Allergy shots or allergy immunotherapy is the only disease modifying treatment for allergy because it can affect the TH-2 biased immune response. Allergy Shots Whereas medication only treats the symptoms. It has been around for over a century and its efficacy and safety have been confirmed in patients with allergic rhinitis and asthma and for the treatment of Hymenoptera (bee) venom. Currently, the routes of administration are subcutaneous and sublingual. SLIT vs. SCIT In addition to these traditional routes, other modes of administration being studied are epicutaneous and intralymphatic.
Allergy shots remains indicated when IgE (allergy) mechanisms are clearly demonstrated by allergy skin testing or allergy IgE blood testing. Currently it is used to treat pollen, dust mites, bee venom allergy and other less studied allergens. The other less studied allergens are animal dander other than cat, molds and work related allergens. Allergy shots for foods seems to be a promising therapeutic approach.
The only standard of care for food allergies is a strict dietary avoidance of properly diagnosed food allergens. Also access to emergency medications such as an Epipen, steroids, antihistamines is mandatory in case of accidental ingestion. Milk, egg, peanut, tree nuts, wheat, soy, fish and shellfish are the most common food allergens. There is a lot of literature on milk, egg and peanut allergy immunotherapy, although they are still in their orphan stages of research. Overall, the results are favorable, although the process is time consuming and adverse effects are frequent. However, desensitization to foods remains an experimental approach and it is not currently recommended for clinical practice. Click on the link below to read more about wheat and peanut immunotherapy studies.
Animal Allergy (Other Than Cat)
Allergy due to sensitization to animal allergens are common. The allergen can be in the urine, saliva and secretions of the animals or dried on fur or bedding. The best efficacy for allergy shots has been shown for cat. Dog allergy shots has been reported in the past as less efficacious. However, a great variability in the quality of commercial dog dander extract has been reported. Since Hollister Steir has produced AP Dog extract, we have seen in our practice great improvements in allergy desensitization.
Allergy shots to other animals that have been done are mouse, rat and rabbit. Approximately 80 percent of patients improved in a small study of those animals. Most of the participants were lab workers who had significant exposure to mouse, rabbit and rats. We have also done allergy shots to parakeet for a patient who was hypersensitive and had one as a pet.
Horse dander may also cause significant respiratory allergy. Small studies for allergy shots to horses have been reported. Approximately 90% of patients had reduced asthma, eye allergy and allergy skin symptoms. We have found it effective in our practice too as well.
Sensitization to fungi (molds) is relatively frequent and it might be a risk factor for asthma. The fungal species most investigated are Alternaria and Cladosporium, particularly in patients with asthma. Patients treated showed improved asthma and nose/eye allergy symptoms. Studies do show improved outcomes to mold allergy shots, although this is a relatively “newer” allergen done for immunotherapy. Most physicians are not informed about the increasing important role of molds as a cause of allergy and particularly asthma exacerbations. The presence of dampness and molds in the human environment is frequent, being traced up to 50% of buildings and the risk of allergy is much higher in damp dwellings. Awareness of the importance of fungal allergy, including Alternaria, Aspergillum and Cladosporium, is low and the lack of diagnosis prevents allergy shots.
These new allergens discussed above for allergy immunotherapy are still in their orphan stages. The rarity of some allergic diseases makes it difficult to study in large trials. Nonetheless, the newer allergens should always be taken into account and if the risk is significant allergy shots or allergy oral immunotherapy should be considered. Always speak to your allergy doctor and discuss what your triggers are. Your allergist can preform allergy testing and allergy immunotherapy will be discussed afterwards.
If you are planning on starting allergy immunotherapy (shots or sublingual), you should only see a board certified allergist or allergy doctor, that have been specifically trained in the treatment.
To read more about allergy shots in general, you can click on the link below.