Allergen Immunotherapy

It’s likely you have patients who have allergies. In the past, you may have referred these patients to a specialist. You may have taken preventive measures to help alleviate their suffering or worsening of symptoms, but if you’re here, you’re probably already aware of the growing allergy crisis and are seeking treatment options to help relieve your patients’ discomfort.

What is Allergen Immunotherapy?

Allergen immunotherapy is defined as the repeated administration of specific allergens to patients with IgE-mediated conditions for the purpose of providing protection against the allergic symptoms and inflammatory reactions associated with natural exposure to these allergens. The exact mechanism of action is not known but may involve an increase in allergen-specific IgG antibodies, a decrease in IgE synthesis, and an alteration in T-lymphocyte activity.

In other words, Immunotherapy is the prevention or treatment of disease with substances that stimulate the immune response. Allergen immunotherapy, sometimes referred to as allergy shots, desensitization, or hyposensitization, is a form of long-term treatment that decreases symptoms for many people living with allergic rhinitis, allergic asthma, conjunctivitis (eye allergy) or stinging insect hyper-sensitivity. 7

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For an in depth look at immunotherapy and the important role primary care practitioners play in the diagnosis and treatment of allergy sufferers

There is evidence that allergen immunotherapy is also effective in treatment of allergic rhinitis, allergic conjunctivitis, atopic dermatitis, and allergic asthma. Download the Allergen Immunotherapy Protocol

How do I know if immunotherapy is right for my patients?

The AllergenScript system will help you determine which patients will benefit most from Allergen immunotherapy. If a patient’s symptoms indicate potential allergies, step one is to test the patient to confirm the allergen trigger.

The AllergenScript test is a safe, easy to administer, needle-free skin test that was designed specifically to be performed in primary care settings. Test results are available within 15-20 minutes, no waiting for lab results, allowing the physician to make an immediate and accurate determination of treatment.

Once a patient is determined to have allergic disease, the physician can immediately determine via clinical guidelines whether the patient can be treated in-house or if they need to be referred to a board-certified allergy specialist.

If the patient can be treated in-house, how is Allergen Immunotherapy delivered?

If it is determined the patient should be treated in-house, there are two methods of Immunotherapy:

  • Sublingual Immunotherapy (SLIT), which involves under the tongue drops twice daily.
  • Subcutaneous Immunotherapy (SCIT); which are injections given weekly, bi-weekly or monthly at the physician office

What do treatment plans consist of?

Treatment plans vary, but generally:

SCIT Immunotherapy

  • Follows initial dosing of short intervals (every 7 days). If no adverse reaction occurs, dosing concentration should be increased .5 to 1 times with each injection.
  • The initial build-up dosing to the intended “therapeutic dose concentration” is followed by a maintenance dosage regimen at 4-week intervals; and is determined by patient tolerance, and relief of symptoms.
  • Length of therapy varies from 3 to 5 years.
  • The progress of the patient should be reviewed at regular intervals by the physician approximately once every 12 weeks.
  • Progressive improvement may be observed over the first 2 to 3 years of treatment.
  • Discontinuation of therapy may be considered after the 2 to 3-years of treatment compliance.
  • The risk of relapse must be weighed against patient preference for continuation of therapy.

SLIT Immunotherapy

  • Patients take allergen prepared drops twice daily under their tongue, in the morning and the evening, for a period of 2-5 years.
  • Initial improvements have been reportedly encountered as early as 90-120 days of treatment.
  • The drops should be held under the tongue for two minutes. It is important the drops be absorbed into the immune system before swallowing.

 

What is the difference in SCIT & SLIT?

While both treatments are proven effective, over the past twenty years, there have been a multitude of studies documenting the effectiveness of SLIT. SLIT consistently showed a significant reduction in both allergy symptoms and necessary use of rescue medication (Canonica et al. 2014). Some patients also report noticeable relief of allergy symptoms as early as 90-120 days into immunotherapy treatment.

Some important things to consider:

  • The physician should review the progress of the patient at regular intervals.
  • Progressive improvement may be observed over the first 2 to 3 years of treatment.
  • Discontinuation of therapy may be considered any time after the 2 to 3-year trial.
  • The risk of relapse must always be weighed against patient preference for continuation of therapy.

 

The fact is, there is a growing crisis in the U.S. Allergic disease is increasing and there aren’t enough allergists to keep up with the demand for diagnosis and treatment. Primary care providers and other non-allergist physicians are the first point of contact for allergy sufferers. It’s more important than ever before to be able to diagnose and treat your patients who are suffering from allergies.