ALLERGY IMMUNOTHERAPY
DON'T LET SEASONAL ALLERGIES HOLD YOU BACK.
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IMMUNOTHERAPY
Immunotherapy is designed to increase your resistance to the allergens that cause your symptoms. Unlike in Europe where monovalent or single antigen immunotherapy is practiced, in the US generally, we generally practice polyvalent immunotherapy or shots that contain multiple allergens. Allergy shots are also called subcutaneous immunotherapy or SCIT. They are injected just under the skin in the forearm and you are monitored for about 20 minutes thereafter for a reaction. That means we give shots containing multiple allergens under the skin to increase your immunity to allergens you are allergic to. In general, injection with one or two shots once or twice a week is initiated and over months it is decreased from once a week to once every other week and then monthly when maintenance dosing is achieved.
DURATION OF IMMUNOTHERAPY
Allergy Immunotherapy requires a time commitment, but the result is worth the wait! Building up your immunity against allergens and allergies must be done slowly and over a period of 3-5 years so as not to trigger an adverse allergic reaction during treatment. Some patients choose to receive treatment for an even longer period of time because of the effectiveness and relief they experience. The length of time that a patient receives treatment will affect how long the immune system will continue to block the allergens that it was treated for.
TYPES OF IMMUNOTHERAPY
At Texas Sinus, Allergy, Snoring & Sleep Institute, Dr. Umang Khetarpal focuses on 2 main treatments for allergies:
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Injections
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Drops
There are other treatment options including sinus surgery that can help reduce sinus congestion from allergies. It is important to discuss treatment options with an allergy specialist and ENT such as Dr. Khetarpal to receive the best recommendation for treatment.
Injections
The testing gives us the information needed to make up your allergy serum for environmental allergens. We customize treatment sets based on your degree of sensitivity to each allergen. Injecting you with these allergens stimulates your body to produce blocking antibodies to those allergens. If you choose to go on allergy injections, you will be required to come to our office for the administration of the injections with a 20 min wait after the injection. There is a 97% incidence that if you are going to have a reaction, it will occur within 20-30 min of getting the injection.
Drops
Allergy drops or sublingual immunotherapy, also called SLIT, is a relatively new form of immunotherapy in the US. While it has been practiced in Europe and South America for over 30 years, it is more widely adopted in the US now. Drops containing allergens that you are allergic to are mixed in a bottle and placed under the tongue. This is a daily treatment and the duration is 2-3 years as well. There are minimal side effects to date with the most common one being a bad taste.
There are many advantages to taking allergy drops. There are minimal side effects and you do not have to come to the office weekly. Travel is possible while on drops and missing a few days of treatment does not require going back to the original dose of treatment. It is a very convenient form of therapy.
As of now, allergy drops are not covered by insurance carriers because they are not FDA-approved. However, we do believe that it is a matter of time before that happens.
RISKS OF IMMUNOTHERAPY
Either during allergy testing or during shots, an anaphylaxis reaction can occur. Tongue or voice box swelling may occur during this resulting in breathing difficulty. Typically an Epipen shot and steroids with Benadryl may be given right away. If you are on immunotherapy, always carry an EpiPen shot with you for use in an emergency.
MANAGING AND TREATING YOUR ALLERGIES - TIPS FROM DR. KHETARPAL
*Wash all bedding, including mattress pads, in hot water or bleach every 10 days.
* Clean your home. Dust mites are, by most studies, the most common allergen to cause
allergic reactions. Regular vacuuming with a HEPA filter, washing items in hot water, and using
mite-proof casings will reduce these allergens.
* Using HEPA filters in the bedroom, study, or TV room will help reduce pollen and particles
levels.
* Dust mite matter and pet dander hide in fabric, such as curtains, furniture upholstery, carpets,
and bedding. Keeping these clean is important.
* Remove carpeting in your home if possible
* Avoid smoking
* Basements, bathrooms, kitchens, and rooms with reduced ventilation must be well ventilated
to prevent or reduce mold growth.
* Bathe pets once a week to reduce pet dander, and, if possible, keep your pet out of the
bedroom. Wash your hands after petting animals.
* Because chalk can irritate children with allergies, advise the children not to sit too close to the
chalkboard
* Limit the number of indoor plants; mold thrives in potting soil.
* For individuals with food allergies, always read the ingredients before ingesting a new or
packaged food. When dining out, ask restaurants for a list of ingredients or for a meal prepared
without the offending food or additive.
* Nasal steroids (such as flonase or fluticasone, Nasonex, available OTC) are very effective in
improving the nasal symptoms of allergic rhinitis. Non-sedating antihistamines (such as Claritin,
Allegra and Zyrtec (all available OTC) are also effective but less so. Antihistamine nasal sprays
such as azelastine or astepro (available OTC) also reduce symptoms.
* Immunotherapy, such as sublingual immunotherapy (also called allergy drops), or
subcutaneous immunotherapy (also called allergy shots) is very effective in reducing an
individual's allergic reactions over the long term.
* Allergy drops or sublingual immunotherapy is our preferred option, given the flexibility in using
it, more rapid escalation towards maintenance dosage, can be taken with you during travels, no
requirement for weekly office visits, and much less risk of anaphylaxis. Because allergy drops
are not FDA-approved, they are not paid for by insurance carriers. However, drops are very
safe, and increasing research and our own data on them show they are highly effective in most
patients.