- Allergy Conditions
- Side Effects
What is allergen immunotherapy?
Some people tend to develop severe allergic reactions to common substances which normally do not provoke an immune reaction in most people. Immunotherapy is a long-term treatment and gradually makes a person’s immune system more tolerant to the allergens.
Allergen immunotherapy is of two types:
- Subcutaneous: Injections given in the tissue beneath the skin, usually in the upper arm.
- Sublingual: Tablets which the patient keeps under the tongue for a couple of minutes before swallowing. Sublingual drops may also be also used, but are not approved by FDA.
Why do allergies occur?
Allergies occur when a person’s immune system overreacts to minor toxins or harmless substances present in the environment such as:
- Dust mites
- Animal dander
- Stinging insects
Exposure to allergens causes certain immune cells known as mast cells to release inflammatory compounds such as histamine, which causes the allergy inflammation symptoms. The mast cells also release cytokines that activate other immune cells which contribute to the worsening of symptoms.
What are the allergic diseases treated with immunotherapy?
Immunotherapy is a useful treatment option for people who are unable to avoid exposure to allergens. Allergen immunotherapy can be used to treat allergic conditions such as:
- Seasonal allergic rhinitis
- Perennial rhinitis
- Allergic asthma
- Eye allergies such as conjunctivitis
- Insect venom anaphylaxis
- Atopic dermatitis
Immunotherapy may not be suitable for
How is allergen immunotherapy administered?
An allergist or immunologist schedules the immunotherapy treatment for an allergy patient. Before starting immunotherapy, the immunologist typically takes the following steps:
- Records a complete history of the patient’s allergic symptoms.
- Checks existing medical conditions and medications.
- Performs a skin prick test that places a small amount of an antigen in the skin to find substances to which the patient is allergic.
- Prepares a diluted solution of specific antigens that cause the patient’s allergic symptoms.
Subcutaneous immunotherapy is performed in two phases:
- Buildup phase: Once- or twice-weekly injections for six months to a year, starting with a low dose, gradually increasing until the patient is able to tolerate the maintenance dose. The maintenance dose is calibrated to roughly equal the levels of allergens present in the patient’s environment.
- Rush immunotherapy: The buildup phase may be speeded up by a higher dose increase every week for patients who can tolerate it. Though it reduces time required to reach maintenance dose, it also increases the risks of a severe allergic reaction.
- Maintenance phase: The maintenance dose of injections are usually given once every two or three weeks for three to five years, depending on the patient’s response to the therapy.
- The patient remains under observation for about 30 minutes after each allergy shot to check for any severe allergic reactions.
Sublingual immunotherapy is the use of common seasonal allergy-causing antigens in tablet form, usually for patients who are unable to take regular injections for any reason. The patient holds the tablet under their tongue for up to two minutes before swallowing it.
Sublingual immunotherapy tablets are typically taken once daily starting approximately four months before the allergy season and continued through the season. The sublingual immunotherapy is started in the allergist’s office so that the patient can be monitored for a possible severe allergic reaction.
Following are the FDA-approved sublingual tablets:
- Oralair: Calibrated pollen extract of five types of grasses, approved for patients from age five to 65.
- Grastek: Approved for patients from age five to 65 for Timothy grass allergy.
- Ragwitek: Approved for patients 18 years or older for ragweed allergy.
- Odactra: Approved for patients 18 years or older for house dust mite allergy.
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Does immunotherapy work for allergies?
Allergy shots reduce the activity of the inflammatory immune cells and bring down the sensitivity to allergens. If allergen immunotherapy is faithfully followed for the required duration, there is a good chance of improvement or even complete remission from allergy symptoms.
Symptoms usually start gradually abating in the first year, and by the third to fifth year, many people may find complete relief and be able to stop taking the shots. About 85% of people with hay fever report improvement from allergen immunotherapy.
What are the risks and side effects of allergen immunotherapy?
A major downside to allergen immunotherapy is the time commitment it requires. Side effects are usually mild and resolve on their own in most people. Rarely, some patients may have anaphylaxis, which is a serious reaction to the injection which can cause symptoms such as:
Side effects of subcutaneous immunotherapy include:
- Injection site reactions such as:
- Systemic reactions such as:
- Serious side effects include:
Side effects of sublingual immunotherapy include:
Allergen immunotherapy is a treatment procedure for preventing/reducing allergic reactions to specific allergens. Immunotherapy reduces the dependence on medications for symptom relief.
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Related Disease Conditions
An allergy refers to a misguided reaction by our immune system in response to bodily contact with certain foreign substances. When these allergens come in contact with the body, it causes the immune system to develop an allergic reaction in people who are allergic to it. It is estimated that 50 million North Americans are affected by allergic conditions. The parts of the body that are prone to react to allergies include the eyes, nose, lungs, skin, and stomach. Common allergic disorders include hay fever, asthma, allergic eyes, allergic eczema, hives, and allergic shock.
