If you suffer from allergic asthma, rhinitis, conjunctivitis or stinging insect allergies, you may benefit from allergy immunotherapy. Allergen immunotherapy, also known as allergy shots, is a form of treatment that is aimed at decreasing sensitivity to allergens. Allergens, such as pollen, mold and animal dander, are substances that trigger allergy symptoms when an allergic person is exposed to them.
Patients who receive allergy immunotherapy are injected with increasing amounts of an allergen over several months. Allergy immunotherapy has been shown to prevent the development of new allergies and, in children, it can prevent the progression from allergic rhinitis to asthma. It is the most effective treatment for inhalant or insect allergies. It can also lead to the long-lasting relief of allergy symptoms after treatment is stopped.
Both children and adults can receive allergy immunotherapy, although it is not recommended for children under five because of the difficulties younger children may have in cooperating with the immunotherapy program. When considering immunotherapy for an elderly person, medical conditions such as cardiac disease should be taken into consideration and discussed with your allergist first.
An allergist/immunologist, such as us, will base the decision to begin allergy immunotherapy on:
Length of allergy season and severity of symptoms
How well medications and/or environmental controls alleviate allergy symptoms
Desire to avoid long-term medication use
Time (immunotherapy requires a significant time commitment)
Cost (this may vary depending on region and insurance coverage)
Allergy immunotherapy should only be given under the supervision of a specialized physician in a facility equipped with proper staff and equipment to identify and treat adverse reactions to allergy injections. Ideally, immunotherapy should be given in the prescribing allergist's office, but if this is not possible, we will provide the supervising physician with comprehensive instructions about your immunotherapy treatment.
Immunotherapy works like a vaccine. Your body responds to the injected amounts of a particular allergen, given in gradually increasing doses, by developing immunity or tolerance to the allergen(s). As a result, allergy symptoms decrease or minimize when a patient is exposed to that allergen in the future.
Two phases are involved in allergy immunotherapy:
Build-up phase - This involves receiving injections with increasing amounts of the allergens about one to two times per week. The length of this phase depends upon how often the injections are received, but generally ranges from three to six months.
Maintenance phase - This begins once the effective therapeutic dose is reached. The effective maintenance dose depends on your level of allergen sensitivity and your response to the build-up phase. During the maintenance phase, there will be longer periods of time between immunotherapy treatments, ranging from two to four weeks. We will discuss with you what range is best for you.
You may notice a decrease in symptoms during the build-up phase, but it may take as long as 12 months on the maintenance dose to notice an improvement. The effectiveness of immunotherapy treatments appears to be related to how long the treatment lasts, as well as the dose of the allergen. During the maintenance phase, 80-90% of patients notice significant reduction of their symptoms.
If immunotherapy is successful, maintenance treatment is generally continued for three to five years. A discussion with your allergist before stopping immunotherapy is recommended.
Adverse reactions to immunotherapy are rare but do require immediate medical attention, which is why immunotherapy should be administered in a medical facility appropriately outfitted with equipment and staff capable of identifying and treating these reactions. There are two types of adverse reactions that can occur with immunotherapy:
Local reactions - These are fairly common reactions that include redness and swelling at the injection site. This can happen immediately or several hours after the treatment.
Systemic reactions - These are much less common than local reactions. Symptoms can include increased allergy symptoms such as sneezing, nasal congestion or hives. Rarely, a serious systemic reaction, called anaphylaxis, can develop after an immunotherapy injection. In addition to the symptoms associated with a mild systemic reaction, symptoms of an anaphylactic reaction can include swelling in the throat, wheezing or tightness in the chest, nausea and dizziness.
Most serious systemic reactions develop within 30 minutes of the allergy injections and will require immediate treatment. This is why it is recommended you wait in the office for at least 30 minutes after you receive immunotherapy.
If you have:
A clear relationship between asthma, rhinitis or conjunctivitis and exposure to an allergen,
A poor response to medications or avoidance measures,
Long duration of allergy symptoms (a major portion of the year),
A child with allergic rhinitis, because of the potential preventive role of allergen immunotherapy in the progression of allergic disease,
Come and see your allergist – We can help you!
-- By Dr. Anlin Xu