Figuring it out

I realize that, not too long ago, I wrote that I probably wouldn't be writing any more blog entries... and since then I've written 3 entries within the last week.  I've found that writing these entries serves as a wonderful way to keep records of what is going on with my little girl. 

Since Thanksgiving, B has had 3 reactions.  Prior to these three events, she only had little hiccups in her treatment.  These last 3 reactions have been significant reactions. The first of the three, I never blogged about,but this is what happened;

"11/30/14 At around 1AM my daughter woke me up calling for me. As I entered her room, she was standing in the middle of it scratching herself all over. I found her covered in head to toe hives. She said her tummy hurt and that her throat was scratchy. We have no idea what caused her to react in the middle of the night. She is in her 3rd month of maintenance for peanut, and she has been doing fine with it. She had taken her daily dose at 5:30 and gone to bed at 8pm. She had observed her 2 hours rest time post dosing, but she may have gotten her heart rate up a little bit b/c she raced up the stairs at 7:30. She had nothing new to eat that day. I am baffled. I don't know if racing up the stairs at 7:30 caused her to break out in hives 5 and a half hours later? I don't know if the people we had over that day may have tracked something in with them? The timing of the reaction was just weird. We called her allergist who, thankfully, answered the phone at 1am. I was "this close" to giving her the epi but b/c she was NOT having trouble breathing and her heart rate was within normal limits we gave benedryl. The tummy pain was very scary for me. I just kept thinking about Natalie Giorgi and all the kids who have no outward symptoms but are reacting on the inside. I stayed up for 2 hours watching her and then slept right next to her for the rest of the night. I am so thankful she is okay, but I am also so puzzled about what happened to her."

I was puzzled, but I'm starting to make the connections.  WE know for sure that B is reacting to her OIT maintenance dose because some environmental allergen is "filling up her immune system bucket" and her daily dose is causing her bucket to overflow.  The question is, what is filling up her bucket?  This is what we know for sure;

• B has seasonal allergies to some trees and some grasses.
• She also has environmental allergies to cat dander, dog dander, and one type of mold.
• She has anaphylactic food allergies to several tree nuts as well as peanuts.

Of all of these allergens, I think it is safe to cross food allergies off the list. She has not eaten any new foods.  Unless the food we are giving her has been processed differently than the way they were before, it is not food allergens that are filling up her bucket.  She is eating peanut, which is a carefully pre-measured dose, and she is obviously still allergic to it... but her body has been trained to be able to tolerate the amount we have taken a year to work up to, and we do not give her even a single smidgen more.  This is the whole purpose of OIT.

That leaves environmental and seasonal allergies as possible bucket-filling-culprits.  So, in looking at her three significant reactions one by one, we can better determine which it is.  Let's first consider seasonal allergens;

1. November 30, 2015- B broke out in hives at 1:00 in the morning. It was cold on the 29th.  I am not sure if there were any trees or grasses releasing pollen, but it's highly unlikely since this is not the growing season.  So, we can safely assume that seasonal allergens did not play a part in that reaction.
2. January 3, 2015-The day that B went into anaphylaxis it was cold, and rainy and we had been inside all day.  Considering the weather, it is safe to cross off seasonal allergens as a culprit.  There was nothing growing or blooming and if there were, the rain would have washed it all away.
3. January 8, 2015- B broke out in hives 2 hours after her dose. Again, it was a cold wintry day... the coldest day of the year, and highly unlikely that she were exposed to any seasonal allergens. In fact, the map on allergy.com stated that there were no seasonal allergens in the air that day.

Second we will consider environmental allergens;

1. November 30, 2014- B broke out in hives in the middle of the night, but during the day I had done Santa photography sessions in my home.  My father-in-law, who plays the part of Santa, has an indoor cat and an indoor dog.  It is likely that he had animal dander on his clothing when he came over.  Of the 6 families that I photographed and questioned, three have confirmed having indoor dogs, one has said she has and indoor dog and an indoor cat and one has said she has no indoor animals.
2. January 3, 2015- B had anaphylaxis one hour after taking her dose. During that day and the night before, B had a friend (L) over for a sleepover.  L has an indoor/outdoor cat.  L's mom confirmed that the cat sleeps in L's room, so it is safe to assume that L's sleepover belongings and clothing all had cat dander on them.  After L went home Saturday morning, my husband's sister and niece came to visit and sleep over.  They also have an indoor cat, and most likely had cat dander on their sleepover belongings and clothing.
3. January 8, 2015- B had been sent to the nurse while at school b/c she had been complaining about itchy legs. The nurse did not see any hives or rashes, applied cortisone cream and sent her back to class.  She attributed the itchiness to the fact that B had tights on under her jeans. That same day, B broke out in hives 2 hours after her dose.  Upon asking B what she was doing when her legs began itching, she stated that she had been working in partners with L (the same friend who came to sleep over and who most likely had cat dander on her clothing).  I'm sure that of all the 20+ children in the class, there are probably more children who have indoor pets. The teacher has told me that she also has an indoor cat.

It has made me feel a little bit better to be able to get to the bottom of the "why"... now we need to figure out what we can do to help B's body deal with these environmental allergens so that she can continue to take her daily dose of peanut without reacting to it.  This probably means we will have to start avoiding people's homes who have indoor pets, and it definitely means that we will have to start B on a daily dose of citirizine (Zyrtec), to help her body deal with the exposures to allergens that we cannot prevent (like at school).  

Upon her OIT doctor's request, we are going to do more bloodwork, and B has an appointment on Monday for a draw.  Hopefully the results of the labwork will help B's doctor get a better understanding of what is going on and give him some ideas on how we can help her.  She simply cannot keep having reactions to her dose.