OIT

Freedom Allergy, Pediatric Allergist, Peachtree City, Marietta, Georgia, Peanut Oral Immunotherapy, Eczema

Chloe_OIT_2

Being able to live a safer and fuller life, thanks to OIT

Written by Carri P.

Dealing with a peanut allergy and eczema has been a way of life for our family since Chloe was a baby. The eczema came first and probably should have been a warning sign that food allergies were a possibility. Having no prior experience with food allergies or eczema, we didn’t know much about either. Unfortunately, I also didn’t know the severity of the situation when she had her initial reaction at 16 months old to an amount of less than a teaspoon of peanut butter. We were told to give her Benadryl and that was that. Looking back, I am so thankful that the reaction didn’t progress. A few days later, we were given a prescription for an EpiPen, and told to avoid all nuts by our pediatrician.

The next several years for Chloe were not exactly normal, as most food allergy parents would understand. It didn’t take long for us to acquire a wealth of both knowledge and anxiety. Our family had all been conditioned to check food labels and life revolved around keeping our little girl safe from accidental exposure. We were lucky to not have any further reactions from peanuts since her initial exposure. I say lucky, because at some point, no matter how careful a parent is – mistakes can and do happen. We sought out a peanut free preschool and learned that we had to educate parents on what that truly meant. We then had to decide about elementary school and were lucky to find a peanut free private school. Chloe was extremely saddened when it closed at the end of her first grade year. That left us with no peanut free options and we were not prepared to have her in a public school setting even with precautions.

Eczema continued to be ongoing struggle. Summer humidity, time spent in the sun and sunscreen all seemed to be culprits that aggravated Chloe’s eczema. She would scratch until she made bloody sores. The most noticeable eczema would appear on her eyelids and below her eyes. The eczema was something that Chloe suffered with, but in comparison to the worry over accidental ingestion of peanuts, it wasn’t high on my list to seek a doctor’s opinion.

In the fall of 2015 Chloe was attending an online public school, which equated to homeschooling in her mind. The situation was less than ideal to her after being happy in her peanut free school the previous year. I was at all time low emotionally struggling about what the right path was for her. It was then that I first heard about OIT. I was immediately intrigued and also frightened. It took me a few months to make the call to Dr. Agrawal’s office to set up a consultation for OIT. At our first appointment in January of 2016, we discussed her food allergies and eczema. The decision to begin OIT was immediately clear once I had met Dr. Agrawal. He explained the protocol and informed us about the use of a good probiotic with specific strains that help with eczema. Chloe did an oral challenge for all tree nuts, except pecan and walnut. She passed that and we decided to address pecan and walnut after she reached maintenance for peanut. For the first time in Chloe’s life, we had someone on our team to help us overcome the struggles and isolation of allergic living. We were excited so to get started at the end of January of 2016.

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Early stages of OIT – dosing with liquid peanut solution.

Chloe’s experience with OIT was a relatively smooth journey. She didn’t have any problems other than her skin. The amazing thing is that her eczema improved dramatically throughout her up dosing phase, even during the summer months. Applying cortisone cream was a daily occurrence prior to OIT. During OIT, she had a few mild flares that I think were related to up dosing and also the summer humidity. The main issue we had with her skin was the occurrence of a random, small hive appearing usually on her arms or hands. These never progressed and would always subside within half an hour. These were quite alarming at first until we learned that it was just a sign that her body was learning to accept the allergen. At some points along the way, she would experience this several times a day and other days nothing would appear. It just became our normal to notice it and then make sure that it didn’t progress. During OIT, we had to learn to let go of some of the fear when we were cleared for cross contamination. Sometimes the mind has to catch up to the body. The daily dosing and observation period became routine. When we had questions or concerns, we knew Dr. Agrawal was only a text or phone call away.

Before we knew it, Chloe was nearing maintenance. She had been taking her probiotics daily, just like her peanut dose. Her eczema had become practically nonexistent. We had slowly begun to enjoy the freedom that OIT brings. We had sheltered Chloe in almost every way possible to keep her safe. She had not had play dates at friend’s houses, but always at her own home. She had only been to peanut free schools. We had never had ice cream scoops at a parlor. She was always the one at the sports banquet who couldn’t enjoy the cake like the rest of the team. We tended to frequent the same restaurants that made us feel safe for her to eat. Imagine a nine year old’s delight to finally go to friends’ homes, go along with other families to a movie theatre and be able to eat the birthday cake that everyone else is having. These are the small freedoms that mean so much!

