Thursday, December 27, 2018

Peanut Oral Immunotherapy

I was hoping to get this post out sooner, but this year has been crazy busy and has flown by! I wanted to share our experiences with peanut oral immunotherapy in hopes it helps someone else. Before starting this journey, I read everything I could and a lot of what I read helped to guide our decision.

DISCLAIMER:

Please note, I am not a medical professional, just a mom. Everything below is just our experiences and this process should only take place after consulting with a qualified allergist and under her supervision.

BACKGROUND:

My seven year old son has a peanut allergy diagnosed at 18 months by an allergist (scratch test). He had his first reaction around 16 months after eating peanut butter. Over the course of the next 6 years, scratch tests and a blood test showed he was unlikely to outgrow his allergy. Strict avoidance gets difficult as my son gets older. Birthday parties, weddings, potlucks, school parties, and school lunches become places were he could have an exposure and subsequent reaction. He carries an epi-pen and benadryl at all times. We use a runner's belt for this purpose (designed for a phone).

INITIAL CONSULTATION

Our doctor reviewed my son's medical record including previous scratch tests, blood work - IGE levels and component test, and performed a scratch test in the office. She asked us questions about seasonal allergies, other food allergies, and explained the process. She gave us plenty of opportunities to ask questions.

The most common side effects of OIT are itching around the mouth and stomach ache. There is a chance of more serious side effects.

If our son were to become ill, especially if he has a fever, we'd need to call the allergist to ask about how to proceed. Illness can affect his body's ability to metabolize the peanut.

Our goal at the end of 1 year (twice monthly visits) will be that our son should be able to consume 1-2 peanuts without going into anaphylaxis or having an adverse reaction. He will still have a peanut allergy and he will still need to carry his epi-pen and benadryl. (Since he turned 6, we've switched to the dissolvable pill form of benadryl, which is smaller and doesn't spill.)

Why we wanted to do OIT:
1. We won't have to worry about cross-contamination in restaurants. He will be able to eat at bakeries and ice cream stores.
2. He will be safer at school. His school is NOT nut free and there is peanut in the classroom daily. Keyboard, books, and toys may all be contaminated with peanut.
3. Travel will be easier. We won't have to stress about nuts on airplanes or peanut in hotel rooms, on amusement park rides.
4. When he goes out with his friends, he can relax and have fun without worry in movie theatres, at diners, at the school cafeteria, in college.

HOW MUCH OIT COSTS

Every insurance plan is different, so I can't tell you what it will cost out of pocket.

We received a paper from the doctor with the charge codes they use to bill insurance. We called our insurance to confirm what this process would cost.

SCHEDULING

We spoke to my son's school about this process and needed to work out with them how he'd make up work he'd miss when going to these appointments. We'd be "up dosing" in the doctor's office Thursday afternoons, which means he'd miss half a day of school every other week.

FIRST DAY OF PEANUT

We were at the office for 5 hours. The doctor took our son's height, weight and vitals, and had him perform a breathing test (when the patient blows into a tube as hard as he can).

We brought lots of carbs with us. After eating, the doctor dosed our son with 0.1mg of peanut (looked like 3-5 grains of salt in a cup) along with water and more food. He was monitored for an hour, then given 0.2mg of peanut protein following the same food, water and rest procedures. Then an hour later, he was given 0.4mg of peanut.

FOLLOW UP
The day after the 5 hour appointment, we returned to the office.

Our son was again dosed with 0.4mg and monitored. We left with enough doses (one per day and an extra in case we spilled) to last until our next appointment, in about 2 weeks (this would be the same process every two weeks after that - leaving the office with the new daily doses, enough to last until the next appointment).

The doses cost $2.50 per dose and are not covered by insurance. The doses are the same as given in the doctor's office. We do not increase the dose at home. "Up dosing" only occurs in the doctor's office where the patient is monitored.

THE NEXT 10 MONTHS

Every day, after school, we give our son his peanut dose.
1. He takes his probiotic when he arrives home. (we've tried the various flavors of Nature's Way and my son says they all taste the same)
2. Give our son carbs, like a muffin, bread, cookie, whatever he wants.
3. Mix the peanut dose with 1/4tsp of water. Stir to dissolve.
4. Drop 1TBSP of applesauce (or pudding or yogurt) into the cup. Stir to mix well.
5. Give the mixture containing peanut to our son.
6. Drink water to make sure none sticks in his mouth.
7. Eat again.
8. Rest for 2 hours. This means homework, movie, video games, reading, etc. No exercise or hot showers (no increase in core body temperature).
9. Record information on log provided by the doctor.

