IMMUNOTHERAPY WITH ALLERGEN EXTRACTS

What is immunotherapy? Why is it helpful in the treatment of allergies?

Your allergist has decided that immunotherapy should be of benefit in the treatment of your allergy symptoms. It was first proven of benefit in 1949 and has been continually improving since that time. This treatment is also called allergy shots, or desensitization. It is used in the treatment of allergic patients with symptoms such as hay fever, rhinitis, sinusitis, asthma, as well as severe reactions to bee stings to prevent reoccurrence. It will be the greatest benefit to those individuals with pollen allergies. In fact, the reduction of symptoms in those is as much as 95%. In mold or dust mite allergies, the reduction of symptoms is around 85% on average. It is our practice to conduct a progressive course of immunotherapy, which is the only form that has been shown to be clinically effective in reducing allergic symptoms. These studies were conducted over several years and published in medical journals and have been confirmed repeatedly. In this form of treatment allergen extracts are administered weekly in gradually increasing amounts beginning with extremely dilute concentrations and increasing to more concentrated extracts progressively. The extracts contain only the allergens to which you are allergic. They do not contain any medications such as antihistamines or corticosteroids. The goal of this treatment is to induce the immune system to develop a blocking response to the allergic reaction thereby making the body less allergic to those particular allergens. This tolerance should bring about a decline in the symptoms experienced by you and less need for medications. The specific schedule for injections and the amount given vary from patient to patient. Some allergens, for example, are incompatible in solution (dust mites and pollens) and may not be mixed together. Therefore, patients with these allergies must receive more than one injection. It may take as long as 6 to 8 months before you can expect to see any dramatic clinical benefit from this therapy. Such injections will not initially control your allergic symptoms as well as the medications you may be taking already. However, after about 12 to 18 months you should definitely begin to experience a reduction in your allergic symptoms. Just how long you should continue your injections in order to obtain optimal results cannot be predicted, but most patients get them for at least 3 years. Usually, immunotherapy is continued for at least 2 years after allergic symptoms have significantly decreased. In general, the allergist tries to increase the allergen dose to the maximum dose that can be tolerated by the patient without a reaction; this maximum dose should also bring about a decrease in

your allergic symptoms. Usually the dose of injected allergen extract must be close to this dose to begin to decrease your allergic symptoms.

How often should I get my allergy injections?

This course of treatment is accomplished by starting with the lowest dose of the most dilute allergen (e.g. 1:10,000 usually) and increasing at weekly intervals until the maximum tolerated dose is achieved (usually 1:1). This dose is called the maintenance dose and will not be increased further. The injections are given weekly until the maintenance dose is reached. Occasionally twice weekly injections are advised in order to reach maintenance faster as with severe bee and ant sting reactions. Once the maintenance dose is reached the interval between injections can be increased first to every other week, then every third week, and finally, monthly. The monthly interval will usually control your allergy symptoms as well as weekly in most cases but if they do not, the interval may need to be shortened for a while longer if that controls the symptoms better.

How often does my extract have to be re-mixed or made up again?

New allergen extract (vaccine) must be re-mixed each year even if some of the old extract remains. This is because all allergen extracts lose about one-half (1/2) of their potency over a 12 month period of time even if they are kept refrigerated. The expiration date will be written on each vial. When on immunotherapy you should see your allergist at least once a year for a check up even if you are not having any problems with your allergy symptoms.

What side effects can I expect from allergy injections?

Since the allergy extract contains the same allergens that produce your allergic symptoms, it is possible for these injections to produce allergic reactions. Therefore, these injections should not be treated lightly or casually. The potential to have such reactions is the reason that we ask you to remain in the office under observation for at least 20 minutes after your injection (or longer if you have side effects). (1) Local reactions: These occur at the site of the injection and are common, especially as the dose of the allergen is increasing. Most patients will experience some local reaction but not with every injection. The first dose from a new vial is more likely to produce such reactions. The local reaction resembles a big mosquito bite and may itch, burn, or sting. The bump is called a whelp. For those patients who experience repeated large local reactions, the increase in allergen dosage will be slower than the regular schedule.

(2) Generalized reactions: These reactions are far less common but may occur after any allergen injection even maintenance injections. It is more likely with a recent heavy exposure to an allergen to which a person is sensitive. The allergen injection could in this case cause the very symptoms it is supposed to decrease. In the event this type of reaction occurs, it will usually happen within 30 minutes after the injection. This reaction, called a systemic reaction, may include: nasal congestion, sneezing, runny nose, swelling of the lips, tongue, throat, or face, hives, wheezing, or asthma. Such reactions can indeed be serious and even life threatening and fatalities have been reported. These reactions should be treated by medications promptly. The next dose of extract will have to be reduced and subsequent increases in dose will have to be more gradual. It is the reason patients are asked to wait for 20-30 minutes after an injection is given.

When should I not get an allergy injection?

The only contraindications (reasons for not receiving) your allergy shot are fever and wheezing. The injection may be given as soon as these symptoms have been resolved for 24 hours. If you are taking an oral beta-blocking agent for your high blood pressure or for your heart condition, you should make sure your allergist knows that you are on this type of medication. Also, immunotherapy should not be given to patients on certain kinds of antidepressive medications. If you are not sure whether or not you are on one of these medications, make sure your allergist is aware of all medications that you take and also is aware of any changes that have been made in your medications after you start immunotherapy. We recommend that you notify the nurse prior to getting your shot of any new medications you are taking, including eye drops, and especially those for heart or blood pressure.