Treatment of allergic diseases has been a difficult problem for clinicians in the past. The general public as well as the clinicians have always considered allergy as a bane to be endured rather than a treatable disorder. But the scenario is now changing. The three main modalities for prevention or treatment that have emerged are
Options for managing allergy include avoiding what you're allergic to, such as not eating a food you have a known problem with, avoiding pets, etc.
2. SYMPTOMATIC TREATMENT
Symptomatic treatment options for allergies include medications such as antihistamines, nasal sprays and short-term prednisone. Biologics such as anti-IgE anti-bodies have been used in severe cases.
3. ALLERGY DESENSITIZATION
Currently, immunotherapy is offered via allergy injections (allergy shots) for inhalation allergies although not for foods. Sublingual immunotherapy (allergy drops) is offered for inhalation allergies and foods. Immunotherapy directly changes the body's ability to react with allergens. Following successful treatment with immunotherapy, allergy symptoms are less apparent or at least less problematic.
Allergy injections (Allergy Shots)
Allergy shots consist of a series of injections containing small amounts of the substances to which a person is allergic. After a course of allergy shots, 80 to 90 percent of patients have less allergy symptoms, and in many cases their allergies have completely resolved. Allergy shots have been given for nearly 100 years and are FDA approved therapies.
How Do Allergy Shots Work?
Allergy shots work like a vaccine. Your body responds to injected amounts of a particular allergen, given in gradually increasing doses, by developing immunity or tolerance to the allergen.
There are two phases:
• Build-up phase. This involves receiving injections with increasing amounts of the allergens about one to two times per week. The length of this phase depends upon how often the injections are received, but generally ranges from three to six months.
• Maintenance phase. This begins once the effective dose is reached. The effective maintenance dose depends on your level of allergen sensitivity and your response to the build-up phase.
During the maintenance phase, there will be longer periods of time between treatments, ranging from two to four weeks. Your allergist / immunologist will decide what range is best for you.
You may notice a decrease in symptoms during the build-up phase, but it may take as long as 12 months on the maintenance dose to notice an improvement. If allergy shots are successful, maintenance treatment is generally continued for three to five years. Any decision to stop allergy shots should be discussed with your allergist / immunologist.
Sublingual Immunotherapy is method of allergy treatment that uses an allergen solution given under the tongue, which over the course of treatment, reduces sensitivity to allergens.
How does the process work? The first step is to confirm a patient's allergies through allergy testing. Then, a custom-mixed vial of drops is prepared for the patient. The patient takes drops under the tongue daily. During the first four months, called the "escalation phase," the dosage is gradually increased. After that, in the "maintenance phase," the patient takes the same dose of drops each day.
Is sublingual immunotherapy safe?
It is very safe, for both adults and children. Patients take the drops in the convenience of their own homes instead of going to the doctor's office every week for shots. The World Health Organization (WHO) has endorsed sublingual immunotherapy as a viable alternative to injection immunotherapy.
Does it work?
Many published scientific studies have shown that it significantly reduces allergy symptoms.
How long must I continue the treatment?
We recommend that patients keep using the drops for three to five years so that the body will build up a lasting "immunity."
Allergen avoidance is always the first recommendation for prevention of allergic symptoms. But this is not always possible or practicable.
• The drugs that have been conventionally used for the treatment of allergy such as antihistamine steroids, mast cell stabilizers, etc, provide, at the most, symptomatic relief only, and do not modify the long-term disease process.
• In the setting of these limitations, Immunotherapy provides a useful adjunct for treatment of allergy.
• Immunotherapy is designed to increase the tolerance of a person to the allergens that provoke allergic reactions.During the course of Immunotherapy, minute amounts of the offending allergens are injected regularly. The amount of allergen extract injected is gradually increased over a period of time. As the treatment progresses, the sensitivity to the specific antigen progressively reduces and the reactions become milder. The symptoms may also disappear completely.
The Immunotherapy course can be divided into 3 stages.
I. In the first four to five months subcutaneous injection are given twice a week in progressively increasing doses.
II. Thereafter monthly injections are given in order to maintain a stable allergen resistance level.
III. After the first year of therapy the patient will experience a reduction in symptoms. The schedule can be readjusted or remain at the monthly rate for 2-4 years. The injections are stopped at the end of 3-5 years for re-evaluation.