post-title Allergy Immunotherapy Update 2014-05-27 21:26:21 yes no Posted by

Allergy Immunotherapy Update

by: Dr. Deborah Ortega Allergy management has traditionally taken 3 forms, avoidance, medications to reduce symptoms and control illness and desensitization.  Desensitization can be successfully achieved with some medications, stinging insect venoms and airborne allergens such as grass pollen, ragweed pollen and mold spores.  The most common form of desensitization for airborne allergens used by […]

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DeborahOrtegaCarr-300x267by: Dr. Deborah Ortega

Allergy management has traditionally taken 3 forms, avoidance, medications to reduce symptoms and control illness and desensitization.  Desensitization can be successfully achieved with some medications, stinging insect venoms and airborne allergens such as grass pollen, ragweed pollen and mold spores.  The most common form of desensitization for airborne allergens used by allergists in the United States is subcutaneous immunotherapy or allergy shots.  In Europe, airborne single allergens are also given sublingually.

Allergy immunotherapy works much like a vaccine. Your body responds to injected amounts of a particular allergen given in increasing doses, eventually developing a resistance and tolerance to it.  Allergen immunotherapy is typically considered when a patient, and his/her physician, find that medications have not effectively controlled symptoms, or when the patient finds it difficult to take the prescribed medications on a continuous basis, or when the patient experiences side effects that hinder his/her ability to use the medication regimen as directed. Allergy shots can lead to decreased, minimal or no allergy symptoms.  Published studies have shown the clinical effectiveness in allergic rhinitis,  allergic conjunctivitis and allergic asthma. Allergy shots also reduce the number of new allergens developed in those receiving immunotherapy for a single allergen. Finally allergy injection therapy can prevent the progression to asthma.

Recent interest on sublingual immunotherapy or SLIT has prompted allergists to take another look at research data on both forms of treatment.  Although both forms of treatment can be effective, doses for effective treatment are well established for allergy shots.  Effective doses are still under evaluation for sublingual treatment.  Current research also suggests that allergy injections provide greater efficacy as compared to sublingual therapy.   Allergy shots have more often provided greater immunologic responses suggesting better long-term benefit.

New forms of allergy immunotherapy (Sublingual immunotherapy or SLIT) recently approved in the United States include Grazax and Oralair, grass sublingual tablets and Ragwitek, a ragweed sublingual tablet.  These treatments may be appropriate for young patients with one or two allergies who are unable to receive allergy injections.  Side effects are typically mild as well and occur early in treatment and include itching of the mouth and throat.   International studies suggest that SLIT can be safe for preschool children.

Oral Immunotherapy continues to show promising results for peanut allergy A recent study of  85 children in England  showed  62%  achieved desensitization with treatment.  Protective effects are being reported in many studies of children with food allergies. Additional studies are needed to determine dosing ( how much allergen is needed?) and the establishment of permanent tolerance (how long dose the protection last?, does the oral dose need to continue indefinitely?  before this treatment is more widely used.

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