From Allergist to Anxious Mom: My Journey Through Food Allergies and the Promise of OIT

Hi I’m Dr. Neha Dunn and I wanted to share my personal journey with food allergies.

Having a child with food allergies can feel scary. You are always checking labels of everything at the grocery store, worrying about an accidental ingestion, and hoping that restaurant staff avoid cross contamination. Vacations and family gatherings can be challenging since you don’t have control over the menu. You feel nervous about your child going places without you. Should you completely remove the food from your house and have your whole family avoid it? What will happen when your child goes to college or has a sleepover without you by their side?

Even as an allergist, I did not fully appreciate that anxiety until I went through it myself. When I realized my son had a peanut and sesame allergy at four months of age, I was eager to do something about it. My colleague and dear friend from fellowship at National Jewish Hospital in Denver, Dr. Jennifer Hill, shared her personal success stories with oral immunotherapy (OIT), a form of food allergy desensitization, that she performed in her clinic. Prior to 2015, the only option for children with food allergies was careful avoidance and carrying an epinephrine autoinjector. Since that time the food allergy landscape began to gradually change. I wanted to give my son and my patients the best opportunity to treat their food allergies, but no one near me in Central IL performed OIT. The only option for food allergy desensitization was a new FDA approved therapy called Palforzia which was approved for ages 4 and above at the time and was very costly. I became eager to learn about all the different options for food allergy desensitization therapy and find the best one for my son and my patients.

Dr. Hill suggested I become involved in a food allergy community, called OITAdvisors – a small online group of allergists across the globe who share information, free of pharmaceutical funding and biases, about protocols being developed, outcomes and research in the food allergy treatment space. She also told me about the Food Allergy Support Team’s (FAST) annual meeting held in Dallas every year where allergy providers from all over the country meet in person to discuss current research and progress in the field, again, free of pharmaceutical biases. This sounded like the perfect learning opportunity.

Around this time, my husband and I were discussing the possibility of moving to Florida to be closer to family and experience sunnier weather. While researching job opportunities, I came across Windom Allergy. I noticed that the doctors in this practice were the same ones speaking at the upcoming FAST meeting. I was intrigued. When I met Drs. Windom, Ly and Fergeson in person at the meeting, they were knowledgeable, experienced, collaborative and compassionate. I knew instantly that I wanted to work with this group. As fate would have it, six months later, my family moved to Sarasota and I joined Windom Allergy in January 2023. During my time here, I have learned a tremendous amount about food allergy immunotherapy. As a practice, we meet weekly to discuss our patients, modify our protocols based on current literature and share information with other colleagues. We treat patients nationally and even internationally.

My son started OIT as my first patient back in Central, IL in 2022. After nearly two years of OIT for peanut and sesame, I am so grateful that I started this journey. This doesn’t mean that my son likes peanut butter or sesame. There are children who start OIT young enough that they will be cured of their food allergies, making it possible to regularly eat the food. Older children and those with high IgE levels to the food, like my son, are desensitized, but still allergic. He has never been able to reach the highest dose of the protocol. He won’t eat PB&J sandwiches like I thought when I first started this process, but it doesn’t matter. I have peace of mind knowing that if he accidentally bites into the wrong food, I don’t have to worry about an anaphylactic reaction, epinephrine administration and a possible ER visit.

OIT is a true time commitment. All parents should know and understand this. It requires daily dosing of a small amount of the food (measured out by grams of protein using a food scale). Personally, I prepare all my doses in small glass bottles every Sunday using organic PB2 powder and Kevala sesame flour. I mix this with chocolate milk and sit with my son while he drinks it every day. With three kids, I have to consciously make sure to work around activity schedules and school drop offs and pickups to find a time to dose him two hours prior to exercise. But despite all of this effort, protecting my kid against an unnecessary reaction is absolutely worth it!

As careful as I try to be, I will admit, we have had accidental ingestions. My son ate a peanut M&M at a baseball game. Another time, he ate a Ritz cracker with peanut butter. Both times, he had already eaten the food when he realized there was peanut in it. I prepared myself for an allergic reaction. I had my Auvi-Q in hand, and… nothing. He had no reaction! I almost cried tears of joy. Those daily OIT doses had paid off.

Oral immunotherapy has been studied for several years now and is offered at a variety of locations across the country and beyond. With oral immunotherapy, the dose or amount of protein ingested is increased during in-person visits to the allergist in order to reach the top or maintenance dose, which is then given every day, just like a daily medication. Doses can be skipped short term for illness or travel but should be given as regularly as possible. Children who take these doses have to avoid exercise for two hours after their dose, because exercise can increase the risk of a reaction. Children must also snack or eat before their doses so they have something in their stomach.

Not only do we continue to provide this therapy, but there is now a safer, newer form of desensitization therapy called sublingual immunotherapy for those highly allergic, high-risk patients who cannot tolerate oral immunotherapy. Sublingual immunotherapy involves holding a small amount of diluted solution (containing the allergen) under the tongue for one minute. The build up to the highest dose in this form is faster and there are no exercise restrictions. Both treatments are able to increase the threshold or amount of food ingested to provoke an allergic reaction, i.e. desensitization. Food allergies don’t go away completely – there is always a risk of re-sensitization (or becoming allergic again) if you don’t continue some form of therapy. But when done correctly, this can protect patients from unnecessary reactions and fear of reactions.

The truth is, death from food allergy is very rare, thankfully. Carrying an epinephrine device at all times and reading food labels protects many people from reactions. But sadly, there are some fatal cases and there are many non-fatal reactions to accidental ingestion. Now, it’s preventable. No matter how rare, if I could do something to prevent my child from potentially being in a near-death situation, that’s enough for me! It brings me great joy to work at a clinic specializing in food allergy treatment and to be able to offer this therapy to my patients with food allergies. Thank you for reading my story.