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Updated: Thursday, 28 Jun 2012, 9:46 AM CDT
Published : Thursday, 28 Jun 2012, 9:46 AM CDT
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
of adverse reactions when using pollens and house dust mites. These patients will see results from immunotherapy sooner than those who undergo traditional immunotherapy.
These techniques of immunotherapy have been scientifically studied and proven. There are other techniques that are still unproven. These include the administration of allergens sublingually, or under the tongue, and neutralization-provocation therapy. These techniques are also different from the process of rapid desensitization, which is sometimes used in a controlled environment to prevent a reaction to a substance to which the patient is known to be allergic.
Duration of Immunotherapy: The optimal duration of immunotherapy for inhalant allergens has yet to be determined. For most patients that have a good response, 4 to 5 years of therapy is recommended by most allergists. Continuation of immunotherapy for 4 to 5 years is still recommended in patients who undergo rush immunotherapy despite more quickly reaching a maintenance dose.
It is believed that the benefit from a brief course of immunotherapy may be rapidly lost, whereas benefit from a longer course may persist after injections are discontinued. The time frame for a patient to respond varies from person to person. Some will notice a response within 6 to 8 months. Others may take up to 18 months to respond. In general, if there is not an adequate response by 2 years of therapy, the use of this treatment modality in that patient should be reassessed. In patients who have had a good response after 4 to 5 years of therapy, a trial period off of immunotherapy should be undertaken.
A few patients will have an exacerbation of symptoms once the allergy shots have been discontinued. In these cases it may be desirable to continue the immunotherapy for a much longer period of time. These decisions must be made on a case-by-case basis.
Allergy shots for insect allergy may be safely discontinued after 5 to 7 years of therapy in many, but not all, patients. This decision must also be made on an individual basis.
Patients must wait in the physician’s office 20-30 minutes, as instructed, after your injections and then have the nurse check the injections site before you leave. Patients receiving venom injections will need to wait 30 minutes. If you cannot wait this amount of time, it is better to skip the injections and come in when you have more time. This is for your protection.
If within the 20-30 minute waiting period you should begin to cough, sneeze, develop a runny nose, itch all over, become short of breath or experience other symptoms that were not present prior to the injections, you should report this to the nurse immediately. If you should experience an exaggeration of your allergy symptoms in the afternoon or night of the same day after your injections take antihistamine and report the response to the nurse.
Should you develop a large area of redness and swelling at the site of the injection, apply cortisone cream, use ice packs on the area for 15-20 minutes and take an antihistamine. This too should be reported to the nurse at the time of the next injection. Your dose will need to be adjusted.
You shouldn't have allergy injections if you have recently developed any type of acute illness. If you are unsure if you will be able to receive a shot, call ahead of time to speak with a nurse. This may save you an unnecessary trip. Once you are feeling better, it is permissible to receive an injection, even if you are on an antibiotic.
Asthmatic patients who are in respiratory distress should not receive allergy shots. There should be no strenuous exercise or over heating for 1 hour before and 1 hour after receiving your injection.
You should not take other injections on the same day that you take your allergy injection. This is because it would be impossible to determine which substance was responsible, should a reaction occur. Allergy injections should not be given if swelling remains from previous injection. Postpone the next injection until the swelling has subsided.
The average length of time you will be on immunotherapy is 3 to 5 years. Patients receiving venom injections will be on immunotherapy at least 5 years.
Medications known as “Beta-Blockers” may make allergy injections unsafe by blocking the actions of other medications that may be used to treat injection-related reactions. Beta-Blockers may be administered in several forms, including pills or eye-drops.
Beta-Blockers are used to manage medical conditions such as angina, hypertension, certain types of headaches, essential tremor, and glaucoma. If you wish to begin immunotherapy and are taking a beta-blocker, tell your doctor. Allergy injections must not be given during the same period of time that beta-blockers are given. This is for your protection.
You can learn more about synAllergy online at http://126.96.36.199:8080/synAllergy-war/.
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