Therapies specific to allergy
The medications used by an allergist are not unique because we have the same choices as other healthcare professionals-dermatologists, pulmonololgists, ENT specialists etc. But¬†how we choose to use the medicine may be unique. For example,¬†the medications we use¬†to treat¬†asthma are the same medications that ourcolleagues in pediatric pulmonary¬†use. What does differ is¬†our¬†expertise in environmental control and the use of immune modulators.
- Avoidance (enviromental control)
¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬† Allergy injections- allergen immunotherapy
Note- Information on environmental control can be found under ‘Asthma’ and ‘Animal Allergy’. Here the focus is on altering the immune response.
Allergy shots, desensitization, hyposensitization, injections,¬†and ¬†immunotherapy are all terms used to describe the treatment of allergic disorders by injecting small doses of allergen into the patient. The procedure usually takes many weeks or months. It begins with a small amount of a highly diluted allergen¬†that is injected in the upper arm, just under the skin. Each week,¬†larger amounts of allergen are injected; first, we increase the dose, and then we increase in concentration until¬†a patient reaches their “top” dose. This ‘top” dose is -either the strongest dose we offer or the highest amount tolerated by the patient.
Once¬†a patient reaches their “top” dose we c0ntinue with¬†weekly injections of a maintenance dose (equal to the “top” dose. Hopefully, at this point, ¬†the patient is experiencing relief of symptoms and is even possibly¬†decreasing the use of their medication. Depending on the time and how the patient is doing we try to stretch out the interval between shots to every 2, 3 and eventually every 4 weeks. Reactions to the shots may cause us to slow down the program and even go backwards. We are trying to achieve a maximum dose with no side effects and excellent control of the symptoms.
Your child may miss their¬†allergy shots¬†due to illness or vacation. Depending on their individual situation we will make adjustments in the dose and schedule.¬† If your child has¬†a significant fever (over 101F) ¬†or flu, or if your child is¬†actually wheezing the “shot”should be cancelled and rescheduled for¬†the following week.
Parents often question how long this program will last. There is no standard answer to this 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 your child to stay on the program for 3-5 years. If the shot have been spaced out to 4 weeks, and your child is not taking anything other than the shot to control their allergy-and this has been the cse for at least a year- we will strongly consider stopping the shots.¬† Some allergists will use 3 successive seasons of relief as the indication shots should be stopped. Again, this is an individual decision. There is no way to know- other¬†than by history when to stop the allergy shot program. Skin test results may decrease during treatment, but these are not usually used as an indication the treatment should be stopped.
There is also no way to know how long a patient will continue to do well after their program is stopped. Some patients may have life-long relief, others may have a relapse. With relapses, another course of allergy shot treatment should be started.
If after one year of treatment,¬†a patient is at¬†their “top” maintenance dose and¬†has no change in their symptoms – we need to consider:
- Lack of environmental control
- Chronic infection
- Another allergy has developed
Often, there may be a new sensitivity that develops in some patients. At this point a re-evaluation is necessary. If nothing can be found with allergy testingthen 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.
Newer forms of therapies for a variety of clinical condition use monoclonal antibodies directed against mediators of a specific condition. Allergic asthma has anti-IgE available as a treatment. This is a humanized mouse monoclonal antibody directed against the antibody that mediates allergic conditions. Currently it is used for uncontrolled moderate to severe persistent asthma. The patient has to be >12 years old, have evidence of sensitization to a perennial allergen and have the total IgE level within a specific range. This is an antibody against an antibody. The idea is that if all the allergy antibodies are bound and not available to mediate allergic reactions, then the asthma improves. We have a few children on this agent with great results.