(Allergy
shots)
This information is about Allergy Immunotherapy, or Allergy Shots
Allergy shots are a means of
reducing the symptoms of allergic rhinitis (hayfever, sinusitis) and asthma, and
in some cases reversing the allergic process. If started on a timely basis, they may also be effective in
preventing asthma. Most patients
choose to treat their allergic symptoms by avoiding the allergy triggers and/or
with medications (nose sprays, pills, etc.) but some find this too difficult,
costly, and tedious over many years. Some patients simply do not like to take
medications or become frustrated because medications do not alter the course of
allergies over time. The
allergy injections are then the preferred alternative.
It
is a method that has been used for 80 years and, in recent years, improvements
in the science of allergy have made this technique even more effective.
The
following will tell you more about Immunotherapy.
Immunotherapy is appropriate for patients who have allergy symptoms lasting longer than six (6) to eight (8) weeks each year. It is also helpful for asthma, insect allergy, and chronic sinusitis. Immunotherapy is not recommended for food allergies. It is not proven useful for less well-defined areas such as intestinal and emotional problems, arthritis, headaches unrelated to sinus problems, or hives.
How Does It
Work?
Immunotherapy
is a process in which an allergic patient can become desensitized to those
pollens and inhalants that trigger allergic rhinitis (nasal congestion),
allergic conjunctivitis, asthma and insect reactions. Small doses of the
actual allergic substance are injected weekly.
Each week the dose is increased. Gradually
a protective antibody known as Immunoglobulin G (IgG) is formed to block the
allergic reaction. When someone has
allergy, they have high levels of the allergic antibody, Immunoglobulin E (IgE),
in their blood. This IgE is
activated by the allergen (dust mite, ragweed, cat, etc.), and it attaches
itself to “mast” cells that release histamine.
The histamine causes swelling and congestion.
It can cause a tightening of the airways to create asthma.
The change induced by immunotherapy is gradual. Many patients notice an improvement within six (6) months at which time the patient should schedule a 6-month evaluation appointment. Progress is evaluated every six (6) months to one (1) year. Immunotherapy does not work in about 5% of patients who were correctly diagnosed to have significant allergies.
A two (2) year period is usually
adequate to assess the success of treatment.
If high doses of treatment have been achieved, one should notice a
significant improvement in symptoms.
At year 4 or 5, a trial of discontinuing treatment is often attempted. After immunotherapy is stopped symptoms may return at a rate of 5% in the first (1st) year, 10% in the second (2nd) year and up to 35% in the third (3rd) to fifth (5th) years.
Allergy shots are not started for a woman during
pregnancy, though there is no medical reason not to do so.
The beginning of immunotherapy has the most allergic reactions to the
shots (see reactions to shots). If
a woman has been receiving immunotherapy and becomes pregnant, she
may safely continue the shots during the
pregnancy. Immunotherapy has been
used for eighty (80) years and does not harm the baby.
There
are two (2) kinds of reactions to the allergy shot: Local and Generalized
(Systemic).
***Local: Reactions occur
at the site of the injection on the arms (where the shot was given).
Redness & itching are
frequent and are not a reason to hold or decrease the dose.
Swelling or a lump that are irritating are reasons to hold or
decrease the dose. This might occur
in the office during the 20-minute waiting period or at home over the 24 hours.
Patients are asked to tell the doctor or nurse before the next injection
about any swelling. We want to know
how large it is…Is it the size of a
dime, nickel, quarter, half-dollar or larger?
We can adjust the dose of future injections.
An ice pack and an antihistamine, such as Chlortrimeton or
Benadryl, can be used to reduce any swelling.
Patients are asked to call the office during office hours to report these
reactions.
***Generalized (Systemic): Reactions
occur when there is any chest tightness,
breathing difficulty, throat or lip swelling, hives, dizziness or an overall
feeling of warmth in the face and body.
This usually occurs in the first 10 minutes after the injection but can
occur over the first hour. This is
a strong reaction, not a minor feeling, which sometimes starts with a general feeling of itchiness.
Other times it starts with a tickle
or tingling in the throat. One
should return to the office during office hours or go directly to the emergency
room for evaluation and treatment of this reaction. If someone else can
drive you, this would be best. Patients
are requested to have an antihistamine (available from the nurse or at the desk)
with them in the glove compartment of their car.
They should be replaced every 6 months.
If any other physician wants to
put you on any of the following medications which all contain a family of drugs
called Beta-Blockers, it is important
to notify him/her that you are on immunotherapy and have been told you are not
supposed to take them.
***If you are currently taking a Beta-Blocker, please notify you doctor
or a nurse. There is some
evidence that patients who are taking these medications are more likely to experience reactions or more severe allergy symptoms.
Also Beta-Blockers can interfere with epinephrine (adrenaline) which is
the most important drug used to treat severe reactions to immunotherapy.
The following is a list of Beta-Blockers
used to treat high blood pressure:
Betapace (Solalol)
Biocadren (Timolol)
Brevibloc
Cartrol (Carteolol)
Corzide (contains Nadolol)
Corgard (Naldolol)
Inderide (contains Propanolol)
Inderal (Propanolol)
Kerlone (Betazolol)
Lovatol (Penbutolol)
Lopressor (Metoprolol) (Toprol)
Lopressor HCT (contains Metoprolol)
Normadyne (Labetolol)
Normozide (Alpha, Beta)
Sectral (Acebutolol)
Tenoretic (contains Timolol)
Tenormin (Atenolol)
Trandate (Labetolol)
Toprol XL (Metoprolol)
Zebata (Bisoprolol)
Visken (Pindolol)
Ziac (contains Bisoprolol)
Intra-ocular Beta-Blockers (eye
medications) include:
Betagen (Levobulol) Betatopic (Betazolol)
Timoptic (Timolol)
Betatopic S