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Allergen Immunotherapy

Purpose

Your individualized course of allergy shots (immunotherapy) is designed to decrease your allergic sensitivities. The vast majority of allergic patients (80-90%) will experience substantial reductions in their symptoms over time (months to years). Many also reduce or eliminate the need for other medications. Together with avoidance of offending allergens and medication allergy shots represent one of the recommended treatments for allergic rhinitis, allergic conjunctivitis, atopic dermatitis and asthma. Allergy shots are not useful for food/drug allergies or non-allergic conditions like infections.

Treatment Duration

The length of a treatment course varies on a case by case basis but in general a course requires 3 to 5 years of maintenance treatment for completion. Initially there is a build-up phase where the injections are given more frequently but as the High Dose, or maintenance dose, is reached the frequency of injections may be adjusted. The total duration of therapy can vary considerably from patient to patient. During your treatment you will be re-evaluated frequently by your physician. These visits will occur at least annually.

Schedule of Administration

Your series of injections begins at a low dose selected by your physician based on your skin test results and history. Over time the shots build gradually until you reach your High Dose. This High Dose is called the maintenance dose and you will stay on it for the duration of your treatment course unless it is changed by your physician. Maintenance therapy can be continued if you are pregnant BUT notify your OAAC physician when you become pregnant.

The build-up phase of the allergy shots can occur in different formats. Your physician will help you decide which is right for you. Most common is the weekly building schedule. Various accelerated schedules include: 2 or 3 time a week shots, clusters of several shots given on the same day and finally RUSH therapy where many injections are given on one day and then weekly shots follow until you are at your High Dose. RUSH therapy is associated with significantly more side effects (see below) and is not for every patient. However, it does bring you to the High Dose level in a month rather than slowly over many months. This is an advantage for some patients.

Safety

All allergy shots carry some risks for severe anaphylactic reactions. Therefore the injections need to be administered in a medical facility under medical supervision on a regular basis. Weekly or twice weekly shots from our clinic carry a risk of anaphylaxis of 0.015 to 0.02% of injections compared to nationally published risks of 0.1 to 0.3% of injections. RUSH therapy carries a nationally published risk of almost 40% of shots whereas our RUSH risk is closer to 10% of injections. This marked increase in risk however makes RUSH therapy unacceptable for many patients.

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Don’t Forget the Drinks if you have Food Allergies

Managing food allergies requires constant avoidance of allergens, emergency preparedness and effective communication. Going out to eat with food allergies can be challenging but is completely doable. When it comes to avoiding allergens while out to eat, the focus in the minds of patrons and eating establishments is often the food, but it is important to keep in mind that beverages can contain allergens as well. Outlined below are key points and tips to consider before you take your sips.

Avoid Cross Contact
Remember that allergens can remain in someone's saliva for several hours after eating and for some people even small amounts of an allergen can cause a severe allergic reaction. To prevent the chance of cross contact drink from your own cup and don't share with others around you. Also remember cross contact can occur with drink stirrers, shakers and other utensils used to mix drinks as with condiments like sprigs of mint or slices of fruit.

Be Aware of All Ingredients Added to the Beverage
This is especially true in the case of mixed drinks. For example if you are allergic to dairy and cream is added to your pina colada, then this can cause an allergic reaction. Some drinks contain raw egg whites - the white 'fuzz' of a Pisco sour, for example, is from beaten egg whites. Raw eggs are particularly dangerous in people with egg allergies.

Know What Ingredients Are in the Beverage
The drink itself may have an allergen in it (for example, wheat in beer). Things to consider here are that since alcohol is not regulated by the Food and Drug Administration (FDA), beverage companies that are bottling alcoholic products do not need to follow current labeling laws and do not need to disclose allergens. In fact, many alcoholic beverages do not list ingredients at all. This certainly becomes an issue for those allergic to wheat, rye, and barley as well as those with celiac disease who need to avoid wheat, rye and barley because of gluten. Similar concerns can arise with wine. If ingredients are unclear then consider calling the company for a list of ingredients. Distilled alcohol is a bit less of an issue but still worth discussing with your healthcare team.

Consider Sulfites
Also, keep in mind that sulfites can exacerbate asthma and in rare cases can cause allergic reactions. Sulfites are commonly found in many alcoholic beverages including wine, beer, ciders and drink mixes added to the alcohol.

Know Alcohol’s Effects
Another issue to take into consideration is the effect of the alcohol itself. Alcohol can decrease our ability to make good decisions and communicate effectively. Other things to consider are that alcohol can decrease the threshold level to trigger an allergic reaction, can decrease the time to develop an allergic reaction, and increase severity. However, alcohol itself is an unlikely allergen.

If you have been prescribed an epinephrine autoinjector, remember to carry this with you at all times, even if you're just going out for a drink.

This article is for educational purposes only. Talk to your healthcare provider before any change in food allergy management.

Find out more about food allergies.

The post Don’t Forget the Drinks if you have Food Allergies appeared first on Oklahoma Allergy and Asthma Clinic.

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