Steven Machtinger, MD

Is Immunotherapy for Me?

When should I consider beginning allergy shots?

Immunotherapy, also referred to as allergy shots or desensitization, is an effective method for treating allergic conditions caused by inhaled allergens. These allergens include house dust mites, mold spores, pollen of certain trees, weeds, and grasses, and the dander of mammals. You should have a history of symptoms related to exposure to the inhaled allergens confirmed by allergy testing. Symptoms should be sufficiently troublesome to you to justify the time, effort, risk, and the expense of immunotherapy. Even if symptoms can be controlled with medication, IMMUNOTHERAPY is indicated if these medications cause unacceptable side effects or must be taken year-round. Additional effort should be made to reduce exposure to avoidable allergens such as household pets, dust, and mold and mildew.

What are allergy shots?

Allergy shots consist of suspensions or solutions of allergens dissolved in glycerin, human serum albumin and water. These allergens are the protein components of the various environmental substances that trigger allergic symptoms. Extracts of tree, grass, and weed allergens are made from pollen, the male reproductive cells of the plant. Allergens from animals are made from dander, a complex of proteins found in saliva and skin. Dust allergens are contained in the bodies and waste of the house dust mite, a nearly microscopic arachnid, related to spiders, that lives in mattresses, pillows, bedding, upholstery, and carpeting.

Will I be protected against all allergens?

Protection is specific. Allergy shots against cat dander will not protect you against dog dander if you are allergic to dogs. However children allergic to house dust mites are less likely to develop additional allergies if they receive immunotherapy to dust mites at a young age. The younger you are when you begin to receive immunotherapy, the less likely you are to develop additional allergies later on.

How do shots work?

The amount of allergen material inhaled into the nose or lungs is quite small in allergic rhinitis or asthma. Effective IT delivers these same allergens in much greater amounts while bypassing the respiratory tract. Large amounts of allergen administered over time gradually alter the type of lymphocyte (white blood cell) response from an allergic one to a tolerant one. This results in a change in the type of antibodies produced against allergens as well. The result is that your immune system will learn to ignore or tolerate allergens that currently trigger allergic symptoms.

Are allergy shots safe?

In general, yes but precautions against adverse reactions should be taken. After all, you will be receiving injections of substances capable of making you ill. Serious reactions occur only about once in a thousand injections. Most reactions, resembling a mosquito bite in size and discomfort, are of little consequence. Rarely, excess allergen may escape into your bloodstream triggering a serious reaction throughout your body called anaphylaxis. Symptoms of anaphylaxis include hives, swelling of the lips, tongue, eyelids, hands, or feet, difficulty breathing due to swelling of the vocal cords or asthma, and even a dramatic fall in blood pressure. Loss of consciousness and death are rare complications of allergy injections.

What can be done to reduce the risk?

Wait at least thirty minutes after receiving an injection before leaving the office. Allow the nurse to inspect your arm before you leave. If you have asthma, don’t receive an injection if you have had cough or wheezing in the past 24 hours. Take an antihistamine 1-2 hour before receiving IT. If another physician changes your medications, let us know immediately.

How is my allergy injection prepared?

From a prescription written by the allergist, the allergy nurse will prepare a combination of specific allergens. The history of your symptoms and the positive skin tests (or RAST) determine the constituents of your specific mix. Stock solutions are purchased from reputable laboratories producing allergenic material of superior quality and purity. Many of these allergens are now standardized, an additional safety factor. Because allergenic extracts lose potency over time, they are replaced annually.

How often will I receive injections?

There are three phases of IT: advancement, therapeutic, and maintenance. The goal of advancement is to gradually and safely increase the dose of injected allergen until the highest tolerated dose is reached. During the advancement phase you should come at least once a week. With weekly visits, most patients complete this phase in six months, three months when coming twice weekly. The goal of therapeutic and maintenance phases is to administer sufficient allergen to first relieve symptoms and then prevent their return. Once you reach the therapeutic level you should continue on weekly injections until your allergy symptoms are relieved and your dependence on medication substantially decreased or eliminated. After several months, you should be able to increase the time between injections. In this maintenance phase the interval between injections may be gradually increased to every four or even every six weeks.

How long before the injections begin to work?

You may not have any noticeable improvement until reaching the therapeutic phase. In the meantime, medication and environmental control measures will have to suffice. If you have not improved after receiving one year of therapeutic level injections, you’re probably among the 10% of allergy sufferers not helped by shots.

Are there faster methods?

Employing an accelerated protocol you may receive up to six advancement injections in a single visit. There is some additional risk involved. You will need to remain in our office for several hours at such visits. This accelerated protocol is not appropriate for everyone.sits. This accelerated protocol is not appropriate for everyone.

How long will I receive injections?

Our goal is 5 years of combined therapeutic and maintenance therapy. If you are receiving monthly injections at that time you may elect to stop receiving injections. About half of patients find that their symptoms return promptly with cessation of injections and choose to resume immunotherapy.

Will shots help my other allergy symptoms?

Immunotherapy works for allergic rhinitis and allergic conjunctivitis (hay fever) and for allergic asthma. It is also effective for anaphylaxis to the stings of bees, wasps, and yellow jackets. It is not useful for food or drug allergies, hives, eczema, or any other allergic on non-allergic condition.

What about mosquito bite and spider bite allergy?

IT for allergy to mosquitoes, fleas, and spiders is not effective. Imported fire ant allergy is amenable to IT. Fortunately, these insects do not reside in the Bay Area.

Will we administer shots prescribed by other physicians?

The method and prescription advised by other allergists will be reviewed and, if appropriate, will be continued for you. When therapy does not conform to accepted guidelines or when the passage of time or changes in your allergy symptoms warrant, new skin testing and extract preparation is prudent.

May I receive my injections at another office?

Because many practices are not comfortable with IT and are not equipped to handle allergy emergencies, we prefer to administer injections in our office. When time or distance become an obstacle, we will make every effort to assist the physician of your choice in administering successful and safe allergy injections.

What should I do if I have problems with my injections?

Some patients report a slight increase in allergy symptoms soon after beginning IT. This will gradually resolve with treatment. Report any and all unusual symptoms to us BEFORE your next injection. We can adjust your medications or IT dose to minimize further problems.

When should I not get my injection?

You should not get an injection if you have asthma and you are coughing or wheezing. If uncertain, ask us to check. We are happy to listen to your chest or perform a peak flow test before administering allergy injections. You should not receive IT if you are taking a beta-blocker for high blood pressure, migraine headache, or any other medical condition.

Can pregnant women receive immunotherapy?

When near or at maintenance levels or at therapeutic levels women may continue to receive allergy injections during pregnancy. The dose may be lowered slightly in those women prone to large reactions. Because of the risk of anaphylaxis allergen doses are not increased during pregnancy. For women who have recently begun immunotherapy it's more practical to stop until after delivery and then restart injections. Breast-feeding is fine while on immunotherapy.

What about oral immunotherapy?

There are several methods currently under clinical investigation for oral administration of allergens. The potential benefits of this form of treatment includes less discomfort, home administration, and possibly an improved safety profile. Sublingual immunotherapy (SLIT) where allergen drops are held under the tongue and then swallowed is now being used in parts of Europe. SLIT is not yet approved for use on patients in the United States. SLIT, like other therapies considered investigational, is not a covered benefit of your medical insurance.

CAUTION

The information above represents the writer's opinions and is not meant as a substitute for evaluation by a physician. The reader is advised to seek sound medical evaluation and guidance before undertaking treatment for any medical condition.

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