The hallmark of allergic disease is inflammation of the affected areas of the body, causing itching and redness of the skin, itching and swelling of the nasal membranes, and swelling/constriction of the bronchial tubes with excessive mucous production, cough and wheeze. This inflammation is caused by the immune system going haywire, producing excessive amounts of IgE (the allergic antibody), or interleukins (the hormones of the immune system) that trigger the release of histamine and other inflammatory chemicals from specialized white blood cells, and that recruit more of these cells to the sites of disease.

The mainstay of allergy therapy has been antihistamines, which block only one of these many inflammatory chemicals, and are therefore only sometimes effective. Another mainstay has been steroid medications, which are far more effective because they target multiple aspects of the immune system, although admittedly in a “shotgun” fashion. If given systemically (by pill or injection), particularly for prolonged periods, steroids can cause side effects, so we rely more often on topical steroids (skin creams, nasal sprays or asthma inhalers) for chronic use to help dampen inflammation where they are applied, and not cause side effects. But often, patients tire of taking daily medications which are suppressive rather than curative; and which are sometimes not adequately effective. For many of our allergy and asthma patients who prefer to take fewer medications, or who do not respond adequately to medications, immunotherapy (allergy shots) is by far the most effective and satisfactory approach. By building up a tolerance to the very items causing the problem (for example, pollen, dust mites, animals or molds), allergy shots “re-train” the immune system to behave normally when confronted by these items. It is the only truly curative and natural approach to allergic disease, and helps 80-90% of our patients achieve a permanent remission of their allergies.

However, as in all medical conditions, there is a small percentage of patients with particularly severe or difficult-to-control allergic disease. In these cases, we sometimes turn to high-tech therapies, or so-called “designer drugs,” which specifically target either the IgE antibody itself, the various interleukins, or other inflammatory mediators produced by the immune system. These are products resulting from extensive biomedical research and genetic engineering, and some of the clinical trials for these were conducted by Allergy Partners physicians along with others. The first of these was Xolair (initially for severe allergic asthma, and now also for severe hives), followed more recently by Nucala and Cinqair for certain types of severe asthma, and just this month Dupilumab for severe eczema. More are on the way, as this field of medicine is rapidly evolving not only in the care of our allergic patients, but also in other fields of medicine including dermatology, rheumatology, gastroenterology, and oncology. Their main drawbacks are expense, and that each product is only useful in a particular subtype of allergic disease—there is no “one size fits all” approach—thus the moniker “designer drugs.” The key is in selecting the right high tech therapy for the right patient.

Your Allergy Partners physicians will provide expertise and guidance in determining if high tech therapy is for you, and if so, which one. Please contact us if you have any questions regarding your condition or treatment options.

 

John Van Wye, MD
Allergy Partners of Western North Carolina