Therapies Specific To Allergy
Medications used by an allergist are not unique, but how an allergist chooses to use the medication may be unique. Allergists have the same choices as other healthcare providers. For example, the medications we use for asthma are the same that pulmonologists (lung doctors) use, but allergists differ in their expertise in environmental control and the use of immune modulators (drugs that affect the immune system).
- Avoidance using environmental control
- Allergy injections, allergen immunotherapy
- Anti-IgE medication
Allergy shots are also described as desensitization, hyposensitization, allergy injections or allergen immunotherapy. Allergy shots treat allergic disorders by injecting small doses of an allergen into the allergic patient. The procedure usually takes many weeks or months and begins with a small amount of a highly diluted allergen that is injected in the upper arm, just under the skin. Each week, increasing amounts of allergen are injected, first by increasing the dose, followed by an increase in concentration. This continues until the patient reaches a top dose, which is either the strongest dose available or the highest amount the patient can tolerate.
Once the patient reaches this top dose that amount becomes the maintenance dose, and weekly injections continue at that level. Hopefully, the patient experiences relief of symptoms and can possibly decrease the use of their medication. Depending on how the patient is doing, the interval between shots can be stretched to every two, three and eventually four weeks. Reactions to the shots may require slowing down the program and even going backwards. The goal is to achieve a maximum dose with no side effects and excellent control of the symptoms.
Allergy shots may be missed due to illness or vacation. Depending on the individual situation, your doctor will make an adjustment in dose and schedule. If you have a significant fever or flu, or if you are wheezing, the allergy shot needs to be cancelled and rescheduled for a week later.
Frequently, a question arises as to how long an allergy shot regimen will last. There is no standard answer to that question. It is an individual decision. For the most part, the longer the program is continued, the longer the benefit from the therapy. As a general rule, you should expect to stay on the program for three to five years.
If a patient has been on a four-week schedule for at least a year, and is only taking shots to treat the allergy, then stopping the allergy shots can be considered. Some allergists prefer to see three successive seasons of relief before considering stopping the allergy shots. Again, this is an individual decision. There is no way, other than by history, to know when to stop the allergy shot program. Skin test results may decrease during treatment, but they are not usually used to decide if the program should be stopped.
There is also no way to know how long a patient will do well after the program is stopped. Some patients may have life-long relief; other patients may have a relapse. With relapses, another course should be started.
If the patient is at a top (maintenance) dose for one year, and there is no change in the symptoms, possible reasons include:
- Lack of environmental control
- Chronic infection
- Another allergy has developed
Often, there may be a new sensitivity that develops in some patients. If so, a reevaluation is necessary. If nothing can be found, then a discussion about stopping the program should occur. Please give the program at least one year before deciding if it has worked for your child.
Oral immunotherapy may be available soon. The FDA has not approved any products for general use. However, this form of allergy therapy has been around for a long time, but only recently have well-performed studies shown efficacy. These new studies have originated in Europe and there are studies ongoing in the United States. The products showing promising results in Europe are not available here in the United States. The products being used in studies in the United States are not available for commercial use. Current use is confined to research study purposes only.
There are some new medications that treat asthma caused by allergy. These drugs are called anti-IgE. IgE stands for immunoglobulin E. IgE antibodies form in response to an allergen. The antibodies are made to attack the allergen and are responsible for triggering an allergic reaction. The new drugs act to reduce the circulating IgE, which helps prevent an allergic reaction.
Currently anti-IgE medicine is used for uncontrolled moderate to severe persistent asthma. The patient must be older than 12, have evidence of sensitization to a perennial allergen and have a total IgE level within a specific range.