How We Found Our Way to the Food Allergy Institute: What We Looked at First
- P. Murray
- Oct 30, 2024
- 3 min read
Updated: 5 hours ago
When Z was first diagnosed with tree nut allergies, I did what any physician-parent does: I went deep into the literature. I read studies. I read systematic reviews. I read the AAP guidance and the ACAAI guidelines and, at some point, I started reading message boards at 11pm, which is when you know you've left the clinical literature behind and entered parent territory.
The diagnosis itself wasn't a surprise .... we'd had signs .... but sitting with the formal confirmation that your kid carries an epi-pen now, that you're doing epi-pen training at the preschool, that birthday parties now require a phone call to the host beforehand.... that takes some time to adjust to. Even when you're a physician and you know exactly how the immune system is doing what it's doing, the emotional reality of it lands differently when it's your child.
Tree nut allergy is the second most common cause of anaphylactic reactions requiring epinephrine, after peanut. According to FARE (Food Allergy Research & Education), tree nut allergies affect approximately 1.2 million children in the United States, and unlike peanut allergy .... which about 20% of children outgrow .... tree nut allergy is rarely outgrown. That's why treatment matters so much.
What We Looked at as Treatment Options
I want to share in this post .... and in the posts that follow .... what we actually looked at as treatment options, and why we made the choices we did.
Food Allergy Treatment Options: What We Evaluated
Option | How It Works | What We Decided |
Strict avoidance | Read every label. Carry epi-pen. Educate every adult who spends time with him. | Started here .... required, not sufficient |
Antihistamines + epinephrine | Treats reactions; essential to have at all times. Not a cure. | We have these; not a solution |
Oral immunotherapy (OIT) | Gradual increasing doses of allergen to desensitize the immune system. FDA-approved for peanut (Palforzia, 2020); evidence growing for tree nuts. | Compelling; looked for the right program |
Food Allergy Institute program | Multi-allergen OIT with detailed monitoring; 99% reported success rate across families. | This is what we chose |
Standard allergist OIT | Single allergen; limited to practices offering the service. | Less comprehensive than FAI for our situation |
SLIT (sublingual drops) | Under-tongue allergen drops; lower dose than OIT. | Z is doing this for environmental allergens |
Finding FAI
We found FAI through other families. I was skeptical at first .... the program is years-long and the research isn't yet published in the major peer-reviewed journals at the volume I'd want to see. But the mechanism is sound, the clinical outcomes families reported were compelling, and after the onboarding visit, I left feeling genuinely confident in the team's depth of knowledge. We're about 18 months into the program now.
Why OIT Works (The Mechanism)
OIT works by repeatedly exposing the immune system to tiny, increasing doses of an allergen. Over time, this shifts the immune response .... reducing IgE-mediated reactivity and increasing regulatory T-cell activity, which turns down the allergic alarm. It's the same principle behind allergy shots (subcutaneous immunotherapy), which have decades of evidence. The oral route is newer but growing rapidly.
If you're in the research phase right now .... reading everything, evaluating your options, trying to think like a clinician while also just being a worried parent .... I see you. It's a lot to hold at once. I'll share what we learned, what we wished we'd known earlier, and what's actually happened along the way.
This post reflects my personal experience and is for informational purposes only. It is not medical advice. Please consult your own physician before making any health decisions.
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