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Allergen Immunotheraphy

Dear Dr. Kagen:

My allergist is encouraging me to receive allergen immunotherapy because he says it will probably be beneficial, but I'm skeptical. I've talked to people that have received this therapy, and they say the beneficial results only lasted from 1 to 3 years. Plus, their allergic symptoms initially increased following the administration of the allergen shot, and there's also the risk of anaphylactic shock. What's the reported incidence of anaphylactic shock and adverse reactions?

Running back and forth to the doctor once or twice a week for a sustained period of time for what may be months is also a factor. How often are these appointments going to be, and how long do I have to undergo this therapy? Is the disruption and time consumption of this allergen immunotherapy going to be worth the result?

Also, there is the monetary factor. My insurance won't cover because this is a pre-existing condition. Do the results of allergen immunotherapy justify the cost? I've asked these questions twice, once of the doctor and once of the PA, and I seem to get vague, non-committal answers like, "The results are different for everybody," and "It has to do with quality of life." They say they have no in-patient stats. They say the results of the studies say the immunotherapy lasts 3 to 5 years. What exactly is it that lasts for 3 to 5 years or 1 to 3 years? I understand technically it's the "beneficial effects," but is that a 50% reduction of allergy symptoms, a 20% reduction, a 1% reduction? Is there an average?

The PA told me that, in her personal experience, people with severe allergies seemed to get the best results. (I have severe allergies to grasses & weeds, 4s on a scratch test; trees were 2s & 3s; dust, 2, mites 3; and some other stuff too, so I guess I have "severe" allergies.)

So what exactly is the potential benefit? What exactly is the average actual benefit? Is allergen immunotherapy obviously justified, or is it just an overrated treatment? Can you please help me to better understand the benefits of immunotherapy so that I can make an informed decision?

Thank you,
Jorene

Thanks for asking about allergen immunotherapy, Jorene.

Allergen immunotherapy, or "allergy injections", is the only form of therapy for allergic diseases that reverses the disease process. All other forms of allergy treatment simply "clean up the mess' so to speak after the allergic reaction has occurred. Allergen immunotherapy can prevent the progression of the allergic disease as well. Patients with allergic rhinitis who are on immunotherapy will have a 50% reduction in the risk of developing asthma.

The benefits of allergen immunotherapy include not only a better quality of life (reduction in allergy symptoms, better breathing, less need for allergy medications, fewer days off from work and school due to illness, and improved school performance in allergic children), but an increase in tolerance to aeroallergens that specifically bother you.

In order for the allergy injections to work, it is most important that an exact diagnosis is made and that all of the relevant allergens are present within the syringe. The attentive an interested Allergy Specialist is in a position to accomplish this. In our allergy clinic, we prepare all of the allergy vaccines/extracts in our laboratory so that we can control exactly what is in the patients' materials. I believe that the difference between allergists is their ability to formulate the specific allergy vaccine for each individual patient.

The inconvenience of weekly allergen injections is temporary. Once a patient has reached a therapeutic level of allergen administration, the injections can be separated by one or two weeks. In our experience, patients need to receive their injections no longer than every three weeks at maintenance levels.

The duration of therapy is specific for each patient. Most patients need to receive allergen immunotherapy at least for three years and some for much longer periods of time.

Since the allergy patient is receiving injections of something they are allergic to, it is possible for an allergic reaction to take place. For that reason, allergy injections should be given in a doctors office and the patient should remain in the office for at least 30 - 40 minutes as reactions usually occur within this time frame.

In our clinics, 3 to 5 patients per year require adrenaline treatment in the process of receiving their allergy shots. In the past 18 years only one patient has required hospitalization due to an allergic reaction in our office, and this was not from an allergy injection. It was from a testing visit. So allergy immunotherapy is very safe in an experienced Allergy Clinic.

Patient selection for allergen immunotherapy is quite important. We recommend immunotherapy for patients who have experienced allergy symptoms which are disabling and which occur in more than one season of the year, providing that there is a suitable allergy vaccine for the patient. [i.e. no therapeutic vaccine is available for ferret allergy]

If one of our patient's allergy symptoms are no better after one year of adequate allergen immunotherapy therapy, then we recommend that the injections be discontinued. Approximately 90% of patients improve significantly on this form of treatment.

I hope that this answers some of your concerns about allergen immunotherapy. Good luck.

Steve Kagen, M.D.
Allernet.com