Every two weeks, we go to the doctor's office to increase the dose (up dose).

RESULTS

We expected the process to take at least 1 year. At 10 months, he is eating 4 peanuts (or 5 peanut M&M's daily). He's not had any adverse reactions. He's not had any stomach aches.

COMMUNICATION WITH THE SCHOOL

This is the letter we sent to his school which updates them to his progress.

To Whom It May Concern:

[STUDENT NAME] has completed an initial course of peanut oral immunotherapy. While [NAME] is still allergic to peanuts and will carry his auvi-q/epi-pen, the following changes may be made to his 504 educational plan or equivalent:

Not safe:
- peanut
- peanut butter
- candy containing peanut – like peanut M&Ms, Reece’s Cups, Snickers bars
- anything [NAME] feels “weird” about eating

Safe:
- bakery foods that do NOT contain peanut such as Dunkin donuts / munchkins
- grocery store bakery foods that do NOT contain peanut or peanut butter
- foods that list “May Contain Peanut” are okay
- foods that are “Made in a facility with peanut” are okay
- foods that are “Processed on shared lines with peanut” are okay
- buffet foods / catered foods that do not contain peanut (but may have had minor cross-contamination) are okay

[NAME] should still ask an adult about foods that are handed out during classroom parties, birthday parties, super kid parties, classroom treats, or similar.

Any allergic reaction should be treated as described in his FARE Food Allergy and Anaphylaxis Emergency Care Plan on file with the school nurse.


PROS OF OIT

This could be a massive list.

Holidays parties were much less stressful. After completing this round of OIT, the number of times he couldn't have something were slim. Before, we had to pack a lunch for him everywhere we went since we could never be sure what was safe. Now, it's usually pretty clear if something has peanut butter or peanuts. Previously, so many foods were off limits because every ingredient couldn't be checked and it wasn't worth the risk.

Now, we've eaten bakery foods. We've eaten at dunkin donuts.

My son is no longer excluded from classroom birthday parties (his school does not have a policy about safe food and allows students to bring whatever they want to celebrate their birthdays...and yeah, I have a HUGE chip on my shoulder about this and about parents bringing peanut into the classroom because it could've killed my child and they knew it and did it anyway...)

My stress level is lower. I don't worry about accidental exposure.

CONS OF OIT

We had to follow the protocol every day. This sometimes took scheduling, planning ahead, and forgoing plans to make sure that OIT was not interrupted. My son wanted to go outside and play with his neighborhood friends, but couldn't while "on dosing" (the two hour window after dosing).

My son will also be on maintenance - 4 peanuts and a probiotic - for the foreseeable future.

OIT is not a "cure" for a peanut allergy. He still has a peanut allergy.

THE FUTURE

At any point, my son can return to OIT and continue up-dosing. There's a concept of free eating, which means raising the level of peanut tolerance to the point that anything could be eaten. This requires dosing up to 20 peanuts, a food challenge and a daily maintenance dose of 8 peanuts. I don't know if we'll take this path, or if more options will open up with the peanut "patch" or AIMMUNE, but I believe a true cure is coming.

But until then, the world is a safer, happier, more inclusive place for my son.

If you have any questions, feel free to post below. Allergy parents always stick together.

Friday, December 21, 2018

DIY Wizarding Potion Kit

One of my kids' favorite toys this year are the wizard and witch wands that they made at the library from chopsticks and hot glue.


Seriously, they play with the wands every day.

I had the idea to make them a potions kit.


Supplies:

measuring spoons

plastic spice bottles with lids

cauldron

labels

craft sticks (as mixers)

vinegar, spices, glitter, baking soda, Pop Rocks, grass, rocks (food store, craft store, or found outside)


Ideas to label the spice bottles:
nightshade essence
porcupine quills (dried pine needles)
moonstone dust (white glitter)
knotgrass
ground unicorn hoof (colored glitter mixed)
baneberry
ginger
octopus powder (orange spice mixed with glitter)
sage
rose oil
pond water (white vinegar)
dragon drool (rubbing alcohol)


The potions:
Pop Rocks + Soda = fizzing
Vinegar + baking soda = bubbling
(I'm still working on this part of the kit, and will post more details when I'm finished)


It's one of the gifts I'm most exciting about giving them for Christmas!