Chloe reached maintenance at the end of November 2016. Overall, it took about 10 months, which would have been less without some scheduling issues on our part. Maintenance has been going well for two months. Chloe has passed an oral challenge for pecans and walnuts so tree nuts are no longer a concern. She has continued the probiotics to keep her skin healthy. She has not experienced any eczema or random hives since reaching maintenance. We have continued to enjoy new freedoms and Chloe has tried several new foods that were off limits in the past due to cross contamination. What we don’t do anymore is check labels and live in fear. The biggest change planned for this August, is that Chloe will start 4th grade at public school. I cannot thank Dr. Agrawal enough for providing the means to allow Chloe to have a safer, fuller life without the fear of peanuts holding her back.

Please visit www.smashingpeanuts.blogspot.com to read about Chloe’s experience with OIT in greater detail.

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A day of celebration – the day Chloe reached her peanut maintenance dose.

 

Red Meat Allergies are on the Rise

Freedom Allergy, Red Meat Allergy, Pediatric Allergist, Peachtree City, Marietta, Georgia

lonestartick-45114ba9fc67a1de8aebb58ffe8f805eb616861e-s700-c85

 

What is an alpha-gal allergy?

The number of cases for an alpha-gal allergy, or red meat allergy, has risen over the past few years, and the cause is due to the Lone Star tick.  The tick is predominantly found in the southern parts of the United States, ranging from Texas to the East Coast.  People who have been bitten by the Lone Star tick may find that they become allergic to red meat, such as beef, pork, venison, bison, and lamb.

How does a person become allergic to red meat?

When the lone star tick bites a mammal, like a deer, it picks up a sugar called alpha-gal, which is not found in humans.  Then, when the tick bites a human, the alpha-gal is transferred into the human’s bloodstream, where the immune system identifies it as foreign and creates IgE antibodies to it.  The next time the person consumes red meat, the body will recognize the alpha-gal, and the IgE antibodies will cause the release of large amounts histamines through the body, causing an allergic reaction.  The reaction may range from symptoms like upset stomach, diarrhea, hives, or itchy mouth, to more serious symptoms like constriction of the airways, a drop in blood pressure, or anaphylaxis that would require epinephrine.

How is an alpha-gal allergy diagnosed?

An alpha-gal allergic reaction usually takes between 3-8 hours after consumption of red meat.  Because the reaction does not occur immediately after ingesting red meet, like most other food allergies, it is harder to diagnose.  An alpha-gal allergy can be identified by a blood test.  Once diagnosed with an alpha-gal allergy, the patient will be prescribed an epinephrine auto-injector.

If have been recently been bitten by a tick, and you are suddenly experiencing symptoms after consuming red meat, visit an allergist and inquire if you may have developed an alpha-gal allergy.

Why is the alpha-gal allergy on the rise?

No one knows why the number of red meat allergies have risen over the recent years.  There are currently at least 3,500 cases reported, and doctors believe there are many more that have not yet been diagnosed.  The reason could be that ticks have steadily increased in the past 20-30 years, along with an explosion of the deer population.  It’s also possible that doctors are now more aware of the allergy, and are able to identify it quicker.

How can I prevent this allergy?

Since an alpha-gal allergy is linked to the Lone Star tick bite, it is important to protect yourself when outside.  Avoid wooded areas, leaf litter, and high grass areas.  Wear long-sleeved clothing, and use insect repellent like DEET or Permethrin when going to areas where there are ticks.  In addition, be sure conduct a full-body tick check and bath or shower after coming indoors.

Is there a cure for an alpha-gal allergy?

There is good news for people with a red meat allergy.  The alpha-gal allergy may recede with time.  As long as the patient is not bitten by another tick, and has avoided red meat, studies have shown that the allergy may go away within 8 months to 5 years for certain individuals.

 

 

References:

http://acaai.org/allergies/types/food-allergies/types-food-allergy/meat-allergy

http://www.webmd.com/allergies/news/20140813/tick-bites-red-meat-allergy

http://www.today.com/health/tick-bites-linked-rising-number-meat-allergies-t84821

https://en.wikipedia.org/wiki/Alpha-gal_allergy

http://allergicliving.com/2016/07/14/red-meat-allergy-incidence-on-the-rise-therapy-in-works/

http://alpha-gal.org/basics/

http://wncn.com/2016/05/09/unc-doctor-calls-alpha-gal-meat-allergy-tremendously-underdiagnosed/

http://www.cdc.gov/ticks/avoid/on_people.html

Starting Young – Breckan’s OIT Journey

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!

First peanut OIT dose!

Eating peanut M&M’s with Nurse Danielle!

OIT – A life-changing treatment

Pediatric Allergist, Peachtree City, Fayetteville, Marietta, Georgia

 

OIT – A life-changing treatment

written by Heather B.

