Tuesday, June 22, 2010

Food Challenge Time

It's finally time. We've been participants in a Peanut Sublingual Immunotherapy Clinical Trial for over a year. May 18th marked our one year anniversary and June 23rd marks our first food challenge. Come 8:00 Wednesday morning, Abigail and I will be at the Duke Clinical Research Unit nervously and anxiously waiting to begin.

I've been quite excited waiting for this day to come.  Abigail has been more on the nervous side.  I've given her all the details I think she can handle.  I've clarified that they are not going to take her to the point of her having an anaphylaxic reaction, and it was evident that she was relieved.  Now, the day before, I'm getting a little anxious as well.  I just so badly want to see good results!

Here's what our day looks like. We start right off with testing.  Abigail will have to immediately get an I.V., then have blood drawn, have a skin prick test and spit in a tube for a saliva test.  Around 9:00 a.m. we'll start the 1st of 2 food challenges.  It's a blinded challenge so one will be peanut flour and the other oat flour.  The staff in the kitchen actually makes the call as to what comes first.  We're not supposed to know until after both challenges, but I hear it's pretty hard to not smell the peanut flour.  The flour will be mixed with applesauce.  I'm also bringing chocolate pudding, cinnamon applesauce and because she occasionally eats sunflower butter, I'm bringing sunflower butter and crackers to give her some variety.

There should be no issues with the first couple of doses.  If I'm reading my notes from our last Duke visit correctly, by the 4th dose, she'll be getting 100 milligrams, 5th dose, 250 milligrams, etc.  The 9th dose is the equivalent of 8 to 10 peanuts, over 1500 milligrams.  If she can tolerate it, they'll stop the challenge at the 9th dose.  There's a 2 hour break, and then the process is repeated with the second challenge.  It's going to be a long day.  We're expected to wrap up between 5 and 6 o'clock.

They'll be monitoring her the entire time.  Benadryl and Epi Pens will be right there, and of course, she'll have the I.V.  Every few minutes they'll check for a reaction.  Our doctor and a nurse will be there, with another nurse stopping in periodically with a new set of eyes.  We're looking for sinus issues, hives, stomach pains with possible vomiting.  Any of those symptoms will stop the challenge.  Her history of stomach aches adds a little complexity.  Her stomach hurts when she's nervous so we'll have to push through that.  That's also why they do a blinded challenge with both peanut and oat flour so they can rule out a psychological reaction.  According to her doctor, the biggest sign of a reaction is a change in behavior.  He says that the kids will be playing their Nintendo DS, watching a movie, reading a book, etc., and then all of a sudden, they stop and go lay down, kinda withdraw.  Small children will crawl in their mom's lap.

We're taking lots of movies, and I've got my bag of treats packed.  It's a big day for Abigail.  The good news is that they're seeing a clear difference in the study results between the children getting the peanut protein and the children getting the placebo.  At the end of the day, Abigail's file will be unlocked and we'll see what she's getting.  I'm 99% sure that we are getting the real thing, and I'll be embarrassed if we find out that she's been on a placebo all this time.  I really don't think so though.

According to our doctor, based on the 40 plus food challenges already completed, they know that the sublingual immunotherapy works, the question now is how to make it work better.  Keep us in your prayers on Wednesday that it works for us.  I'll post an update Wednesday night.


momof2inNY said...

Best of luck to you!!!!! I hope you get the results you've been so anxiously waiting for!!!!

Julie Redfern said...

Go Abigail! Good luck Melanie!

Horning's said...

wow.. chills. I am sorry I didnt read this prior to now. I will be praying for you both today. I am so excited for little Abigail!! wow, again.. I am praying and expecting! God is Great, he will watch over and protect little Abigail and guide the minds and actions of the nurses/doctors today. I cant wait to read an update :)