Eye allergy (or allergic eye disease) are typically associated with hay fever and atopic dermatitis. Medications and cosmetics may cause eye allergies. Allergic eye conditions include allergic conjunctivitis, conjunctivitis with atopic dermatitis, vernal keratoconjunctivitis, and giant papillary conjunctivitis. Dry eye, tear-duct obstruction, and conjunctivitis due to infection are frequently confused with eye allergies. Eye allergies may be treated with topical antihistamines, decongestants, topical mast-cell stabilizers, topical anti-inflammatory drugs, systemic medications, and allergy shots.
Indoor allergens are substances that can cause an allergic reaction in some people. Common sources of indoor allergens include dust mites, cockroaches, molds, pets, and plants. Avoiding indoor allergens is one way to reduce allergy and asthma symptoms.
Fragrances and preservatives in cosmetics may cause allergic reactions in some people. Symptoms include redness, itching, and swelling after the product comes in contact with the person's skin. Treatment typically involves the use of over-the-counter cortisone creams.
COVID-19 vs. Allergies
Though there is some overlap in allergy and COVID-19 signs and symptoms there are also significant differences. Symptoms that they have in common include headache, fatigue, tiredness, shortness of breath, wheezing, and sore throat. Fever does not occur with allergies but is one of the defining symptoms of COVID-19 infections.
Cold, Flu, Allergy Treatments
Before treating a cold, the flu, or allergies with over-the-counter (OTC) medications, it's important to know what's causing the symptoms, which symptoms one wishes to relieve, and the active ingredients in the OTC product. Taking products that only contain the medications needed for relieving your symptoms prevents ingestion of unnecessary medications and reduces the chances of side effects.
Hay Fever (Allergic Rhinitis)
Hay fever (allergic rhinitis) is an irritation of the nose caused by pollen and is associated with the following allergic symptoms: nasal congestion, runny nose, sneezing, eye and nose itching, and tearing eyes. Avoidance of known allergens is the recommended treatment, but if this is not possible, antihistamines, decongestants, and nasal sprays may help alleviate symptoms.
Insect Sting Allergies
The majority of stinging insects in the United States are from bees, yellow jackets, hornets, wasps, and fire ants. Severity of reactions to stings varies greatly. Avoidance and prompt treatment are essential. In selected cases, allergy injection therapy is highly effective.
About 1% to 2% of people in the U.S. have a peanut allergy. Symptoms and signs of a peanut allergy include rash, hives, redness, and itching. Severe reactions may cause difficulty breathing, nausea, decreased blood pressure, lightheadedness, and behavioral changes. People with a peanut allergy should carry an epinephrine auto-injector with them at all times.
Sinus Infection vs. Allergies
Both sinus infections and allergies (allergic rhinitis) cause symptoms such as runny or stuffy nose and fatigue. Sinus infection (known as sinusitis) is inflammation of the sinuses, caused by infection from bacteria, viruses, and/or fungi (molds). Allergic rhinitis occurs when certain allergies cause nasal symptoms. When a person with allergies breathes in an allergen, such as pollen, dust, or animal dander, symptoms such as runny or stuffy nose, itching, sneezing, and fatigue occur.
The allergic cascade refers to allergic reactions that happen in the body in response to allergens. A variety of immune cells and chemical messengers participate in the allergic cascade. Symptoms of the allergic cascade range from mild swelling and itching to full-blown anaphylactic shock. Allergen avoidance and medications are used to prevent or treat allergies.
The most common food allergies are to eggs, nuts, milk, peanuts, fish, shellfish, strawberries and tomatoes. Symptoms and signs include nausea, vomiting, diarrhea, abdominal pain, itching, hives, eczema, asthma, lightheadedness, and anaphylaxis. Allergy skin tests, RAST, and ELISA tests may be used to diagnose a food allergy. Though dietary avoidance may be sufficient treatment for mild allergies, the use of an Epipen may be necessary for severe food allergies.
Allergy Treatment Begins At Home
Avoiding allergy triggers at home is one of the best ways to prevent allergy symptoms. Controlling temperature, humidity, and ventilation are a few ways to allergy-proof the home. Cleaning, vacuuming, and using HEPA air filters also helps control allergies.
Drug Allergy (Medication Allergy)
Drug or medication allergies are caused when the immune system mistakenly creates an immune response to a medication. Symptoms of a drug allergic reaction include: Hives Rash Itchy skin or eyes Dizziness Nausea Diarrhea Fainting Anxiety The most common drugs that people are allergic to include: Penicillins and penicillin type drugs Sulfa drugs Insulin Iodine Treatment may involve antihistamines or corticosteroids. An Epipen may be used for life-threatening anaphylactic symptoms.
Latex allergy is a condition where the body reacts to latex, a natural product derived from the rubber tree. The reaction can either be delayed and cause a skin rash or immediate, which can lead to anaphylaxis. Avoiding latex is the most effective way to prevent an allergic reaction.
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