Immunotherapy

Immunotherapy

Immunotherapy is a method of allergy treatment that involves introducing small amounts of allergen to your body and then gradually building up doses over a period of time until you develop an immunity. There are two types of immunotherapy treatments: subcutaneous immunotherapy (SCIT), also known as allergy shots, and sublingual immunotherapy (SLIT), or allergy drops.

Individuals with allergy symptoms that do not respond to medical treatment are prime candidates for immunotherapy. Once the allergen trigger has been identified, an extract of that substance is prepared. The delivery method depends on which type of immunotherapy treatment you are receiving.

Sublingual immunotherapy works on the same principle, but instead of allergy shots, you are given drops that you place under your tongue for several minutes and then swallow. This is usually done on a daily basis and, like allergy shots, results take anywhere from three to five years. Sublingual immunotherapy is not yet FDA approved but has several advantages over allergy shots, namely the ability to self-administer at home, and a lower risk of side effects and allergic reactions.

Is Immunotherapy Safe?

Both forms of immunotherapy are considered safe and effective long-term treatments for a number of allergies. It is most effective for those allergic to pollen, mold, dust mites, animal dander and insect venom. It will not work for food or drug allergies.

Side effects and complications are rare. Those receiving allergy shots might notice a little redness, swelling and tenderness at the injection site. Maintaining a consistent injection schedule helps to reduce the odds of serious reactions.

Allergy Drops

People who suffer from allergies that don’t respond to medical treatment may find relief from immunotherapy, a method of building tolerance to an allergen by introducing it to the body in small doses over a period of time. It is usually given as injections (allergy shots), but can also be taken orally. When ingested, it is known as sublingual immunotherapy.

How Does It Work?

By introducing an allergic substance to your body in gradually increasing doses over time, you will eventually build up resistance to it. The immune system becomes less sensitive to the offending substance as the size of the dose is increased, leading to a reduction in the severity of your symptoms.

The first step involves identifying the allergen that is responsible for your symptoms. Your doctor or allergist will perform allergy skin testing to isolate the offending trigger. Once this is determined, an extract of the substance is prepared in drop form, which will be taken daily. You will need to hold the drops under your tongue for a minute or two before swallowing. It takes anywhere from three to five years for most patients to develop an immunity to the substance.

Who Benefits from Therapy?

Those suffering from a range of allergies – including pollen, grass, animal dander and dust mites – who don’t respond favorably to traditional treatment methods like decongestants and antihistamines are good candidates for sublingual immunotherapy.

Advantages of sublingual immunotherapy versus traditional immunotherapy include ease of use (patients can treat themselves at home as no needles are required), and there is less danger of side effects or allergic reactions.

Allergy Shots

Allergy shots (subcutaneous immunotherapy) are the most common form of immunotherapy. They can be used as a long-term treatment for seasonal, indoor and insect sting allergies.

Allergy shots work by getting your body used to the allergen slowly, with the hopes that you will develop an immunity or tolerance to the allergen. The process takes place in 2 phases, the build-up phase and the maintenance phase. The build-up phase involves a small amount of the allergen being injected into the upper arm once or twice a week for a few months. The dosage is gradually increased at each visit. The length of the build-up phase depends entirely on your body’s reaction. Once you have reached the effective dose, typically the most you can handle without showing symptoms, the maintenance phase will begin. The dosage is no longer increased at each visit and the number of shots is decreased. The maintenance phase involves an allergy shot once every month for three to five years.

Allergy shots are recommended for anyone whose symptoms are not well controlled through medications or those that want to reduce their long-term use of medications.

Since allergy shots contain a substance you are allergic to, there are some risks involved. Swelling and redness usually develop at the site of injection but are quick to clear up. Sneezing, nasal congestion and hives may develop as well as more severe reactions such as wheezing or chest-tightness. Anaphylaxis, the most serious reaction, rarely occurs. Since these shots are administered in a clinical setting, any reaction that does occur can be easily treated.

Allergy symptoms will not improve overnight; symptoms will typically improve over the first year of treatment and continue to improve over the next few years. The shots may even decrease symptoms for other allergens and prevent new allergies from developing.

Allergy Medical Therapy

Allergy symptoms can often be relieved through the use of over-the-counter or prescription medications and nasal sprays. Medical therapy provides short-term relief and may be enough of a solution for people with seasonal allergies or those whose symptoms are not severe.

If your symptoms do not improve with the use of medications, you should consult with an allergist over alternative treatments such as immunotherapy.

Antihistamines are often the go-to drug for treating allergy symptoms. They work by reducing or blocking histamines, chemicals produced by the immune system that are responsible for many common allergy symptoms including runny nose, stuffy nose and itchy, watery eyes. They are available in tablets, capsules, liquids, nasal sprays and eye drops. Antihistamines can cause side effects such as drowsiness, dry mouth, dizziness and nausea, though newer generation antihistamines have fewer side effects. Popular antihistamines include:

  • Allergra
  • Benadryl
  • Claritin
  • Chlor-Trimeton
  • Tavist
  • Zyrtec
  • Clarinex
  • Xyzal

When your allergy symptoms include a stuffed-up nose, you’re better off using a decongestant for relief. Decongestants shrink swollen blood vessels and tissues that line the nose. They can be found in pills, liquids, nasal sprays and nose drops and are available over-the-counter or by prescription. Decongestants may increase anxiety or cause sleeping difficulty. If you have a medical condition such as glaucoma, high blood pressure, heart disease, thyroid disorder, diabetes or enlarged prostate, consult with a doctor before using. Common decongestants include:

  • Afrin
  • Dristan
  • Sudafed
  • Suphedrin

In addition, many antihistamines also contain a decongestant, such as:

  • Allegra-D
  • Claritin-D
  • Tavist-D

Nasal corticosteroids are nasal sprays that help to reduce inflammation of the nasal lining associated with allergies. They can be extremely effective at relieving symptoms, but may cause nosebleeds, nasal dryness and sore throat. Nasal corticosteroids are generally safe to use long-term. They are usually available by prescription only. Common brands include:

  • Flonase
  • Nasonex
  • Nasacort
  • Rhinocort

Decongestant nasal sprays are generally available over-the-counter. They provide short-term relief from nasal allergy symptoms but wear off quickly. Overuse can lead to a “rebound effect” in which symptoms worsen. Patients are advised not to use decongestant nasal sprays for longer than three days. Popular brands include:

  • Afrin
  • Dristan
  • Vicks Sinex

Allergy eye drops help relieve the symptoms of eye allergies. If you are experiencing itchy or watery eyes, a burning sensation in the eyes, redness and swelling, you can benefit from either over-the-counter or prescription eye drops. They are available in several different types including antihistamines, anti-inflammatory, decongestants and mast cell stabilizers. Some of the more common brands include:

  • Clear Eyes
  • Visine
  • Refresh
  • Claritin Eye
  • Alamast
  • Opcon-A

Mast cell inhibitors are medications that prevent allergy symptoms such as runny nose or itchy, watery eyes from occurring. They work by inhibiting the release of histamines the immune system produces in response to allergens such as pollen. They are available in the form of nasal sprays and eye drops, and must be taken a week or two before the start of allergy season, and continued on a daily basis for the duration of the season.

Call Eastern Shore ENT & Allergy at (410) 742-1567 for more information or to schedule an appointment.