Embedded Files
Discussion Guide
A unique feature of Zippy: A Story about Oral Immunotherapy (OIT) for Food Allergies is the inclusion of QR codes on its pages that link to additional material for parents and guardians. The discussion guide will include more detailed information about the topics being introduced in the picture book and provide guidance on how to initiate open conversations with children about the process of oral immunotherapy. QR codes can be scanned using the camera on your mobile device.
Page 3: Exploring Your Child's Feelings about Food Allergy
This is a good opportunity to discuss with your child what “fuel” they are allergic to, and how it makes them feel to have this allergy. Jot down key words, which may be a mix of negative and positive emotions. Does your child have any goals or desires that are hindered by food allergy? You can come back to this list after completion of desensitization to gauge shifts in attitudes about the impact of food allergy on quality of life over time.
Page 4: Your Allergist is Your Crew Chief
Discuss with your child how the Crew Chief is a doctor for racecars, just as the Allergist is a doctor for kids with food allergies. Does your child know their allergist’s name? Breeding familiarity with the medical team can help to reduce anxiety. Write down the names of key players on your child’s medical team and attach photos if possible.
Page 6: Who is in Your Pit Crew?
Food allergen desensitization requires a full team for optimal results. A medical team, to be sure, but also a support team in the home setting. Parents and guardians will typically take on much of the responsibility associated with medical care. However, there is also a role for siblings, grandparents, and friends in creating a strong support system for a child undergoing food allergen desensitization. Who is in your “pit crew”?
Page 8: Your Body is a Race Car
Analogies are a great way to teach children about health. Here, we compare the parts of a car to organ systems in the body to help children grasp the importance of health maintenance.
Uncontrolled eczema can flare up during food allergen desensitization, so it is essential to gain control over any skin rash before starting food oral immunotherapy. Talk to your child about how Zippy’s rusty patches are like areas of active eczema on the skin, and how taking care of the skin is just as important as Zippy keeping his paint job smooth and shiny.
Gastrointestinal symptoms are the most common side effects during OIT. Although they are generally mild and self-limited, GI side effects can be more problematic during food allergen desensitization if bowel habits are irregular at baseline. Constipation, in particular, can result in abdominal pain that can be difficult to differentiate from dose-associated discomfort during OIT. Teach your child that bodily functions are not shameful. If your child is old enough to handle all toileting independently, have a discussion about frequency and consistency of stools. We need hydration, fiber intake, and physical activity to keep the bowels moving. Some doctors also believe taking a probiotic during OIT can help keep the gut microbiome balanced and promote regularity. However, a more proactive approach is sometimes needed. Discuss with your pediatrician, gastroenterologist, or allergist if bowel irregularity or baseline abdominal discomfort are concerns.
Additionally, maintain a diet with a balance of lean protein, fresh produce, complex carbohydrates, and healthy fats. Having healthy food in the belly before dosing is essential to reduce to chances of experiencing pain, nausea, or vomiting after dosing.
For a more detailed explanation of the risks and benefits of OIT, please refer to Dr. Bajowala’s book, “The Food Allergy Fix: An Integrative and Evidence-Based Approach to Food Allergen Desensitization”.
Allergic rhinitis and asthma must be controlled before beginning food allergen desensitization. In fact, poorly controlled asthma is a risk factor for severe reactions during OIT. Does your child tend to cough at night or with exercise, or does it take a long time to recover from viral illnesses? Devote whatever time it takes to get your child breathing well before embarking on the journey of food allergy treatment. In addition to subjective assessments of asthma symptoms, consider objective measurements of airway function (spirometry) and inflammation (fractional exhaled nitric oxide) to ensure that you are on solid footing.
It is to be expected that both child and parent may have some anxiety about the prospect of intentionally ingesting a known allergen. This can be eased with reassurance and a complete discussion of procedures and expectations throughout the process. Open communication is key. However, if anxiety is generalized and uncontrolled at baseline (for patient or guardian), it makes sense to have it addressed before beginning desensitization therapy. This does not necessarily require medication, and often benefits from counseling or cognitive behavioral therapy.
Page 15: The Importance of Rest
Most allergists recommend a defined rest period after OIT dosing to minimize the risk of experiencing a reaction. It is important to be organized and plan dosing and rest times around important activities that involve exercise. With careful planning, kids can continue their favorite activities while pursuing OIT.
Patience is a virtue. It is understandable for families to want to complete the desensitization process as quickly as possible. However, immunomodulation requires us to let the patient’s immune system set the pace for therapy. If we push too hard and fast, adverse reactions can occur. So, slow and steady wins the race! Have a discussion with your child about something they wanted for which they needed to wait. Likewise, share with your child something for which you have needed to be patient. Celebrate small milestones during the course of desensitization to break up the therapy into manageable chunks of time.
Page 19: Routine & Preparation
It is essential to understand that food allergen desensitization is a commitment. Regular dosing is needed over the long-term to cement the retraining of the immune system. Discuss with your child things that are part of the daily routine, and why they are important. Brushing teeth, exercise, eating meals, reading, bathing. How can OIT dosing be incorporated into the routine?
It is also essential to recognize that while OIT can be an excellent management strategy for food allergy, it is not a cure. Reactions to the dose can still occur. Therefore, the rest period after dosing should be observed until advised otherwise by your allergist, and autoinjectable epinephrine must always be accessible. To help your child understand the importance of carrying epinephrine, discuss how Zippy’s toolkit and spare tire are always handy, even though his training is complete. Also, continue to review your allergy action plan regularly. Preparation is the best prevention.
Page 21: Safety is the Priority
It cannot be overstated that food allergen desensitization therapy can ONLY be performed safely under the direct supervision of a board-certified allergist, who is specially trained in desensitization treatments and has the clinical expertise to immediately recognize and treat anaphylaxis. It is not safe to attempt this therapy on your own.
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