Dr. Sussman from Allergy Partners of New Mexico
explains how effective immunotherapy is.
Dr. Sussman from Allergy Partners of New Mexico
explains how effective immunotherapy is.
As the weather begins to warm up this spring, people in the Southern United States will begin to see small mounds of dirt ranging from 1-2 feet in diameter and less than a foot in height. Be careful, as this might be a fire ant mound. These ants are very aggressive and can sting a person multiple times almost immediately upon being disturbed.
The feet and ankles are main places on a person’s body where fire ants usually sting, but stings can certainly occur on other parts of the body. Typically, the victim of a fire ant sting will develop localized reaction/swelling, along with eventual development of a small pustule/blister at the site of the sting. There is no need to pop the small blister. For treatment of this, many patients will apply an over-the-counter topical steroid, such as hydrocortisone, and use an over-the-counter oral antihistamine to help with itching. If the localized reaction does not get better within a few days, and especially if there is any concern for infection, the patient should seek medical care.
For patients who develop symptoms beyond just localized swelling such as hives on multiple areas of the body, swelling away from the site of the sting (including the throat), vomiting, diarrhea, difficulty breathing, low blood pressure, and/or passing out, they should call 911 and seek immediate emergency medical care. Patients who have had severe allergic reactions to fire ant sting are typically prescribed an epinephrine auto-injector in case of future severe allergic reactions.
Board-certified allergists at Allergy Partners are trained in the recognition, management/treatment, and testing involved in fire ant allergy. After taking a detailed history and performing a physical exam, the allergist will decide on the need for testing to fire ants, which may include a skin test and/or blood test. Patients with severe allergic reaction history to fire ant and a positive test to fire ant are typically candidates for allergy shots (immunotherapy) to fire ant. Initially, at least once weekly shots occur at a medical office, & patients are asked to wait 30 minutes after an injection. Once patients reach the top dosing of the injections, the injections for fire ant allergy are often spaced to at least once monthly. Most patients at the top dosing of the shots will tolerate fire ant stings better and be at decreased risk for severe allergic reaction in the future.
We recommend that patients, adults and children, learn to recognize a fire ant mound if they live in a part of the country where fire ants predominate. Never provoke a fire ant mound, and wear closed-toe shoes and socks when outside. Patients prescribed an epinephrine auto-injector for fire ant allergy should always carry it with them in case of accidental sting. Those who have had severe reactions should contact their trusted Allergy Partners physician for evaluation and consideration of fire ant immunotherapy.
By Dr. Freccia
Allergy Partners of Fayetteville
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: All immunotherapy is the same
THE BACKGROUND: Immunotherapy (also known as allergy shots) is an effective treatment for allergic nasal and eye symptoms (allergic rhinitis and allergic conjunctivitis), allergic asthma, and eczema. Immunotherapy can also be used to treat stinging insect allergies. Small amounts of the allergen (the substance that patients are allergic to) are injected in regular intervals over several years to desensitize patients to those substances. Immunotherapy is designed to alleviate current symptoms as well as prevent the progression of allergic disease. Relief of symptoms also continues after allergy shots are stopped making it a cost effective and beneficial treatment for many allergy sufferers. Several people and even physicians believe that all immunotherapy is the same.
THE SCIENCE: Not all allergen immunotherapy is created equally.
Allergy testing identifies specific allergies in each patient. Small amounts of these allergens are then combined to make allergy shots. Immunotherapy is tailored specifically for each patient based on their degree of allergies and underlying disease. Current medications and other coexisting diseases should also be taken into account when formulating the strength of these extracts. If the dose of allergen included in the allergy shots is too weak, the patient will not mount an effective or long lasting immune response. If the dose of allergen in the allergy shots is too strong, the patient will have increased risk of an allergic reaction or adverse reaction to the shots.
Board certified allergists are specialists who have performed the highest level of education based on national standards for the field of allergy and immunology. They are extensively trained on doses and concentrations of allergens that are the most effective and safe. They are also trained on specific allergens that are more prominent in their local area and are aware of any cross reactivity between allergens that might affect your treatment response. Here at Allergy Partners, our providers have many years of experience in formulating allergen immunotherapy, and our immunotherapy program is the nation’s largest. Our physicians continuously review studies and safety data to determine the most up to date recommendations on the safest and most effective allergen dosing for allergy shots.
THE VERDICT: The Myth that all allergen immunotherapy is the same has been busted.
Ingrid Hoffmann, MD
Allergy Partners of the Piedmont
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.
THE SCIENCE:
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.
MYTH BUSTED!
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
512-349-9111