My child is too young.
We’ve started patients as young as 6 months old and we find the younger they are, the better they do in OIT. That’s at least partially because kids under 5 years old are less reactive on exposure to a food than older children. So, when we start OIT at a very low dose we are a long way from their threshold of reacting.
The IgE is too high, I am too allergic.
No such thing. In fact, the opposite is true, the more allergic the patient, the more critical it is that we control the sensitivity to the food via OIT.
We live too far away.
We feel terrible that patients have to travel so far (we’ve had Dubai, Trinidad, London, and others), but we do our best to find an allergist near you to help out with the later doses. This is not only helpful for you, but gives us a chance to introduce OIT to other allergists around Florida and beyond.
Eating the food daily will be difficult.
Make it part of one of your regular meals, no big deal. A recent egg/milk patient reports eating one scrambled egg and a tub of yogurt each morning - kind of sounds like a normal breakfast. Plus, over time, typically a year or two, you’ll only be required to dose 4-5 days a week and even less often.
We will need to use epinephrine.
Somewhere between 4-14% of patients will use epinephrine (Epipen, Auvi-Q) in the first year of OIT. While this may be more than you used in previous years, it is given under a controlled situation after a dose at home (not at baseball game with Uncle Joe), often used early for mild symptoms, and in over 50% of cases, an ER visit isn’t necessary.
I will get eosinophilic esophagitis (EoE).
EoE is the accumulation of allergy cells, eosinophils, in the esophagus. While this has been reported in patients undergoing OIT, it is seen just as often in the general population of allergic kids, similar to them developing hay fever (eosinophils in the nose) or asthma (eosinophils in the lungs).