IMMUNOTHERAPY

Immunotherapy is a preventive treatment for allergic reactions to substances such as grass pollens, house dust mites and bee venom. Immunotherapy involves giving gradually increasing doses of the substance, or allergen, to which the person is allergic. The incremental increases of the allergen cause the immune system to become less sensitive to the substance, probably by causing production of a “blocking” antibody, which reduces the symptoms of allergy when the substance is encountered in the future. Immunotherapy also reduces the inflammation that characterizes rhinitis and asthma. Before starting treatment, the physician and patient identify trigger factors for allergic symptoms. Skin or sometimes blood tests are performed to confirm the specific allergens to which the person has antibodies. Immunotherapy is usually recommended only if the person seems to be selectively sensitive to a particular allergen.

HOW IMMUNOTHERAPY IS DONE

There are different forms of immunotherapy based on which allergen is being treated:

• Aeroallergens (dust mite, pollen, pet dander, molds): Options include allergy shots, allergy drops or under the tongue allergen tablets

• Venoms: Allergy shots for fire ant, bee, wasp, hornet, or yellow jacket

• Foods: Oral immunotherapy might be an option for select patients. Other treatments such as epicutaneous patches are under investigation.

ALLERGY SHOTS

An extract of a small amount of the aeroallergen or venom is injected into the skin of the arm. An injection may be given once or twice a week for 2-6 months, after which injections can be administered every four weeks. The duration of therapy is usually three to five years, although sometimes longer for venoms.

SUBLINGUAL IMMUNOTHERAPY

Sublingual (or under the tongue) immunotherapy for aeroallergens comes in 2 forms:

• Drops

• Tablets (available for dust mite, some grass pollens, and ragweed)

The first dose is given in the office, and subsequent doses are done at home. All patients undergoing sublingual immunotherapy will be prescribed injectable epinephrine.​

ORAL IMMUNOTHERAPY

For patients with anaphylaxis to certain foods, they may benefit from treatment options apart from avoidance.
In oral immunotherapy, small amounts of the culprit food are ingested daily in increasing amounts. Overtime, patients will be able to tolerate amounts of the allergenic food without causing anaphylaxis.