How to Give an Allergy Test

Allergen immunotherapy, also known as “allergy shots”, is the repeated administration of specific allergens to patients with allergy-related conditions. The purpose is to provide protection against their allergic symptoms and inflammatory reactions associated with exposure to these allergens. Immunotherapy should be used as part of a comprehensive allergy management plan that includes attempts to control allergy symptoms with appropriate environmental modifications and medical therapies. Immunotherapy is the only potential cure currently available to us for allergic rhinitis and insect hypersensitivity. It is not a cure for asthma, but in those patients with asthma triggered significantly by allergens, it can result in improvement in the asthma as well.

Allergen immunotherapy has been practiced since the early part of the 20th century. Our understanding of how it works is constantly evolving, and although more is understood today than 80 years ago, the precise mechanism(s) for the observed clinical effects has yet to be determined. We do know that giving allergy shots modifies the patient’s immune system in such a way as to decrease sensitivity to the specific substances to which the individual is allergic. The following are theories that have been partially supported by clinical and scientific data.

• “Blocking Antibody” – The immune system responds to immunotherapy by producing a protein which binds with the allergen, blocking the allergy antibody from doing so, and thus not allowing an allergic reaction to occur.
• “Decrease in IgE (allergy antibody) – Studies have shown that there is a gradual decrease (after an initial increase) in allergy antibody levels due to allergy shots.
• “Modulation of Cells That Play a Role in Allergic Reactions” – Immunotherapy decreases the release of certain chemicals from specific white blood cells. These chemicals would normally play a large role in the allergic reactions and would also “call in” other types of cells to the site of the allergic reaction. If left unchecked, these other types of cells would contribute to prolonging the allergic reaction.
• “Increase in Suppressor Cell Activity” – Some cells of the immune system are responsible for suppressing or controlling immunologic reactions. This is to prevent the reactions from actually damaging the host (patient). Allergy shots increase the activity of these suppressor cells.
• Several other mechanisms have been proposed and are also being studied.

Conditions for Which Allergy Shots Have Been Shown to be Effective.
• Allergic Rhinitis. Also commonly known as hay fever, patients with this condition often suffer severe nasal (and possible eye and throat) Reactions when exposed to pollens or other air borne allergens to which they are sensitive. Well designed scientific studies have shown that immunotherapy is beneficial in the treatment of allergic rhinitis due to tree pollen, grass pollen, weed pollen, mold spores, dust mites, and animal allergens (e.g., cat and dog).
• Asthma. Well-designed clinical studies have demonstrated the efficacy of allergen immunotherapy in patients with pollen-induced and mold-induced asthma. Some studies have also shown a1 benefit in patients with animal-induced or dust mite induced asthma.
• Insect Allergy. Allergen immunotherapy should be considered in patients who have had reactions to insects after exposure to these allergens (such as through inhalation or injection). The efficacy of immunotherapy in patients allergic to the sting of honeybees, yellow jackets, hornets, wasps, and imported fire ants has been well documented.

Types of Immunotherapy:
Traditional Immunotherapy: These injections begin at a very dilute concentration (to minimize the possibility of an allergic reaction) and gradually build up to a maintenance level. Patients start by receiving 1 to 2 injections a week for about 9 months at a rate of one injection per week. Once maintenance levels have been obtained and maintained for a period of time, the frequency of injections is gradually tapered. Administration of high doses of allergen is the ultimate goal for this type of schedule. It may take 6 to 12 months to achieve this goal.

Rush Immunotherapy (RIT): This method involves the administration of several injections over the course of one day to reach maintenance levels in a brief period of time. The patient is evaluated in the clinic one week prior to RIT, and baseline lung function testing is performed. The patient is given pretreatment with antihistamines, prednisone and leukotriene antagonists starting three days prior to RIT.

The patient must be prepared to stay in the clinic from 8am-12pm and 1pm-5pm on the day of RIT. After the rush protocol is completed the patient will receive weekly injections for 8 weeks before starting to receive less frequent injections. The protocol has been demonstrated to be as safe and efficacious for insect allergy as standard protocols. However, there is a slight increase in frequency