Inspired by one of our favorite television shows, Allergy Myth Busters looks at a number of popularly held beliefs about allergy. But are these myths just urban legends or are they true?
MYTH: Allergy Shots Don’t Work.
Immunotherapy, commonly called allergy shots, was first introduced in 1911. Immunotherapy is a unique way of treating allergies and asthma. Medications treat the symptoms of allergies. Immunotherapy, however, changes the way a person’s immune system is reacting to the environment. In allergic people, the immune system is reacting to common things in the environment such as pollens or pet dander. This leads to classic symptoms of hay fever and, in some, asthma. Allergen skin testing identifies a person’s allergic triggers. A personalized vaccine is then formulated using all natural protein extracts. This extract is then administered to teach the immune system to tolerate exposure to allergens in the environment. And while some claim that immunotherapy is not helpful, a strong body of scientific evidence demonstrates that immunotherapy, when done correctly, leads to:
∙60-70% reduction in allergy symptoms with a 70% fall in need for medications ∙Improved asthma control while reducing need for medications ∙Reduction of an allergic child’s risk of developing asthma by up to 60% ∙Reduced risk of developing new allergies ∙Improved quality of life ∙Long lasting symptom improvement in 85% of patients that persists after the treatment is stopped
Immunotherapy is generally safe and well tolerated, but like all medical treatment has some risk. Since immunotherapy uses natural extracts of the very things to which a person is allergic, it can cause allergic reactions. Most such reactions are localized but they can be generalized, called anaphylaxis. Again, most of these generalized reactions are mild but in some cases they can be severe and even life threatening. It is therefore very important that immunotherapy be given under the supervision of a Board Certified Allergist.
Immunotherapy can be given by several methods.
Injections: Known as Subcutaneous Immunotherapy or SCIT. This can be administered through a Classic or Cluster protocol in a physician’s office.
Drops: Known as Sublingual Immunotherapy or SLIT. This can be administered at home.
Classic SCIT: In Classic SCIT, patients receive allergy injections in two phases: Build-up and Maintenance.
Build up Phase: Patients initially receive very low doses of allergens by subcutaneous (i.e. into the tissue just under the skin) injection. Patients receive shots once or twice a week. With each shot, the dose is slowly increased to build immune system tolerance. After each shot, the person is monitored for 30 minutes for any reaction. For most patients, the build-up phase is 28 doses.
Maintenance Phase: Once the top, or maintenance, dose is reached, shots are spaced out to every 2-4 weeks. During this time the dose of allergen remains constant. Typically, a person will be on Classic SCIT for 3-5 years.
Cluster Build up – Cluster SCIT is very similar to Classic SCIT except the build-up phase is much quicker. In Cluster, the build-up period is condensed into 9 sessions held once or, ideally, twice a week. At each session, the patient will receive 2-3 doses of immunotherapy separated by 30 minutes waiting periods.
This can allow a patient to reach maintenance in as few as 4 weeks. The maintenance phase is the same as in Classic IT.
Advantages: 1. Can reach maintenance is as few as 4 weeks 2. May see quicker results 3. May be more convenient Disadvantages 1. Sessions can be up to 90 minutes 2. Increased rates of local reactions and premedication with an antihistamine is recommended 3. May not be suited to very sensitive patients
Sublingual Immunotherapy (SLIT)
Unlike Classic and Cluster IT that utilizes shots, SLIT utilized allergens administered in a liquid or tablet form under the tongue to achieve similar changes in the immune system. Similar to SCIT, an extract is prepared based upon a person’s history and skin test results. SLIT has a favorable side effect profile. Common side effects are local itching/burning of the mouth or lips or GI upset. More serious side effects are very rare. Therefore, the first dose of SLIT is administered in a doctor’s office but then is taken at home on a daily basis.
Advantages: 1. Fewer allergic reactions 2. No need for injections 3. Can be administered at home 4. May be better suited for patients who have only seasonal allergy symptoms Disadvantages: 1. May not be as effective as SCIT 2. May not be as effective for patients with multiple allergens 3. Out of pocket costs may be increased 4. Unclear if SLIT has the same preventative capabilities of SCIT
Choosing whether immunotherapy and which type of immunotherapy is right for you is a critical part of your health care. Your Allergy Partners physician will work with you to discern what will work best for you.
However, like any medical treatment, the success of immunotherapy rests on proper diagnosis, selection of the best therapy, and, importantly, the right dosage. If these key elements are lacking, immunotherapy may not give the expected results, leading to the myth that immunotherapy does not work. All Allergy Partners physicians are Board Certified Allergist Immunologists with years of experience treating asthma, allergies, sinusitis and other allergic diseases. Our immunotherapy program is the nation’s largest and utilizes optimized dosages that improve how well immunotherapy works (efficacy) and minimize side effects. We offer the full range of immunotherapy options as noted above. Immunotherapy is customized for each person, because safety and efficacy are paramount. Allergy Partners continuously collects safety data and reviews immunotherapy dosing recommendations to ensure that our patients receive the highest quality immunotherapy possible.
By Dr. Jon Mozena
Allergy Partners of Fredericksburg