Food Allergy OIT and Competitive Sports: It Can Be Done

I cannot remember my first allergic reaction. I know it was triggered by a taste of hummus at 13 months old. Nor do I recall the day I was diagnosed with severe allergies to nuts and sesame.

But I will never forget the recurring trips to the emergency room due to accidental ingestion. Nor will I ever forget the ritual of turning over a pizza slice to check the bottom for sesame seeds. Food allergies created a lot of anxiety in my life which, at times, I was not completely conscious of. Other times – at restaurants, during travel, in hospital beds – the weight of my allergies was inescapable.

Nonetheless, as a kid, I chose to identify with many things before my food allergies. At the top of the list was (and still is) tennis. I started playing tennis when I was 5 years old and became a competitive player. Ever since, tennis has been a defining aspect of my life – much more so than my allergies.

When I was in sixth grade, my family began to learn about oral immunotherapy. OIT is the treatment that can lead to allergy desensitization as the patient consumes tiny, then gradually increasing amounts of an allergen over many months, until a maintenance level is reached. But I made it clear that I was unwilling to sacrifice tennis for the opportunity to undergo OIT, even if it would help protect me from allergic reactions.

In the end, I was able to undertake and complete OIT successfully, greatly reducing the burden of my allergies, while devoting more time to tennis than ever before.

OIT and Sports Misconceptions

I know there are junior athletes with severe allergies in the same position that I was in. You want to do OIT, but can’t bear the thought of abandoning your sport. There is a huge misconception that competitive student athletes can’t do OIT because of the treatment’s “limits” on exercise. To the contrary, you do not have to choose between your sport and OIT. You can do both.

It is important to understand that OIT is a process with rules, and your allergist will explain that it can’t be done nonchalantly. The basic rules include:

Each OIT dose should be taken 24 hours apart. My allergist allows for a three-hour “grace period” past the 24-hour mark. He also allows a patient to take the next dose earlier than 24 hours apart, so long as a minimum of nine hours has passed between doses.
You must eat food, preferably carbohydrate-rich, before taking your dose. A full stomach slows the absorption of the allergen into the bloodstream, reducing the risk of a reaction.
There’s a two-hour rest period after dosing, meaning no exercise, because an elevated heart rate can induce an allergic reaction.
Avoid taking a hot shower after dosing, as increasing your body temperature could induce an allergic reaction.

Anyone doing OIT must be diligent about the rules. For student athletes, there is additional planning involved. The minimum two-hour rest period after dosing is obviously their major issue to manage.

In my case, my doctor knew I played intense, competitive tennis and the cardiac impact was very high. So he instructed that I wait at least three to four hours after dosing before playing tennis. This expanded “no exercise” period worried me and my family. Yet, I was still able to do my sport and OIT.

OIT and Sports Tournaments

On weekdays, when I had tennis practice, I managed the rules easily. I took my OIT dose after getting home from practice, showering and eating a carbohydrate-rich dinner. I spent my post-exercise rest period doing homework and getting ready for bed. This basic routine satisfied all the rules of OIT while maintaining my sport and keeping my life relatively simple.

While my weeknights were highly structured, my weekends were the opposite. Tournaments have unpredictable draw times all throughout the weekend, and I never know the exact time I will play until the night before. This made it tricky to plan my dose in accordance with the meal and 24-hour rules.

But I managed. I often relied on the extra three-hour grace period to dose after the 24th hour had passed, especially if I got back from a tournament late at night. Occasionally, I found myself dosing at midnight.

Other times I dosed in the morning, leaving at least four hours before a match set for the later afternoon. As long as my previous dose had occurred at least nine hours before, I was allowed to take my dose early.

In this case, I had to be careful with the next day’s schedule. For example, If I had to play the following morning, dosing before my match would violate the rules. To avoid this, I would take a second dose the night before. This is known as “double dosing,” which is permitted for some OIT patients.

During these weekends with erratic exercise hours, there was no routine to rely on. Instead, I was forced to adapt to things outside of my control – tournament times, match duration, travel time – and focus on what I could control. Planning was crucial for us to manage dosing with my tennis tournaments – and we never once missed a dose.

For Me, OIT Was Worth It

OIT is a transformative process for kids struggling with food allergies. At the same time, a sport can be one of the most significant parts of a teenager’s life. When I was younger, I didn’t want to sacrifice tennis for even the most valuable allergy treatment. But now, as I am about to turn 16 years old, I can’t imagine my life if I hadn’t tried and successfully completed OIT.

I want to encourage other student athletes not to be deterred by OIT’s reputably restrictive rules. While doing the therapy alongside a competitive sport requires organization and careful planning, it is possible. The increased freedom I now experience in my daily life is confirmation that it was all worth it.

While OIT is not a cure for food allergies, I no longer have to avoid certain cuisines or scrutinize ingredient labels for “may contain” warnings. The anxiety that once burdened my life has dissipated. I have been in “maintenance” for two years, and today only have to dose four times a week. Now, my biggest concern is simply remembering to take my dose – not accidentally ingesting my allergens.

Idan Yedid is a high school junior who lives in Chappaqua, NY. He plays high-level USTA junior tennis tournaments year-round and is nationally ranked.

Photos courtesy: Idan Yedid