Immunotherapy

What is Immunotherapy?

Immunotherapy is the optimal treatment for allergy reduces or removes the symptoms and also correct the immune system's abnormal reactions. Use of symptomatic drugs such as antihistamines or steroids can reduce symptoms, but they do nothing to deal with the underlying disease. If you feel that avoidance measures do not help as much as you would like and your need for anti-allergic drugs is significant, you should consult a specialist regarding allergy vaccination treatment in order to alleviate - and possibly even cure - your disease.

Immunotherapy is specific allergy vaccination, and is the only treatment that interferes with the basic mechanisms of the allergic disease. That is to say, the vaccination treats the cause of your allergy instead of just the symptoms.

Since allergy is an immunologic disease, the immune system ability to modify the disease can be exploited. Vaccination is used for respiratory allergies - e.g. tree pollens, grass pollens, animal dander, moulds and house dust mites. It is also very effective as protection against severe allergic reactions to bee and wasp stings.

Regular vaccination with minute quantities of the offending allergen in gradually increasing doses stimulates your immune system to develop an increased tolerance. The allergy vaccination can be given as injections in the upper arm, just under the skin. It is done with the smallest needle available (the size used by diabetics).

Until your immune system has had time to adjust, you may still need the medication you are already using. After three to six months, your need for drugs will decrease and your symptoms will become less severe. New scientific studies have shown that an effect is maintained for 5-10 years after the course of vaccinations has been completed. Studies are continuing to see if there is an even longer effect. An additional effect of allergy vaccination is that the natural aggravation of the allergic disease is inhibited and the development of asthma and/or new allergies may be prevented.

Among the wide variety of treatment possibilities available today, specific allergy vaccination is still the only treatment that potentially cures your allergy, with all that implies in terms of quality of life e.g.:

  • An end to discomfort and feeling ill.
  • Reduction to the frequent consumption of symptomatic drugs in the case of respiratory allergies
  • No problems playing soccer, golf or tennis in the season.
  • No problems having pets at home or seeing people with pets.
  • The elimination of the constant fear of being stung in the case of insect allergy.

The purpose of subcutaneous immunotherapy (SCIT) “allergy injections” is to decrease your sensitivity to various allergens such as pollen, mold, dust mites, animal dander, stinging insects etc, which will result in elimination or reduction in symptoms. Allergy injections have been shown to alter your immune system’s response to naturally occurring allergens, allowing an individual to tolerate exposure to the allergen. The amount of immunization differs for each person and can be variable.

Indications: Patients who qualify for allergy immunotherapy are those whom have a known sensitivity to an environmental substance. Patients with allergic rhinitis, allergic asthma, or stinging insect venom sensitivity are candidates for SCIT. These patients have a documented allergy to an environmental substance confirmed by a positive skin test (skin prick or intradermal) or a positive blood test (RAST.)

Efficacy: Your symptoms will not improve immediately upon initiation of immunotherapy. You can expect to feel relief of your allergy symptoms within 3-6 months; full benefit may not be noticed until 12-24 months. 85-90% of allergic patients note a significant improvement in their symptoms after the appropriate time period. It is important to understand symptoms are reduced, but not always completely eliminated. Avoidance of allergens to which you have a known sensitivity should be maintained. We advise that you continue your allergy medications (Antihistamines, nasal sprays, eye drops, inhalers etc.) until instructed otherwise.

Contraindications: Coronary Artery Disease, uncontrolled asthma, acute infection, Beta Blocker use (Beta Blockers are medications used to treat cardiac arrhythmias, hypertension ‘high blood pressure,’ and for certain patients who have suffered a heart attack. Examples: Lopressor (Metoprolol,) Tenormin (Atenolol,) Inderal (Propranolol,) Coreg (Carvedilol,) and certain eye drops. It is important to make us aware of all medications you are currently using prior to beginning immunotherapy. If you begin a new medication please notify us immediately.

Pregnancy: Notify office staff immediately if you learn you are pregnant. Your dose will be adjusted and maintained accordingly by Dr. Nejat or Dr. Fiorillo. Your dose will not advance during pregnancy, but will be maintained at a constant level. Immunotherapy is not harmful to mother or baby and it can be safely maintained in pregnant females.

Adverse Reactions: There are certain risks associated with SCIT because a substance you are sensitive to is being injected into your body. It is important to be aware of these potential reactions. It is imperative that after each injection you wait in the office for at least 20 minutes. If you cannot wait you should schedule your injection at a better time that permits you to wait. If you leave the office and a reaction occurs return to the office immediately or go to you nearest emergency facility. Most systemic reactions are not life threatening if promptly treated; however, there are several allergy vaccine- related deaths each year, which emphasizes the importance of waiting in the office after each injection.

Common Reactions:

Local Reactions: Common reaction localized to injection site. Varying degrees of redness, swelling, pain, and itching. Please notify the MD/PA/Nurse if any of this occurs.

Generalized Reactions: Rare reaction, but most important.

  1. Urticaria (hives): various degrees of rash swelling, and/or itching.
  2. Angioedema swelling of any body part (ears, tongue, throat, lips, hands, feet.) may progress to anaphylactic shock and/or swelling of the airway.
  3. Anaphylactic shock although rare, is characterized by acute asthma, hypotension (low blood pressure, unconsciousness, and potentially death.
  4. Other symptoms: Wheezing, chest tightness, cough, flushing, generalized itch, runny nose, sneezing, red eyes, syncope, abdominal pain, nausea.

    Procedure: Allergy injections begin at a very low dose. The dosage will gradually increase on a regular basis (usually once per week) until therapeutic or maintenance dose is reached. It usually takes 3 to 6 months to reach a maintenance dose. The time may be longer if there are multiple vaccine reactions or if the injections are not received on a regular basis. For this reason, it is important that the recommended schedule be followed. If you anticipate that regular injections cannot be maintained, immunotherapy should not be started. You should be re-tested every year or two to measure your progress and reassess for the need for any modification to the treatment. Most immunotherapy patients continue maintenance treatment for 3-5 years, after which the need for continuation is reassessed.

    Please note if you are ill on a shot day, you may come in to be evaluated and treated for the illness if necessary.