 

IMG_1824My daughter Zoe started OIT for peanut in July 2015. She was 6 years old and had a level 6 peanut allergy. Dr. Agrawal was so patient and kind making her and us feel comfortable every step of the way. I was very nervous for her to start OIT but my anxiety over her allergy was increasing, especially at school.

We found out about OIT through a friend who had also started peanut OIT with Dr. Agrawal. She stayed on the first dose for almost a month because of hives but after that it has been smooth. She is now in maintenance 11 months later and the freedom we have gained is invaluable! Zoe can now sit with her friends at lunch, eat kit-kat’s, and have m&m’s! Things that were impossible a year ago. This has been a life changer for her and I’m forever grateful for all the staff and for Dr. A at Freedom Allergy. Anytime I had a concern I could easily reach out to him and he responded almost immediately. I’ve never met a doctor who cares about patients as much as he does. We are looking forward to our final peanut challenge next year and graduating OIT!

 

From Peanut Particles to Actual Peanuts

Pediatric Allergist, Peachtree City, Fayetteville, Marietta, Georgia

Kaitlyn picture

From Peanut Particles to Actual Peanuts, 

Our Family’s Peanut OIT Journey with Dr. Agrawal

written by Jennifer L.

Kaitlyn has a life-threatening peanut allergy that truly dictates every aspect of her daily life.  Her allergy is so severe, that she will go into anaphylactic shock if she ingests even the smallest particle of a peanut.  This includes ingesting any product that has been produced at a facility that also produces peanut products, being touched by someone who has recently eaten a peanut, and even airborne particles such as those recirculated in a commercial airplane.  Daily life is hard, and arguably harder on a such a young girl of 11.

Kaitlyn has many limitations but is overcoming them with dignity and strength.  She is taking action to change the way she lives her life.  In March of 2015, Kaitlyn started peanut oral immunotherapy (OIT) treatment with Dr. Agrawal in hopes that it will desensitize her immune system and potentially save her life.

OIT is a journey, it isn’t quick or easy. Kaitlyn had to put all of her fears aside and ingest the very food that she has been warned about her entire life. She was terrified at first and then slowly warmed to the idea of going in for the initial appointment. Dr. Agrawal was fabulous with her and very understanding of her fears.

We moved forward with scheduling our initial appointment to begin OIT. Other than the nerves, it was relatively easy. We were armed with entertainment and foods to help coat her stomach. She didn’t make it to the highest dose that day because she was having hives, stomach pain and strange bumps on her tongue that came up after the third of fourth dose. We went home with her liquid dose and started the life changing process of OIT dosing once a day every day with a two hour rest period to ensure her body doesn’t fight peanut. Kaitlyn had a lot of nerves for months but she continued to take her dose.

We slowly continued to increase until September when everything came crashing down. Kaitlyn got sick and had horrible stomach pain, we decreased her dose more and more and she still had reactions so we finally had to stop. Kaitlyn felt horrible for weeks. After endless blood work, ultrasounds, and doctor appointments with Dr. Agrawal and our pediatrician they concluded that she had a stomach virus that was further irritated by her peanut dose and possibly a stomach ulcer. Our family was crushed to stop OIT but assured by Dr. Agrawal that we would begin again when she was feeling better.

We did start OIT again but had to go back to a much lower dose. Kaitlyn was beyond terrified and highly discouraged by starting the process over. Dr. Agrawal made several attempts to encourage her and get her to take her dose. It was agonizing to start over the process that we had worked so hard to get through. As of June 2016, Kaitlyn has successfully increased to 4000mg (roughly 4 whole peanuts). It’s absolutely amazing the freedom for her and our family to eat at restaurants we’ve never had the luxury of eating at, or consuming foods that we never dreamed of, and to relax just a little while she is at school or a playdate. Our goal is 6-7 peanuts to secure her safety.

Every little girl has big dreams.  Kaitlyn’s big dreams are ones that may seem small to the average kid; to fly on an airplane, to be able to eat a cookie cake with her friends, to be able to attend sleepovers, and to not have her Mom hover so closely.  The risk of contamination was too great for her to enjoy birthday cake, cookies, or most any food that her parents couldn’t verify were 100% safe.  Being left out of social functions and school parties has taken its toll on Kaitlyn emotionally.  Kaitlyn’s big dreams are to “fly to Paris,” to eat at the Great American Cookie Company and to one day become an allergist! And, thanks to Dr. Agrawal and OIT her dreams are now becoming reality!

We keep a blog about our OIT journey {kknaughtynuts.blogspot.com} where we share all of the trials and triumphs so feel free to read more details of Kaitlyn’s inspiring OIT journey.