Saturday, June 9, 2018

Midnight Sand Release Day!


One night with a committed bachelor…

Sought-after bachelor Ethan Davenport has been in love only once—and when it ended in disaster, he swore to never let it happen again. The black sheep of his family, he does things his own way—alone. But a one-night stand opens his eyes to the woman who’s been there for him all along.

Scarred from the past, Faith Bishop won’t ever tell Ethan how she feels about him. She tells herself they’re just friends…until one night changes everything. When she becomes pregnant with the billionaire’s baby, she can’t hold back her hopes for a real future with Ethan. Faith’s used to making it on her own, and she doesn’t know if she can trust Ethan to give her the family she’s never had.

But Ethan won’t lose his friend and his baby in his life. He’ll do anything to prove to Faith that he’s changed…and she’s the reason why.

Monday, February 12, 2018

Golden Sand cover reveal


Ocean Sands Series Book 2

On the golden beaches of Ocean Sands, sparks fly between a hardworking single mother and a billionaire from humble beginnings…

Computer tycoon Dominic Russell has more money than he ever imagined, but he’s missing something that money can’t buy. When he meets Eden Bell, he’s intrigued by the down-on-her-luck waitress. A relentless competitor, Dominic sets his sights on winning her heart.

Fiercely independent Eden Bell doesn’t believe in true love. She’s been burned before, and while Dominic’s attention is flattering, she doesn’t expect the committed bachelor to fall for her and her ready-made family. The charming entrepreneur proves hard to resist, and the two embark on a relationship that could change them both forever.

But Eden’s been hiding a life-changing secret from Dominic, and if it comes to light, the truth could tear them apart.

Sunday, September 17, 2017

Starlit Sand cover reveal


Starlit Sand
Ocean Sands Series Book 1

Amazon
Kobo
Google Play
iBooks
Nook

A night of passion with a rock star...

Workaholic family law attorney Lauren Catalano has been burned by love. But meeting a handsome stranger on the beach on the heels of her divorce, she can't ignore the passion he sparks. When Lauren learns her mystery man is rock superstar Noah Devereux, she’s convinced it’ll never last. But one night together turns into more and Lauren resists falling for a man who’s touched her heart in a way she never thought possible.

Humiliated by his supermodel ex’s infidelity, Noah questions the worth of his fame and fortune if all it earns him are hollow relationships and betrayal. Lauren’s honesty and loyalty hit Noah hard and he starts to believe that Lauren’s the woman he needs in his life.

Will Noah convince Lauren to believe in happily ever after or will their affair end in more heartbreak?

Capturing a Colton cover reveal


Capturing a Colton (The Coltons of Shadow Creek)
Harlequin Romantic Suspense
August 2017

The most lethal Colton is out for revenge in the conclusion of The Coltons of Shadow Creek!

Real-estate tycoon Declan Sinclair has a score to settle with on-the-run felon Livia Colton. He can't change his tragic past, but he can demolish her onetime estate. But while coming to terms with his most hated enemy, Declan bumps heads with Livia's youngest daughter, the alluring Jade Colton…

Having always felt isolated from her own family, Jade finds satisfaction in rescuing and rehabilitating Thoroughbred racehorses. And when she finds herself in Livia's crosshairs, Jade turns to Declan for comfort and protection. Can she really trust a man who's sworn to take down the entire Colton clan—once and for all?

Saturday, February 18, 2017

Escorted by the Ranger cover reveal


Escorted by the Ranger
Harlequin Romantic Suspense
June 2017

A chilling murder sparks a red-hot runway romance…

After working her way to the top of the modeling world, Marissa Walker finds her dream turning into a nightmare. Her best friend is murdered before her turn on the runway! Is killing models suddenly in style? Now a deadly hitman is targeting Marissa…even as she becomes a suspect in her friend's death.

Enter Jack Larson, army ranger turned bodyguard. Jack's mission: protect a supermodel while attempting to resist the flesh-and-blood woman behind the stunning face. He's been burned in love before, as has Marissa, but when the hunt for a killer leads them into a world of glamour and danger, they'll put everything on the line for love—and their lives!