Allergy Season Descends Upon Weary Sufferers
By RICHARD COPELAND • APR 12, 2019
Spring is in the air and so is pollen, mown grass, molds and spores. Idaho Matters talks with Dr. Charles “Chip” Webb of The Allergy Group about using immunotherapy to treat allergies.
A natural, proven cure for allergies.
Allergen Immunotherapy (allergy shots) is a safe and effective treatment program designed to reduce allergic sensitivity to environmental substances (allergens like dust mite, mold, animal dander and pollens). Extracts of these substances are injected over a period of time. These extract mixtures are basically vaccines that build your immunity and teaches your immune system to not react to these normally harmless substances. They do not contain any drugs. They are just a combination of proteins that make up the allergens and are safe for children and adults.
The decision to start allergen immunotherapy is based on an individual’s symptoms and allergic sensitivities. Immunotherapy is generally a long term cost effective treatment in managing your allergic sensitivities. The goal is to eventually make patients symptom free with little or no use of medications while being maintained on allergy shots. It is 75-80% effective when used in the appropriate patient with the relevant allergen at a sufficient dose.
Immunotherapy relieves nasal and lung symptoms, decreases the use of medications, improves the quality of life and may prevent the onset of asthma or “atopic march” in children. It is also helpful for those who would prefer a natural therapy that intervenes in the progression of allergic illness, as opposed to medications that may only temporarily relieve symptoms.
What is the course of Immunotherapy?
Injections begin once or twice weekly with weak extract solutions, advancing to shots of progressively stronger extract solutions. The idea is to reach a standard extract concentration you are able to tolerate. This is called the “maintenance” dose. Most patients reach “maintenance” dose at 3 – 6 months, at which time the injection frequency reduces to every two to four weeks, depending on how the patient is responding. Most patients are treated for three to five years, although it can be continued for longer periods as desired by the patient.
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How does immunotherapy work?
The extract vaccine “trains” the immune system to not to respond to an allergen (eg. pollen, dust. animal dander, venom, etc.). One of the several ways that the allergen immunotherapy works is by stimulating the production of “blocking” antibodies by the immune system.
What is my extract made of?
During your visit, you were tested to, and noted to be allergic to specific allergens. The physician decides which allergens are put into your extract, and in what concentration they should be. A board certified allergist has a specialized training and experience to write allergen immunotherapy. Every individual’s extract are unique to them.
Immunotherapy for foods is not currently recommended, as safety and effectiveness have not been shown in scientific studies.
Where is the site that I get my injection?
The injections are given subcutaneous in the outer aspect of the upper arm.
What should my arm look like after the injection?
You are to expect your injection site to become mildly red, swollen, and itchy. This is a normal reaction. If it becomes the size of a silver dollar and does not go away with 24 hours, let the nurse know BEFORE you get the next shot.
The discomfort can be reduced by taking an antihistamine prior to the injection. Placing an anti-itch remedy on it, and applying ice to the area will also help. The nursing staff can help.
What do you do after your injection?
For your safety, wait for 20-30 mins in the office. Report back to the nurse when your time is up so that the injection area can be assessed. PLEASE DO NOT LEAVE THE OFFICE PREMATURELY.
Should you fall ill, itch in places other than your arm, have trouble breathing, tightness in your chest, dizziness, or increased hayfever or allergy symptoms, PLEASE NOTIFY THE NURSES IMMEDIATELY.
If you develop a generalized reaction after you leave the office, be sure to come back or call for advice. If we are unavailable, please go to the nearest urgent care centre, emergency room, or call 911.
Avoid strenuous activity following your injection for one to two hours.
How long does it take for immunotherapy to work?
Everyone is different, but the closer you get to your final “maintenance” dose, you should start feeling the effect. Usually 6-12 months. However, if you do not feel better in 18 months, your physician will either revise your extract or stop allergy shots.
Can I take my extract to another doctor's office?
Yes, if it is agreeable to your physician. Please ask your physician before you take your extract to them, some physicians feel uncomfortable giving allergy shots due to the risk of allergic reactions.
The same rules apply for you when getting your injections in another office. Waiting 20-30 minutes after your shot, and checking with the nurse before you go, so she can document any reaction.
Please keep your extracts cold during transfer. Do not freeze or expose to excessive heat, as this could ruin them.
Obtain an appointment with your doctor for a recheck appointment when you reach 0.25 ml of your final vial. Do not wait till the vial is empty, because it could take up to 4-6 weeks to obtain another. The appointment is to evaluate your responses to your immunotherapy before another bottle is mixed.
You should always bring your shot record and extracts to your appointments.
When you need a refill from your doctor’s office, please fax us your shot record.
Extracts will expire one year from being made, and can lose up to one half of its potency. If this has happened, you should have it replaced.
What is a systemic reaction?
When more extract is absorbed into your system that your body can tolerate at that time, an antibody response and allergic symptoms are triggered. Being late for your injection or receiving your injections sporadically may increase your risk. Also exercising vigorously after your injection can cause this.
Patients who have ASTHMA are at greater risk, especially if their asthma is not under control. If your asthma is not well controlled (e.g. minimal use of albuterol, no nighttime symptoms, good exercise tolerance), please let us know.
How do you treat a systemic reaction?
If you are having a systemic reaction, notify our nurse, our office, or go to the nearest urgent care, or emergency room or call 911, if our office is closed.
You will probably be given an injection of epinephrine intramuscularly.
You may also receive Benadryl (or an alternative antihistamine), by mouth or by injection. A person should not be allowed to drive if they have taken Benadryl or other over the counter antihistamine because of possible sedation/impairment.
Reactions coming on after a lapse of several hours are usually not as dangerous as immediate reactions. Most reactions occur within 20-30 minutes of the injection. All reactions are treated the same.
Allergic or other symptoms that occur 24 hours or more after the injections are usually not due to the injection.
Can I take allergy and asthma medications while receiving allergy shot?
YES. It often takes 3 to 12 months before one notes improvement of allergy symptoms on Immunotherapy, and use of over-the-counter or prescription allergy medications are often needed. There is no interference with your medications and the allergy injections. Overtime, you should see a decrease need for your medications. Always talk with your physician before reducing any medication.
What if I become pregnant
Allergy shots are believed to be safe during pregnancy. Please notify us as soon as you are aware. It is not known whether it is safe to advance the dose of Immunotherapy during pregnancy. However, women on maintenance therapy can very safely be continued on injections.
Immunotherapy will not cause or prevent allergies in your baby. Continuing injections during pregnancy can decrease your need for other allergy medications.
Why can't I give injections to myself at home?
Allergy Injections contain potent doses of allergens to which you are allergic. The potential exists for you to have a serious allergic reaction to the shot. Therefore for your safety, your injections must be given in a facility where emergency treatment can be given.