Back to School Allergy and Asthma Tips

Pediatric Allergist, Peachtree City, Fayetteville, Georgia

ACAAI Back to School Tips

With the new school year now underway, you may consider these back-to-school allergy and asthma tips from the American College of Allergy, Asthma and Immunology. These simple tools can help set up you and your child for success in this exciting new school year!

Teacher Teacher – While your child’s teacher is the first line of defense at school in helping reduce sniffing, wheezing and sneezing, the right systems must be established at home before they get on the bus. If your child takes an allergy or asthma medication, make sure they take them at home, and that good avoidance measures are set up to keep their triggers under control. If your child’s teacher knows your child’s triggers, she may be able to help them steer clear in the classroom as well.

Too cool for school? Nah. – Discuss how to handle emergencies with the school principal and school nurse. Since 2010, all 50 states have laws protecting students’ rights to carry and use asthma and anaphylaxis medications at school. Children who are at risk for a life-threatening allergic reaction (anaphylaxis) from certain foods or insect stings should have epinephrine auto-injectors immediately available for treatment.  Be sure your child and school staff know how to use emergency medications. Continue reading

Senate Bill 126: Access to Epinephrine Auto-Injectors in Public Facilities

Allergy Doctor, Peachtree City, Atlanta, Georgia

Senate Bill 126

Photo courtesy of Food Allergy Kids of Atlanta

In 2013, Georgia became one of the first states to pass legislation authorizing public and private schools to stock a supply of epinephrine auto-injectors in their facilities (House Bill 337).  This year, the Georgia General Assembly passed Senate Bill 126, which provides access to auto-injectors in public facilities such as restaurants, sporting facilities, amusement parks, resorts, and sports and recreation camps.  The bill provides for emergency public access stations to allow a “lay rescuer” to consult with a medical professional to administer or make available epinephrine auto-injectors in the case of a medical emergency.  This measure could be life-saving for anyone in a public facility suffering an anaphylactic reaction.

Read more here.

Back to School with Food Allergies

Pediatric Food Allergy Doctor, Peachtree City, Fayetteville, Georgia

Back to School

School is right around the corner, and along with the excitement of new clothes, bright supplies, and fresh possibilities, your child may also have a few butterflies in the stomach. For a parent of a child with a severe food allergy, you may have some butterflies of your own. Many parents worry their child will accidentally eat a food they’re allergic to while at school, and suffer a severe reaction. Setting your child up at school with an epinephrine auto-injector (EAI) is important, but this also requires staff and personnel who can recognize an anaphylactic reaction and can correctly use the EAI.

Children need help from adults in managing their food allergies. One survey out of Mississippi schools revealed 97% had at least one child with a food allergy, but only 30% had action plans for these students. Schools were more likely to have action plans when the school nurse had received appropriate information from a physician. If you need refreshing on how to use your EAI, or would like assistance in educating personnel at your child’s school on recognizing and treating anaphylaxis, call our office today. Anaphylaxis action plans can also be written by physicians and distributed in daycares and schools.

Reference: O’Keefe AW, De Schryver S, Mill J, et al. Diagnosis and Management of Food Allergies: New and Emerging Options: A Systematic Review. Journal of Asthma and Allergy. 2014;7:141-164.

Accidental Stick with an Epinephrine Auto-Injector

Allergy Doctor, Peachtree City, Atlanta, Georgia
EpiPen, Allergy Doctor, Peachtree City, Georgia

Epinephrine Auto-Injector

It happens – one of your children has an allergy requiring an epinephrine auto-injector, and your other child accidentally sticks himself with it.  Does this accidental exposure mean you need to take your child to the emergency department?

Epinephrine auto-injectors contain epinephrine, which is a hormone made by the adrenal gland in your body.   Epinephrine acts on several receptors in the body to help dampen a severe anaphylactic reaction.  It tightens the blood vessels, which decreases swelling and keeps the blood pressure from dropping.  It also increases both heart rate and how strongly the heart contracts, to keep the cardiovascular system from shutting down.  Epinephrine relaxes the muscles around the lung airways, to make breathing easier, and also keeps the immune system from releasing more substances that can worsen an allergic reaction. Continue reading

Rare Red Meat Allergy and Lone Star Tick

Allergy Doctor, Food Allergy, Peachtree City, Georgia
Freedom Allergy, Meat Allergy, Peachtree City, Atlanta, Georgia

Lone Star Tick U.S. Habitat

A rare meat allergy has increased in prevalence over the past 10 years in the United States, in correlation with bites from the Lone Star tick. Named for the white dot on the back of the female ticks, the Lone Star tick exists all the way from the Southwestern U.S. to the East Coast, and a bite from this insect can cause people to become allergic to red meat. This condition can remain aloof to many patients, who suddenly develop allergic symptoms to red meat when they have never had an issue in the past.  Continue reading