When the Allergy Struggle is Real

    Is Immunotherapy Right for You?

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    The first reports of allergies go back to before 3,300 B.C., when it was noted that King Menes of Egypt died of a wasp sting. In the grand scheme of things, however, allergies are considered a newer problem and one our ancient ancestors did not face.

    Though allergies have existed for many years, the newer onslaught of allergies is thought to be due to the hygiene hypothesis. According to the American Academy of Allergy, Asthma, and Immunology, the hygiene hypothesis suggests that “living conditions in much of the world might be too clean and that children aren’t being exposed to germs that train their immune systems to tell the difference between harmless and harmful irritants.”

    Environmental allergies include pollen, animals, dust mites, and molds. Signs that you may have a sensitivity to environmental factors include itchy/watery eyes, itchy nose, congestion, and post-nasal drip. Additionally, people with asthma may notice worsening of their breathing when environmental allergies are present. The first step in management is identification of what allergies impact your life. The next step is avoidance, if possible. Most times, people need a treatment plan for allergies.

    Treatment can start with medications. Two major categories of medications that are known to be the most useful for treatment of allergies are oral antihistamines and nasal steroid sprays. Think of these medications as a band-aid for allergies, in that they cover up the symptoms. For people who have allergies year-round, this can be a tiresome and expensive routine.

    If medications do not improve a patient’s symptoms, a discussion about allergy shots may need to happen. Allergy immunotherapy (AIT), commonly referred to as allergy shots, are words that may elicit panic in some people’s minds. But what you may not know is that it is one of the best tools your allergist has to treat environmental allergies. In essence, AIT aims to train your body not to recognize harmless irritants – such as pollen, mold, and the like – as the enemy.

    When immunotherapy is prescribed, each allergic patient gets a unique set of vials. These vials are a concoction of things the patient is allergic to. For example, patient A who is allergic to trees, dogs, and dust mites will have those things in her vials, whereas patient B who is allergic to grass, molds, and cats will have those particular things in his vials. The vials are created and then serially diluted. Since we are attempting to train the body not to react, we have to train it with diluted solutions of the allergens, otherwise the body may not react well. The first phase of AIT is the build-up phase, which is getting through all the dilutions. This is usually one or two shots per week and can take around four months, at which point, the body has learned to tolerate the allergens. The second phase of AIT is the maintenance phase, when it’s time for the body to learn that these harmless irritants are actually not harmful. The maintenance phase can go on for three to five years, though this timeline is largely dependent on each patient. In the maintenance phase, the injections are given once every two to four weeks – again, depending on the patient and the doctor – in the back part of the upper arm.

    After completion of AIT, most people notice an improvement in their symptoms. Ultimately, the goal is for patients to not rely on medications all the time to have an improved quality of life, free of annoying allergy symptoms. Immunotherapy can help with the management of asthma, as well. It is the closest tool we have to a cure for environmental and pet allergies.

    Although studies are not conclusive, the positive effects of immunotherapy can last as long as twenty years. The treatment is approved and effective for children as young as five years of age; however, this is very dependent on each physician and the patient’s other medical issues. The treatment can be repeated, and success depends on compliance. Overall, about 85 percent of patients who undergo AIT have some benefit at the end of their treatment. Some patients state that they start to feel better just a few weeks into treatment. Immunotherapy is not effective for food allergies as it stands right now, though that may be coming in the next few years.