Allergic rhinitis, better known as hay fever, is one of the most common chronic illnesses and is estimated to affect 20% or more individuals at some point in time. An allergy can be considered an exaggerated immune response where the body is trying so hard to keep the allergens out that undesirable symptoms such as sneezing, rhinitis, congestion, and wheezing occur. Allergic triggers include seasonal pollens and year-round allergens such as house dust mites, mold, and animal dander.
Many allergy sufferers also suffer from asthma. Upwards of 70% of all asthmatics have underlying allergies. In children, the numbers are even more staggering as 80-90% of asthmatic children are allergic. Conversely, allergic children have a 40-60% risk of asthma. Allergies also can negatively impact quality of life with malaise, fatigue, loss of sleep, and loss of school and work days. The resulting expenses for treatment and lost wages are very substantial, ranking high on the list with medical expenditures.
Fortunately, many allergy and asthma patients respond well to symptomatic treatment and avoidance. Education about allergen avoidance and control and the ongoing use of an effective medication can lead to excellent results for many.
For those patients for whom conservative treatment proves inadequate because of severity, chronicity, and complications, an evaluation by a board certified allergist is in order. An allergist will use a thorough history and exam to establish the best available options for treatment. When indicated, allergy skin tests identify specific sensitivities to seasonal and perennial allergens. Such testing provides the most cost effective answers, which can then be correlated with that particular patients’ history and physical findings.
In a patient with such severe chronic respiratory allergy, subcutaneous immunotherapy (SCIT) or “allergy shots” may offer the best opportunity to modify, in a sustained fashion, the underlying problems. SCIT helps up to 80% of pollen allergic and 60-65% of environmentally allergic patients. By a variety of mechanisms, SCIT teaches the body to “block” or decrease the exaggerated immune response.
In the office, this process takes place by formulating an allergen vaccine targeted against a person’s allergy triggers. Initial doses are very small and administered in increasing doses. As the dose is increased, the immune response begins to change. After a build- up period, immunotherapy is continued at a targeted optimized dose every 2-4 weeks for a 3-5 year course.
Allergy shots have been shown to result in less symptoms, severity, and complications of both asthma and allergies over time. Additionally, successful SCIT leads to less need for medication and less need for medical attention.
Current medications for allergies and asthma are very effective in treating the symptoms and preventing asthma flares. However, they do not alter the underlying cause of asthma. When the medicines are stopped, allergy and asthma symptoms recur.
This is one of the key differences between immunotherapy and other treatments. By fundamentally changing the immune process to underlying allergies and asthma, immunotherapy can change the disease process. After 3-5 years of immunotherapy, many patients are able to stop allergy shots and their symptoms remain controlled without more medication.
In young children, allergy shots may also prevent the development of new allergies and asthma. One study by DeRoches, et al showed that children on SCIT were much less likely to develop new allergies after 3 years. The Prevention of Asthma by Immunotherapy (PAT) study also showed that immunotherapy can prevent the development of asthma in allergic, at-risk children. Children receiving immunotherapy were 48% and 60% less likely to have developed asthma at 3 and 5 years respectively than the children who did not receive SCIT.
By its nature, immunotherapy carries with it the risk of allergic reactions. While most reactions are localized with some swelling, itching and pain, more severe allergic reactions can occur. Immunotherapy, therefore, should always be administered in a doctor’s office and patients should be monitored for 30 minutes after all injections. Fortunately, these reactions are rare and Allergy Partners strives to ensure the safety of all patients.
Learn more about immunotherapy by contacting your trusted Allergy Partners Allergist.