OIT Nut Cross Contamination

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February 7th was a HUGE day for us. Riley reached the tree nut cross contamination safety mark. We no longer have to worry about labels that say “processed in a facility with tree nuts” or “may contain” or “processed on shared lines.” We no longer have to worry about the person who ate trail mix and didn’t wash their hands, or worse yet, spills it on the table or floor. No more worrying about the bowl of pistachios someone has sitting out at their house when you come to visit, or the bakery items that were made in a bakery that also uses nuts. No more worrying if there are nuts at an assembly line restaurant like Zupas, or if someone handling his food has scrutinized the labels adequately. It is unreal.

Riley’s doctor told us at this point, he could pick out the nuts in something and he would still be okay. He could eat Massaman Curry and pick out the cashews. That blows my mind. He could handle a piece of nut if someone accidentally dropped it in his food. This is more than just safety from a fleck of a nut made on the same shared equipment. This is a pretty significant safety net that protects him so long as he isn’t eating nuts purposefully. I can’t breathe a sigh of relief loud enough to express how liberating this is.

When we started Oral Immunotherapy (OIT) my top priority as a parent was Riley’s safety. I wanted to help him have a life where food was not something that made him worry for his life. My second priority was that I wanted to give him the opportunity to participate in social eating with his peers and family. I hoped we could accomplish those things with OIT and we did! My goal was to get him to the point where he could eat milk and egg without worry and that he eat food without worry of nut cross contamination. We reached that this month.

I feel like we have accomplished all I hoped for. I would be okay if we stopped up-dosing right now, but Riley wants to continue on. He said he wants to complete his OIT therapy for tree nuts and be able to eat nuts freely. He said he wants to be able to eat food without reading labels or asking if there are nuts in the food he eats. He wants to feel like he has complete freedom to eat whatever he wants without worry verifying what is in his food constantly. I can’t blame him and I support him fully.

We have a couple more months of OIT up-doses to be able to freely eat tree nuts. He is currently allergic to cashew, pistachio, hazelnut, walnut and pecan. He used to have a peanut allergy but outgrew it. He passed a peanut challenge in June of 2018. We are currently dosing cashew, hazelnut and walnut. As of today, we are up to 7 cashews, 7 hazelnuts and 3 walnut halves. We will continue up-dosing to 12 cashews and hazelnuts each, and 5 walnut halves, and then challenge 24 of each cashew and hazelnut and 10 walnuts (all on separate days.) If we pass the challenges, we will drop down to a daily maintenance dose of 8 cashews and hazelnuts and 3 walnut halves. Our doctor told us that in most cases, treating cashew also treats pistachio and treating walnut also treats pecan. We will challenge for these nuts about a month after we finish treatment and review blood work again.

The end of our weekly visits is in sight, but right now I am basking in the joy of watching my son eat his first Snickers bar, a Daylight Donut, a cupcake from my favorite bakery without worrying or feeling guilty that he couldn’t participate. Life is good, and I am so grateful for OIT.

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