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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.

Recent News

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Not a Cold. Not the Flu. It’s Cedar Fever! Who Knew?

Runny nose, coughing, watery eyes – These are the symptoms Tess (not her real name) just couldn’t seem to shake.

The congestion set in after raking leaves.  Her first thought was, “Wow, I have caught a cold.”

But those pesky cold symptoms lingered.  She worried that perhaps she had contracted Covid, as some friends had tested positive for it recently. She felt fine but tested anyhow. Five negative Covid tests later, she was finally convinced it was not Covid.

So, it was not Covid. It was not a cold, and it was not influenza either. What was it?

It turns out the culprit was not a virus at all.  Tess was suffering from something called Cedar Fever.

“Cedar Fever is not really a fever and it is not a virus,” said Maya Gharfeh, MD, FACAAI, FAAAAI. “It is an allergic reaction to pollen from cedar trees, which do grow in abundance in this state and region. For some, the pollen triggers an allergic reaction.”

Most people worry about allergies in the spring and summer, but for some people, like me, allergies can also occur and sometimes be severe in the winter months too.

Cedar Fever

If you live in Oklahoma, Texas, Arkansas or Missouri or somewhere where these trees are common and have a sensitivity to the pollen, you may notice seasonal allergy symptoms from these trees in the winter months.

Millions of cedar trees release large amounts of pollen each year, with pollen production typically reaching a peak in mid-January.  Tree experts know that when it is dry and windy, pollen cones open and release pollen grains. Some people have even captured video and pictures of the pollen clouds blowing off trees. 

What Are the Symptoms of Cedar Fever?

Dr. Gharfeh explained cedar fever is often confused with a cold or flu because of the time of year when it is most prevalent.

Cedar Fever symptoms are like many common allergy symptoms, and may include a runny nose or nasal congestion, itchiness, and sneezing. As the name suggests, some people may notice a warmer body temperature as part of their symptoms.

“We are talking about a mildly elevated body temperature or feeling slightly warm,” Gharfeh stressed. “If you are experiencing a high fever, it is likely that it is something more than allergies and you should see a primary care provider if those symptoms don’t fade.”

Here are a few other symptoms that sometimes occur with Cedar Fever:

  • Sore throat
  • Coughing
  • Difficulty smelling
  • Plugged ears
How Do You Treat Cedar Fever?

Cedar fever should not put you at risk for any health complications, but the symptoms can be uncomfortable.

“As with so many allergies, the appropriate treatment depends upon the patient and the severity of his or her symptoms,” Gharfeh explained.

Common treatments at home may include:

  • Prescription medications
  • Over-the-counter antihistamines
  • Over-the-counter medications

“For some simple over-the-counter medications are sufficient, but if you find that those medications are not enough, it might be time to talk with your doctor or an allergy specialist,” Gharfeh said. “At the Oklahoma Allergy and Asthma Clinic, we have 100 years of experience helping people navigate life with allergies. We are able to help determine the best treatment for your allergies, which may include stronger prescription medications.”

Prevention of Cedar Fever

Gharfeh explained that for those most susceptible to Cedar Fever, avoiding pollen as much as possible can help.  Here are a few strategies that may help:

  • Avoid outdoor activities when tree pollen counts are high
  • Close windows and change air filters often to reduce pollen levels in your home
  • If you need to do yard work, wear a mask to reduce exposure to cedar pollen
  • Vacuum and clean your home regularly to reduce indoor allergens

Tess has learned to watch the pollen counts displayed daily by the official Oklahoma Allergy and Asthma Clinic website, taking precautions when the tree pollen counts elevate, especially to medium (yellow on the graph) or higher.  The clinic’s pollen count is posted daily Monday through Friday and can be found here: https://oklahomaallergy.com/allergy-report/

With a simple pollen count check daily and some allergy medications, Tess finds she is better able to maneuver Cedar Fever season.

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Oklahoma Allergy and Asthma Clinic celebrates its 100th Anniversary this year. Founded in 1925, the clinic has a century of patient-focused, state-of-the-art allergy and asthma care. Today, the clinic is home to 13 allergy and asthma specialists, caring for tens of thousands of patients a year from across Oklahoma, the region and nation.  OAAC also has earned the Better Business Bureau’s Torch Award for Business Ethics, the Oklahoman’s Community’s Choice Award for Top Allergy Clinic, 405 Magazine’s Best OKC Allergy Clinic and the Journal Record’s Reader’s Rankings Award, among others. In addition, the clinic remains a staunch supporter of the community through organizations such as Allied Arts, United Way, the Oklahoma City Philharmonic and Museum of Art, Ronald McDonald House Charities of OKC, Toby Keith Foundation, Positive Tomorrows and more.

The post Not a Cold. Not the Flu. It’s Cedar Fever! Who Knew? appeared first on Oklahoma Allergy and Asthma Clinic.

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