By our Smarty friends at Charlotte Eye Ear Nose & Throat Associates
What are allergies?
Allergies are due to your immune system over reacting to harmless substances in the environment. When you breathe in a substance such as ragweed, your immune system perceives it as something harmful and causes your nose to run and sneeze in an attempt to get the ragweed out of your nose.
What is immunotherapy?
By giving you small amounts of allergens (i.e. the substances to which you are allergic), immunotherapy attempts to alter your immune system so that it no longer over reacts to those harmless substances. Therefore, immunotherapy is an allergy therapy of the immune system.
What are the advantages of immunotherapy?
Medications are simply treating the symptoms associated with allergies, while immunotherapy is addressing the underlying cause of the problem. Instead of just putting a band-aid on the situation, immunotherapy holds the potential of providing more long-term control of allergy problems. The vast majority of patients, but not all, need less medication and get more relief of symptoms than with medications alone. After being on immunotherapy for a few years, most patients can stop it without having their symptoms redevelop.
How do I know if immunotherapy is a good choice for me?
Immunotherapy is appropriate if your allergy symptoms are severe and/or frequent, and if they persist despite the use of avoidance measures and medications.
Immunotherapy is not an option if you are taking a beta blocker medication. It should also be avoided if you have severe or unstable asthma, a history of anaphylaxis or serious cardiac issues. During any pregnancy, you can continue maintenance immunotherapy but no changes should be made with it.
Is immunotherapy safe?
Immunotherapy delivers substances to which you are allergic. Therefore, you can have a potentially life-threatening systemic reaction, called anaphylaxis, which results in breathing difficulties and worrisome lowering of your blood pressure. This type of reaction is rare and should respond to prompt medical attention. More minor systemic reactions (ex. headache and nausea) and local reactions (ex. swelling and itching) can also occur. Safety precautions require that you have an auto-injector of epinephrine (EpiPen or Auvi-Q) and someone else around while administering immunotherapy.
What types of immunotherapy are available?
The three types of immunotherapy are:
1. Allergy shots (subcutaneous injections)
2. Allergy tablets (sublingual prescription tablets)
3. Allergy drops (sublingual custom-made drops)
Sublingual refers to placement of the tablets or drops underneath the tongue. Sublingual immunotherapy can be done with FDA-approved prescription tablets or custom-made allergy drops.
Allergy Shots (Subcutaneous Immunotherapy)
What is involved?
Allergy shots involve injecting substances under the skin to which you are allergic. It requires a build-up phase during which the strength of the shots is gradually increased. During the build-up of your shots, you will need to come to one of our offices or to another physician’s office at least every ten days for an injection. You can actually come as often as twice a week so that you reach your maintenance level faster. In order that we can promptly treat any systemic reaction, you must wait in our office 20 minutes after every build-up shot. On average, 30 or more visits over a few months time are required to complete build-up. Once maintenance immunotherapy starts, you will continue to receive injections at that dose every 1-4 weeks for the next 3-5 years. Although you can continue to receive your shots in our office, you may do maintenance immunotherapy at home as long as you do not have severe asthma or a history of anaphylaxis.
What are the advantages?
Allergy shots have been around the longest and are the method that has been studied the most. It is likely more effective and reliable than sublingual immunotherapy. Numerous inhalant allergens can be treated, including pollens, dust mites, animal dander, molds and cockroach. The injections are FDA-approved and covered by most insurance plans.
What are the disadvantages?
Allergy shots are not as safe as sublingual immunotherapy. Although still rare, the risk of a systemic reaction is greater with allergy shots. In addition to safety issues, subcutaneous immunotherapy is less convenient and more painful.
Allergy Tablets (Sublingual Prescription Tablets)
What is involved?
Allergy tablets are obtained from your pharmacy like other prescription medicines. Currently, tablets are available for grass pollen (summer season) and ragweed pollen (fall season). You begin using them on a daily basis 3-4 months before that pollen season and continue during that season for a total of approximately 6 months out of the year.
What are the advantages?
Tablets are an especially good option if your symptoms are substantially worse in the summer or fall. They have been studied in well-designed trials and the proper dose has been determined. They are FDA-approved and covered by most insurance plans. No build-up is required. Systemic reactions are exceedingly rare. Only the first dose is administered in the office and the rest are done at home.
What are the disadvantages?
Tablets are only available for grass pollen and ragweed pollen at this time. The other things to which you are allergic will not be treated. Furthermore, the cash price for the tablets is expensive. Although covered by most insurance plans, the co-pay may be high.
Allergy Drops (Sublingual Custom-made Drops)
What is involved?
Allergy drops are made from the same liquids used for allergy shots. Instead of being injected, they are held under the tongue for two minutes and then swallowed. The first dose is given in the office, while the short build-up phase actually occurs at home. The inhalant allergens that can be treated include everything that subcutaneous immunotherapy treats except for mold, cockroach and certain animals. As with allergy shots, each vial is custom-made to match your sensitivities. Unlike with sublingual tablets, the drops are used year-round.
What are the advantages?
Allergy drops at the proper dose may be as nearly as effective as allergy shots but without the discomfort and inconvenience. They are also safer than allergy shots. Drops can treat more allergens than prescription tablets.
What are the disadvantages?
The proper dose of allergy drops has not been as well established as with allergy shots and tablets; therefore, their efficacy is less certain than the other methods. In addition, the amount of allergen placed in the treatment vial is much more than with allergy shots. The volume required limits the number of allergens that can be treated and increases the cost of the treatment. Finally, the liquid being used is approved by the FDA to be injected under the skin but not to be placed under the tongue. Since sublingual allergy drops are not FDA-approved and are considered to be investigational, insurance companies do not pay for them. Payment is out-of-pocket and may be up to $100 each month.
Conclusion
Immunotherapy is an excellent option for certain allergy patients due to its efficacy and its treating the underlying cause of the allergic process. Before proceeding with this treatment, you should take into consideration that not all patients get improvement, that a small risk of anaphylaxis or other negative reaction exists and that a long-term commitment is required. Immunotherapy is a worthwhile consideration for patients with severe or year-round symptoms, especially if medications are not providing adequate relief. The options of subcutaneous immunotherapy, sublingual prescription tablets and sublingual allergy drops provide various advantages that should fit most patients’ needs.
We are well aware of how bothersome allergy symptoms can be and how they can impact your quality of life. We look forward to working with you on finding the best treatment regimen that provides you adequate relief. ~CEENTA
Charlotte Eye Ear Nose & Throat Associates
6035 Fairview Road
Charlotte, NC 28210
704-295-3000
Click here for locations.
You can find CEENTA on facebook, twitter, blog & youtube.
