What Is Immunotherapy For Allergies? Part 1/2

Here are some basic answers to questions you may have regarding allergen immunotherapy, also known as "allergy shots."

Allergen immunotherapy is a treatment designed to decrease nasal allergies (also known as allergic rhinitis), allergic asthma and reactions caused by insect stings. Specific allergens are identified through allergy testing, so the allergist first knows what is causing the allergy symptoms, in order to effectively treat them. After the culprit has been identified, allergen immunotherapy involves getting injections of increasing amounts of specific allergens over the course of several months.

Does Immunology Work?

Aside from decreasing allergy symptoms like sneezing, runny nose and congestion, Immunotherapy can help prevent the development of new allergies. In children, Immunotherapy can help prevent allergic rhinitis from progressing into asthma. Even after the treatments have stopped, allergen immunotherapy often leads to long-lasting relief of allergy symptoms.

Many studies have shown that immunotherapy is effective for the treatment of nasal allergies, for both adults and children. A review of 18 published studies involving nearly 800 patients concluded that immunotherapy is highly effective in the treatment of allergic rhinitis. An extensive review of immunotherapy as a treatment for allergic rhinitis in children, showed that the only treatment able to affect the natural cause of the disease is immunotherapy. Studies showing the effectiveness of immunotherapy suggest that roughly 8 out of 10 allergy patients benefit significantly from immunotherapy.

Immunotherapy may also prevent the onset of asthma, and a review of multiple studies showed that allergen immunotherapy is also an effective treatment for asthma. These studies have indicated that treatment with immunotherapy results in reduced symptoms of asthma and improved pulmonary functions, and at the same time, reduces the need for asthma medications.

For individuals with a previously demonstrated allergic susceptibility to insect stings, immunization with insect venom is an extremely effective treatment for preventing future allergic reactions. A review of nine published studies indicates that a course of immunotherapy is highly effective in the management of insect sting allergy. Immunology can be a great alternative if you have any of the following concerns:

Poor response to medications
Impractical or impossible to avoid the offending allergens
Negative medication side effects
Wanting to avoid long-term medications or reduce the cost of medications
Coexisting allergic rhinitis and asthma
Possible prevention of asthma in children
Individuals with allergic asthma

If Immunotherapy Works Why Doesn't Everyone Do It?

People who have very light symptoms or have found an effective medication that eliminates symptoms, may not need immunotherapy. For others, the time and commitment involved in starting and undergoing immunotherapy can be seen as an obstacle, especially when looking for a "quick fix". In time however, more and more patients are realizing that the long-term benefits of immunotherapy are much better than having to be on medications for the rest of their life.

Who Is a Good Candidate for Receiving Immunotherapy?

Immunotherapy is recommended for those with allergic asthma, allergic rhinitis (involving various nasal symptoms) and conjunctivitis, or stinging insect allergy. It may be the best option for those who have difficulty controlling symptoms through avoidance or medication. Other considerations are that you do not like the side effects of allergy medication, the allergy medications are inconvenient, or having to take multiple medications in order to control symptoms. Immunotherapy is not recommended for those with food allergies. The best treatment for severe food allergies is to strictly avoid the offending food. The decision to begin immunotherapy will be based on several factors including:

Length of allergy season and how severe symptoms are.
How well medications and/or environmental controls take care of the allergy symptoms.
Wanting to avoid long-term reliance on medication.
Immunotherapy will require a significant time commitment-are you willing to make the commitment to the therapy?
Cost: may vary depending on insurance coverage.

Will Insurance Pay For Immunology?

Most insurance companies and HMOs will pay for immunotherapy, especially if your primary care doctor refers you to an allergist and the allergist recommends immunotherapy as part of your treatment. Even patients with milder symptoms may be recommended immunotherapy to avoid worsening of symptoms, particularly if they cannot always avoid the things they are allergic to, such as a family pet, bee stings, or specific native plants.

Who Is a Good Candidate for receiving immunotherapy?

Immunotherapy is recommended for those with allergic asthma, allergic rhinitis (involving various nasal symptoms) and conjunctivitis, or stinging insect allergy. It may be the best option for those who have difficulty controlling symptoms through avoidance or medication. Other considerations are that you do not like the side effects of allergy medication, the allergy medications are inconvenient, or having to take multiple medications in order to control symptoms. Immunotherapy is not recommended for those with food allergies. The best treatment for severe food allergies is to strictly avoid the offending food. The decision to begin immunotherapy will be based on several factors including:

Length of allergy season and how severe symptoms are.
How well medications and/or environmental controls take care of the allergy symptoms.
Wanting to avoid long-term reliance on medication.
Immunotherapy will require a significant time commitment-are you willing to make the commitment to the therapy?
Cost: may vary depending on insurance coverage.

How Is the Treatment Administered?

A very small hypodermic syringe is used to inject commercial allergen extracts. The injections are usually at the site of the loose tissue over the back of the upper arm, between the shoulder and elbow. This area is the least painful site for injection as there are very few nerve endings. Injections are given under the skin ("subcutaneous"). When administered correctly, the injections should only be slightly uncomfortable. They are not usually painful, and are well tolerated by adults, teenagers and most children. You may be advised to take an antihistamine a few hours before each injection to reduce the likelihood of any local allergic reaction and other side effects.

Can Young Children Receive Immunotherapy?

Children over the age of 5 may be good candidates for the therapy. Very young child will likely have difficulty cooperating with the immunotherapy regimen. However, immunotherapy can be a good option for children in general. Studies suggest that immunotherapy treatments may prevent the development of new allergies in children, and may help prevent the development of asthma in children who have rhinitis.

Is There an Age Limit to Receiving Immunotherapy?

Not really. Anyone from age 5 on up may benefit from receiving immunotherapy. With elderly persons, consideration should be given to the overall health and chronic medical conditions (such as cardiac disease), which could potentially cause problems. However most healthy children and adults can benefit from Immunotherapy treatments.

Where Does the Immunotherapy Take Place?

Ideally, immunotherapy should always be given in the prescribing allergist/immunologist's office/clinic. If this is not possible for some extenuating circumstance, your allergist/immunologist should provide the supervising physician with all needed information about your specific treatment. Either way, you must always be in the care of an appropriate medical professional, who is qualified to administer Immunotherapy.