Allergy Immunotherapy: Get Back to the Great Outdoors
Allergy immunotherapy is one of three ways to treat allergies:
- By avoiding allergy triggers
- By taking medications to mask the symptoms
- By using allergy immunotherapy (allergy injections to retrain your immune system so that you are less allergic)
Avoiding Allergy Triggers
Once we find what you are allergic to, we will give you tips and advice on how to reduce your exposure to the offending allergens. This can help significantly for some people. However, it is difficult to completely avoid things like dust mites, molds, and pollens, and most people are unwilling to remove beloved pets from their homes. Pollens can blow for more than 300 miles. Some people ask if moving would help their symptoms. While moving may buy you a year or two, allergies exist throughout the world. Plus, if you are allergic, you would likely develop allergies to the local pollens and molds within a few years.
Medications have come a long way in the past 30 years. We now have non-sedating antihistamines, and nose sprays that put a small amount of a steroid or antihistamine right where you need it on your nasal mucosa. Drug companies spend a lot of money trying to get you to buy their products so this is what most people think of when they think of allergy treatment. Unfortunately, the benefit of allergy medicines is fairly limited. We use them all the time, but most antihistamines only improve your symptoms by about 25% while most nasal sprays help by about 45-50%.
Allergen immunotherapy, or allergy injections, works to change your immune system and improve symptoms beyond what medications alone can do. Allergy immunotherapy (via injections) is the only treatment that offers the chance of long-term improvement even after stopping treatment. Typically, patients see initial improvement after a few months and significant improvement by six to nine months. This benefit may last for more than 10 years after stopping the allergy injections.
How Allergy Immunotherapy Works
Allergy injections work by retraining your immune system. When your body is exposed to anything through your mouth, eyes, nose, or lungs, it has to decide if it is an infection. If you have allergies, your body mistakenly decides that otherwise harmless pollens, danders, and other proteins are an infection. It tries to get rid of the allergen just as it would try to remove an infection. Your body can’t get rid of the allergen, though, since it is everywhere in the air.
As it starts to lose the battle with what it thinks is an infection, your body ramps up the inflammation and eventually treats the allergen similarly to how it would try to eliminate a parasite. Our immune system kills parasites by pouring poisons in the area. These chemicals include histamine and leukotrienes. While these chemicals will kill the parasite, they cause significant damage to our own bodies. In short, those chemicals are what cause itching, congestion, sneezing, coughing, shortness of breath, and wheezing of allergies and asthma.
Fortunately, your body has a way to decrease this immune response. You have a type of white blood cells called T-Regulatory or T-Suppressor cells floating in your blood. When these cells see a protein in your blood on a regular basis, they assume it is part of you and tell the rest of your body not to attack that protein. This is why we are not allergic to the proteins of our own body, such as those made in our heart or liver.
With allergy injections, we use these T-Regulatory cells to decrease your reaction to your allergies. By injecting the things you are allergic to under your skin at regular intervals, we trick your body into not responding to those allergens when they hit your eyes, nose, and lungs.
According to the Agency for Healthcare Quality and Research, a review of scientific studies showed that allergy shots improved symptoms and decreased medication use for asthma, allergic rhinitis, and allergic conjunctivitis. It was found to be more effective than allergy drops for asthma and allergic nasal and eye symptoms.
Safety and Allergy Immunotherapy Schedule
There are studies and guidelines on the correct doses of allergens in your shots. We try to get everyone up to these recommended doses. If we use too low a dose, the injections simply don’t work. If we start off too high, your body could have a negative reaction. As Goldilocks once discovered, we need to start you off at a dosage that is “just right” and work you up from there.
In order to be safe, we dilute your target dose down 10,000 fold and gradually build you up over a 28-visit schedule. We know that if you tolerate a small dose, you will be able to tolerate a slightly higher dose for a short while. This is called desensitization. Desensitization wears off quickly – so during this build-up phase you need to come in at least one time per week. We recommend, but do not require, that you come in twice per week in order to get benefit from your shots sooner.
Once you reach the higher doses, the allergy injections become more effective and the desensitization starts to last longer. At this point, most patients are starting to see significant benefits. Once we get you to your maintenance dose, we will try to space your shots out and eventually should get you to one set of shots about every 4 weeks. Some people feel they are better when they come in more frequently, but our only requirement on the maintenance shots is that you come in at least once per month to make sure the desensitization doesn’t wear off.
Our goal for allergy shots is to give them to you for three years. Studies have shown that if you quit before three years, your symptoms are likely to return. Once you reach three years, though, there is about a 50% chance that you would be able to stop allergy shots and continue to have benefits, despite no longer needing shots or even possibly medications.
Allergy injections are a natural way to control your allergies. There are no chemicals or medications in the shots. They just contain the natural pollens, danders, molds, and insects that you are being exposed to every day, with a small amount of glycerin to help stabilize the proteins and keep them effective.
Protecting Against Reactions from Allergy Immunotherapy
The main side effect of allergy injections is the potential for an allergic reaction. Since we are giving you something that you are allergic to, there is a chance that you could experience an allergic reaction after the injection. Because of this, we do three main things to make them as safe as possible.
First, we dilute the shots as described above and use a conservative build-up schedule to get you safely to your higher dose.
Second, after every injection, we ask that you wait in the waiting room for 30 minutes. We use 30 minutes because while reactions are rare, if they are going to happen, they almost always start within 30 minutes of receiving the injection. We are not concerned with a little redness or swelling at the injection site on your arm – just think of that as telling us that you are still allergic but that we have the right allergens and are making progress. If that local reaction is bothersome, we can give you some steroid cream or an “ice hand” – an exam glove filled with water and frozen. What we are concerned about is chest tightness, coughing, wheezing, shortness of breath, throat closing, tongue swelling, itchy and watery eyes or nose, or hives. If you noticed any of these symptoms or anything else you were concerned about, just let our front desk staff know. They’ll get one of the nurses and we’ll bring you back to one of the exam rooms. There we’ll check your vital signs and perform an exam. If there are any signs of anaphylaxis, we would use epinephrine to counteract its effects.
Third, we prescribe each patient an epinephrine autoinjector to carry with them for 2-3 hours after they receive their allergy shot. Most people keep this with them and never use it. However, rarely, someone will be fine for the 30 minutes they wait and then notice some symptoms after they leave. We would rather be safe and make sure everyone has the protection they might need, even if the likelihood is low.