No one really knows what causes one person to have allergies when another one doesn’t, or why one substance triggers an allergic reaction in an individual when another doesn’t. Allergic reactions can range from mild irritations to anaphylaxis (a severe reaction that’s a life-threatening emergency), but for the sufferer, allergies are always unpleasant and unwelcome.
Fortunately, it is not necessary to live with chronic allergies, because there is a cure. “Immunotherapy actually retrains the body to no longer be allergic,” said Amy Brookman, Physician Assistant and Allergy specialist at WWMG’s Ear, Nose & Throat clinic.
Taking Over the Counter Antihistamines
Nearly 1 in 3 U.S. adults and more than 1 in 4 U.S. children, have some type of allergy. For a large percentage of them, allergies are a mild or occasional inconvenience.
Over-the-counter antihistamines can minimize the symptoms when a person is experiencing seasonal allergies. Utilizing this ‘medical management’ approach may be sufficient for an individual who gets allergies in the spring for a couple of weeks when pollen counts are highest.
For folks who are mildly allergic to pet dander, taking antihistamines daily may suppress symptoms enough to live comfortably with a cat, dog, or other type of pet.
“Medical management does a good job of keeping the symptoms at bay. If there’s ever a point when the symptoms just become too much, then immunotherapy is a great next step,” said Brookman.
Immunotherapy for Chronic Allergies
Immunotherapy treatment can actually cure a person’s environmental allergies.
It’s time to consider immunotherapy when:
- allergies consistently interfere with your quality of life
- your allergic reactions are increasingly severe, or
- you don’t want to take antihistamines every day for the rest of your life.
Brookman explains, “Immunotherapy is actually retraining the body to no longer be allergic to these [environmental] allergens. It’s different than medical management. This is actually getting to the source of the issue, desensitizing and raising [the patient’s] tolerances so that when they’re exposed they’re not getting the symptoms that they used to.”
Just like gradually adding chili powder to food over time can train the taste buds to tolerate spicy food, immunotherapy slowly and carefully trains the immune system to tolerate allergenic substances.
Diagnosing the Allergy
WWMG’s ENT clinic offers immunotherapy to treat patients with environmental allergies. The first step is accurately identifying the substances that cause an allergic reaction.
“When we do allergy testing, we do skin pricks on the [patient’s] back and intradermal on the arms. The reason we do both tests is to help us see both if you are allergic and how severely. It helps us decide where to start on the allergy treatment journey,” said Brookman.
Catering to the individual, patients with a severe response to skin testing will begin immunotherapy with more diluted allergens in their dose to avoid an allergic reaction to the treatment.
A blood test is a diagnostic option when allergies are so severe the patient can’t stop taking antihistamines long enough for a skin test, or when a patient’s other prescription medications put them at risk of a negative reaction from a skin test.
Immunotherapy Treatment Options
There are three forms of immunotherapy treatment: tablets, shots, or drops.
Most allergies will be treated with a customized formula that is either administered through shots or sublingual drops (under the tongue). Tablets are available only for specific allergies.
Tablets
If a patient is diagnosed as allergic to only one substance, and that substance is either grass pollen, dust mites, or ragweed, they can receive a prescription for immunotherapy tablets.
The tablets are taken as a daily pill just like antihistamines. The antigen (allergen) content in prescription immunotherapy tablets is gradually increased until the patient’s body no longer reacts when exposed to the target substance in their environment.
Shots
The most common immunotherapy treatment is allergy shots. Shots may be recommended for patients with allergies to trees, grasses, weeds, mold, house dust, animal dander, and insect stings.
Allergy shots must be given at a health clinic, and are usually covered by most health insurance plans (check with your insurance provider to verify coverage).
A custom treatment formula is developed for each patient based on their diagnosed allergies. The formula is tested on the patient through an initial injection, and if they tolerate it, they can begin the full course of treatment.
Patients receive shots weekly for a full year, and then monthly for the next four years. In most cases, patients begin to see an improvement in their symptoms after six months, but it can take up to a year for substantial relief from some allergy symptoms.
Patients may experience some swelling at the injection site for a couple of days after each shot. In the event of a more severe reaction, the allergist will reduce the exposure levels to the allergen and adjust the treatment plan accordingly.
“We are giving you things you’re allergic to, so there is the chance of anaphylaxis,” said Brookman. Although the chances of having an extreme reaction is rare, every patient who undergoes immunotherapy is prescribed an EpiPen as a precaution.
Drops
Drops may be used to treat the same allergens as immunotherapy shots. Immunotherapy drops relieve allergies faster than shots, and are less likely to cause a severe reaction.
Patients who opt for immunotherapy drops receive their first dose at a health clinic. Drops are placed under the patient’s tongue for 2 minutes, then swallowed.
After the initial dose, patients can administer the drops themselves at home, ideally at the same time each day.
Brookman shares, “You reach maintenance phase much faster than with the shots, so you should feel relief much sooner.” Patients’ symptoms are usually relieved within three to six months, and they generally complete the treatment after about three years.
“The drops have a higher safety profile. There’s much less chance of having adverse reactions because it’s absorbed under the tongue instead of injected into the bloodstream,” said Brookman. Usually, the worst reaction is itchiness around the tongue and mouth or a stuffy nose.
“The drops are really the way of the future for allergies. Allergists in America and Europe have been doing this [treatment] for years,” said Brookman.
Until sublingual allergy drops complete the FDA approval process, healthcare providers cannot bill insurance for them. Patients choose to pay out of pocket for immunotherapy drops because the ease and effectiveness are substantial benefits of this form of treatment.
Shots vs Drops
Once an allergy is diagnosed, if tablets are not recommended, the choice of immunotherapy shots or drops belongs to the patient.
“We like to say the most effective one is the one that will fit your schedule. Both will treat the allergies extremely well over time,” said Brookman.
As mentioned above, shots are usually covered by insurance, and drops are paid for out of pocket by the patient. Brookman adds that many patients find the total out of pocket costs to be about the same for shots or drops, partly because the length of immunotherapy treatment is longer if you’re getting shots.
Whether you opt for shots or drops, at the start of treatment you can keep taking over-the-counter allergy medications to control symptoms until the immunotherapy starts to work. “The further we get along on the shots then we can start to taper down what they’re taking,” said Brookman.
At the end of the three-to-five-year treatment program, you will be tested for allergies again. If there is a 90% decrease in the reaction, your allergist will stop the therapy for a three-month trial period to see if allergy symptoms return. Brookman says 95% of the time patients discover their allergies are completely gone, and can discontinue treatment. “Sometimes it’s a little bit longer. But no one needs to be on immunotherapy forever.”
When to Seek Help for Allergies
If chronic allergies are affecting your quality of life, or if your seasonal allergies are severe, the team at WWMG’s Ear, Nose & Throat clinic can help. Request an appointment today with Amy Brookman, our Allergy specialist. She’ll diagnose the root cause of your allergies and recommend an immunotherapy treatment plan to help you find relief.