Immunotherapy for Allergies
Allergies are an abnormal response of the immune system to a substance known as an allergen. Allergens are substances to which particular individuals have extreme sensitivity. When a person is exposed to an allergen, the body releases chemicals including histamine, which produce the allergic reaction.
Some of the most common allergens are pollen, dust mites, mold and animal dander. Allergens can also be substances to which everyone reacts with pain or discomfort, such as bee venom, but to which certain individuals have life-threatening reactions.
Immunotherapy is the administration of small doses of the allergen causing the problem which are gradually increased to help the patient develop increased tolerance. Immunotherapy works to bolster the immune system without triggering an allergic reaction. It is a good option for patients who have persistent allergies for more than three months of the year, do not respond well to allergy medications, or are in danger because of their allergy. Immunotherapy can relieve allergy symptoms and help reduce the frequency of reactions.
A course of immunotherapy typically begins with the injection of minute quantities of the allergen injected into the patient's arm once a week. Gradually, these doses are increased. In a month or two, the patient is usually receiving the optimal amount of allergen in the injection, enough to demonstrate sufficient tolerance to allow the patient limited exposure to the allergen without developing symptoms. This is referred to as a maintenance dose.
Once the maintenance dose is reached, the patient will receive the same dose with decreasing frequency. That same dose may be administered every 2 weeks for about 6 months. At that time, the period between injections is increased to about 4 weeks. Patients may be kept on a maintenance dose once a month for up to 5 years to help them retain at least partial immunity to the irritating allergens.
In some instances, immunology for allergens may be administered more intensively, reaching the maintenance dose more quickly. This variety of treatment is called cluster, or rush, immunology.
Sublingual Immunotherapy (SLIT) vs. Traditional Allergy Injection
Sublingual Immunotherapy or (SLIT) is a method of allergy treatment that uses an allergen placed under the tongue, which over the course of treatment, will quickly and safely reduce the patients' sensitivity to the offending allergens. SLIT can be used to treat both airborne and chronic non-severe food allergies. Examples of airborne allergies are pollen, dust mites, molds, feather, and animal hair. The treatment is done daily at home and only takes 2 minutes to complete. It is indicated for both adults and children. In contrast, the allergy shot, subcutaneous immunotherapy or (SCIT) is the traditional method. This method is usually administered by subcutaneous injection administered either in the upper part of the triceps area or thigh. After the inoculation, the patient will be required to wait a minimum of 20 minutes within the office for observation to check for adverse reactions. The escalation phase of treatment takes about 1 year to complete. Within that year the patient will be required to receive weekly inoculations, and the volume of allergen injected will be increased with each visit. After the first year, once the patient has reached maintenance, the inoculations can be spread out to every other week, and so on. By the end of the fourth year, the patient should be at a "once per month" regiment. Complete desensitization with conventional immunotherapy usually occurs within 5 years. However, positive effects of treatment may be seen way earlier. In comparison, with SLIT there is only a 3 month ramp up period commonly known as the "escalation phase of treatment". After that, the patient will have reached maintenance. All of this will be performed painlessly and conveniently at home.
SLIT has been shown to be very safe and effective and much more convenient than getting allergy injections. SLIT has been used for over 60 years and is especially popular in Europe. Most allergy patients in England who are receiving immunotherapy use SLIT. In Italy and France, 50% of the allergy patients are on SLIT. In the 1990s, the World Health Organization (WHO) approved SLIT as a safe and effective method in providing allergy treatment.
Compared to traditional injection therapy, SLIT is more convenient, requires fewer clinic visits and costs less. Most importantly, allergy drops are a safe, painless and effective treatment for young children, asthmatics, the highly reactive patients and those with underlying medical conditions that prevent them from being candidates for Injection therapy. One of the problems with allergy shots is that when patients are sick, they will not be permitted to receive an allergy injection since there is a higher chance of developing an adverse reaction when ill. If patients are unable to obtain their allergy shots on a regular basis, their progress is hindered. With SLIT, except for the initial 3 month escalation phase of treatment, the dose is the same for the entire vial until it is completed. Drops can be taken even if the patient comes down with common illnesses. Patients typically do not fall behind in their progress. Usually patients on allergy shots are getting somewhere between 2-4 injections each time, one for each vial for the entire length of treatment. In comparison, with SLIT, the "maintenance treatment set" can be mixed in either 1-2 vials. It is only during the "escalation phase of treatment" that a patient will be required to administer multiple vial sets at various concentrations. This process of course only lasts for the initial 3 month period.
SLIT is not FDA approved in the United States (even though the ingredients are the same as in conventional subcutaneous injection immunotherapy) so the majority of insurance carriers do not cover the costs of allergy drops. However, the allergy test is usually covered by most insurance carriers. (We check your medical insurance and obtain any pre certification if necessary). The cost of SLIT is about $300 for a 3 month supply. Each vial of allergy drops will last about 3 months. The cost is the same no matter how many vials with inhalant allergens are necessary. If you are doing food drops, that will be a separate charge of $300.00 for a two month supply. If you add up the indirect costs of having frequent allergy injections in a doctor's office, such as lost time and wages and the cost of gasoline and parking to get to the doctor's office, SLIT may actually be cheaper for you.
SLIT has very infrequent side effects. Some patients may complain of itching in their mouth. Since the drops are swallowed, some patients may have some gastrointestinal symptoms. It requires a huge overdose to get more serious reactions such as swelling of the mucus membranes that could lead to anaphylaxis. If you are having any symptoms that you feel are related to the drops, call us so we can help you to feel better. More than 100 scientific articles in peer-reviewed journals prove that SLIT is both safe and effective. Although there are potential risks of allergy injections, drops are even safer. There is 1 report of anaphylaxis in over 100,000,000 dosages.
At any time, we can switch you over from allergy shots to SLIT. If you are an existing patient and have decided to make the change, you may simply call our office and leave a message with the allergy department. At your convenience, we will be more than happy to formulate your serum as per your allergy test result specifications. If you are presently receiving allergy injections at another facility and have never been treated by Dr. Han or if you are an existing allergy shot patient, we would simply have you either schedule a "new patient appointment" or a "quick follow-up" with the doctor. Then we would schedule an initial counseling session and a vial test. The visit should take no more than 20 minutes to perform.
You will then be handed the allergy serum (conveniently formulated in glass metered dose vials) and treatment will commence at home on a daily basis. If after using SLIT for a while you feel that you would rather go back to conventional allergy injections, we can certainly remix your serum. Our allergy treatment program is flexible enough to suit anyone's needs.
If you are already receiving allergy injections and everything is going well, then there is no need to change to SLIT unless you'd prefer a quick, painless and risk free alternative.
- National Institutes of Health
- Centers for Disease Control and Prevention
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
- U.S. Department of Health & Human Services
- U.S. National Library of Medicine