Update

Just when I think I know it all (or most of it) and just when I feel like I've got the hang of it... this allergy life hands me another lemon, but we all learn and grow from it.  After B's anaphylactic ordeal last weekend, we've grown to understand how we can keep her even more safe. For that, I am thankful.

We have come to the conclusion that we may never know what caused B to react to her daily peanut dose, a dose she had been consuming for the last 4 months and doing fine with... but we realize that there were several very likely culprits and that all of them came together to create the perfect storm.  B's OIT doctor explained her situation as being like a "bucket."  When she reacted, it was because her bucket had reached it's capacity. We know that B's immune system was already being challenged when I gave her the dose that sent her into anaphylaxis.

B has a class 4 allergy to cat dander, which is pretty high.  Even though we do not have any pets, she was probably exposed to it because our in-laws who were visiting have an indoor cat (which we did not know prior to their arrival).  Cat dander may have been on their clothes and sleep-over belongings and tracked into our house.  This combined with the pre-dose high physical activity, lack of water and not enough food before her dose sent her over the top.

So, what we have learned from all of this and what we will be doing differently from now on is;

1. Zyrtec;  Anytime we have visitors who have pets or anytime we visit anyone else's home that has pets, we will be sure to dose B with Zyrtec before she comes into contact with them.
2. Water; I am pretty sure that from now on, both B and I will be sure that she has at least 4-6 oz of water to swish and wash down her dose with.  Neither of us will allow distractions to prevent her from drinking water after her dose.
3. Meals; we are going to re-train our brains concerning meal times.  B takes her maintenance dose right after school.  From now on, she will have a full meal before her dose (not a snack) and we will make dinner our lightest meal of the day.
4. Rest periods;  We are going to observe the "no physical activity for 30 minutes prior to the dose" rule.  We'd never been told that before, but some of the OIT docs have that included in their protocol, and so we will include it in ours as a precaution.

The day after she experienced anapylaxis (Sunday), B skipped her dose. On Monday, she had 1/3rd of her normal dose and did very well.  No complications.  On Tuesday, her OIT doc was back in town and we went to his office to dose her.  We all decided that her dose could be lowered from 4.5grams to 4grams.  She ate her 4 grams and had no complications at all.  She will remain on 4g of peanut for the next month or so and then will return to 4.5grams.

We thank all of you for your prayers and well wishes for B.  I am so happy that she will be able to continue on this journey to being free from her peanut allergy.