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November 12, 2022
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Speaker provides tips to improve a child’s OIT compliance

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LOUISVILLE, Ky. — “OIT is a marathon and not a sprint,” Aikaterini (Katherine) Anagnostou, MD, PhD, FACAAI, said during a lecture. “The families need to know that, and the kids need to know too.”

Anagnostou, director of the food immunotherapy and food challenge programs at Texas Children’s Hospital and professor of pediatric allergy at Baylor College of Medicine, spoke about OIT compliance during the Luisa Businco Lecture at the International Food Allergy Symposium at the American College of Asthma & Immunology Annual Scientific Meeting.

 "I … try to fit OIT dosing within the family schedule, not the other way around.” - Aikaterini (Katherine) Anagnostou, MD, PhD, FACAAI
Source: Anagnostou A. International Food Allergy Symposium: Common oral immunotherapy challenges in your allergy clinic. Presented at: ACAAI Annual Scientific Meeting; Nov. 10-14, 2022; Louisville, Ky.

She outlined issues that may affect compliance including anxiety, finding a time of day to take the therapy due to exercise restrictions; bullying; boredom; and taste aversion.

When talking to families, she reminds herself, “I am going to try to fit OIT dosing within the family schedule, not the other way around. Because the whole point of this is to make their life easier, to make their life better, to improve the quality of life and not take out things they enjoy doing.”

Taste aversion and behavioral issues are quite common, she said.

Anagnostou suggested changing the peanut product can help as well as masking the taste with strong flavors and smells.

“My patients’ favorite is barbeque sauce [given that we are] in Texas,” she said. “I also reassure them that taste will become neutral over time.”

When there is a compliance issue, Anagnostou said to validate the patient’s feelings; review the goals of the therapy; and “allow them to stop.”

“Reverse psychology actually works,” she said. “By allowing them to stop, they sort of lose the fighting spirit a little bit, you get them in your corner and then you review their options.”

She also suggests peer support and with an abundance of caution she considers “dose-free days” that align with an outing or a sporting event.

Ultimately, she reminds the patient of the “big picture” — “improved quality of life for those who are successful, protection from accidental exposures ... and free eating for some.”