The common person would say children will likely outgrow allergies as their immunity gets stronger. This is true for the majority of children with mild allergic symptoms. But my 4-year-old son doesn’t belong to this majority. He is severely allergic to eggs, dairy and peanuts, together with house dust mites (HDM) allergy.
Our allergist had prepped me many moons ago to be ready to battle for the long haul.
And what a battle it has been in the last 4 years.
As an allergic parent, there are many things vying for our attention. If we do not prioritise we end up making missteps and inappropriate decisions with regards to our children’s health.
How I prioritise is through observing Corey’s allergic symptoms which have changed as he grows.
Corey’s allergic symptoms from HDM allergy has been getting worse in recent months based on my observations. Rashes, red eyes and constant sneezing would show up after he naps or first thing in the morning. His eczema would flare in the middle of the night (of all times?!) despite my lathering him with moisturisers before bed.
I would notice the improvement of these symptoms with a dose of antihistamines. Likewise, once we missed a dose of meds, the symptoms would show up with a vengeance.
Thus my focused shifted from food allergies to HDM allergy in the past few months. Read more on why this came to be in my previous post: “Corey’s Eczema & Allergy Progression 2020”.
Corey’s Dust-mite allergy ‘growing with him’
Last week was our first allergist review in 2020. The focus was to investigate and confirm if my suspicion is true. Doctored ordered a follow-up skin prick test for HDM to corroborate my observations since our last HDM skin prick test was May 2019.
Skin Prick Tests conducted regularly and compared across time add more value to allergy diagnosis than one-off tests.
Doctor preempted me long ago that as Corey moved through The Allergic March his food allergy would wane as he grows and environmental allergies would get stronger.
The test results are below. The numbers for the 3 classes of HDM in Singapore have grown from 6,6,3 in May 2019 (pictured on the left), to 9,9,3, in March 2020 (pictured on the right). Our allergist’s conclusion is that his HDM allergy is ‘growing with him’. If the numbers had doubled, that might have indicated a severe increase in HDM allergy. In this case, it is increasing in proportion to his growth, but it is also not improving.
A Glimmer of Hope – embarking on Sublingual Immunotherapy (SLIT)
I explained to doctor our dependence on antihistamines being the only thing holding the allergic symptoms down for HDM. Thus we revisited the idea of embarking on Sublingual Immunotherapy (SLIT)
What is Sublingual Immunotherapy (SLIT)?
Quoted from the American College of Allergy, Asthma & Immunology: Sublingual Immunotherapy (SLIT) is “an alternative way to treat allergies without injections. Currently, the only forms of SLIT approved by the FDA are tablets for ragweed, northern pasture grasses like timothy and dust mites. Tablets used under the tongue boost tolerance to the substance you’re allergic to and reduce symptoms.”
In my own layman terms, this is a slow rewiring of the body’s immune system to accept the allergen as a norm thus ‘telling’ the body not to react.
How is it given?
Patients spray a specially formulated extract (or tablet form) of the allergens under the tongue and hold it there for a short period of time before swallowing.
We first discussed SLIT for Corey’s HDM allergy last year. Doctor felt it was too soon for a 3-year-old to do SLIT therapy effectively. Why?
To be effective, patients must hold the extract under the tongue for anywhere from 30 seconds to 1 minute. The patient must do this every day around the same time for months (some required to do it for years) to see a positive effect. This means the success of the therapy largely depends on a patient’s adherence to administer the extract accurately every day.
Why and how it can boost tolerance to the allergen?
It works by slowly brainwashing the body’s immune system to accept the allergen as a normal part of your body. It takes months (some take years) to show results.
I drew a chart below to summarise what is ‘slow brainwashing’ in layman terms. The red line represents the erratic exposure daily to HDM for those who suffer from it. SLIT serves to neutralise this erratic behaviour by keeping the exposure at a high level constantly. This in effect would rewire the immune system over time to believe that this amount of HDM is normal. With this normalisation, the theory is that the body’s histamine response will be reduced over time.
To read more about HDM allergy and Sublingual Immunotherapy go to Asthma and Allergy Foundation of America: Dust Mite Allergy and also speak with your attending allergists.
Normalizing Allergies as a part of our lives –
There was never a doubt in my mind that we would embark on SLIT, it was only a question of when.
Last year doctor told me he was too young. And that we will consider it once Corey could hold liquids under his tongue for 1 minute without swallowing. This year, Corey has just turned 4, which doctor says is still very young. But he could tell how motivated both Corey and I were to reduce ‘those itchies’. I have also started training Corey on holding something under the tongue which I will share in my upcoming posts.
The best way I learnt to cope with Corey’s severe allergies and chronic eczema over the past 4 years is to treat them as part of our daily lives. Huge adjustments were made to our lifestyles to keep him comfortable but they are paying off. Just like how his (extremely cumbersome) skincare regime has become second nature, SLIT must be done (as doctor puts it aptly) like brushing teeth every day.
My allergy mum glass is always half full
Doctor has reminded me many times that Corey has an 80% chance of developing asthma. So far, his lungs have been perfect. With SLIT, doctor says we might potentially protect Corey from developing this allergic asthma. If SLIT can help me to beat those odds, it is definitely worth a small inconvenience of a daily spray administering.
So our first dose of SLIT is scheduled in hospital next month and I am excited.
Next up, I will share what I learn about SLIT along our journey and how we are training to take our first dose of SLIT. Subscribe to this blog to get notified when it’s up!
All opinions and views expressed herein are the author’s own and not anyone else’s. Any quotes from medical healthcare professionals are written from the author’s perspective and should not be construed as medical advice. Every child and every symptom is different thus it is important to seek advice from a professional allergist or dermatologist for your unique situation. All images and pictures on this website are copyright of the owner of this website and cannot be used or downloaded without permission.
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