Immunotherapy: Allergen Desensitisation
Allergy management has always involved a combination of allergen avoidance measures and medications. However, while such avoidance measures and treatments may be effective they do not alter your allergy itself. This means many years or even a lifetime of taking anti-allergy tablets, sprays and inhalers. Immunotherapy offers the chance to target the root cause of your symptoms by inducing tolerance and therefore long term relief from your allergy symptoms.
What is Allergy Immunotherapy?
Allergy Immunotherapy (AIT) is a desensitisation treatment course which works by gradually retraining your immune system to develop tolerance to the culprit allergen. Through controlled exposure to tiny amounts of the specific allergen you're allergic to, your body learns to tolerate it rather than reacting defensively. This process aims to "switch off" your allergic response over time, leading to significantly reduced or even eliminated symptoms.
Allergy Immunotherapy (AIT) is available in oral sublingual forms (SLIT) and in subcutaneous injections (SCIT) but in Ireland we primarily use the oral sublingual forms. The treatment duration is approximately 3-5 years but significant improvements are expected within the first year. The results typically last for life.
Which Allergies can Immunotherapy be used for?
At Allergy Ireland, our doctors use the following oral licensed Immunotherapies (SLIT):
What Medical Conditions is Immunotherapy be used for?
Immunotherapy can be used to prevent the symptoms associated with grass pollen, tree pollen and house dust mite allergy. This includes:
- Allergic rhinitis (Nasal Symptoms)
- Eye symptoms (allergic conjunctivitis)
In susceptible individuals it can also prevent pollen or house dust mite induced exacerbations of:
How does Allergy Immunotherapy work?
Allergies are characterised by a Th2 (T-helper cell 2) immune response involving an environment rich in IL-4 and IL-13 which induce IgE production from B cells. Allergen specific IgE then attaches to mast cells and basophils which primes them for activation in the event of future exposures to the specific allergen. This is referred to as primary sensitisation.
Immunotherapy is thought to work through the induction of specific IgG antibody's which compete with the specific IgE antibody's responsible for potentiating the allergic immune response. Immunotherapy also increases the number of allergen specific T regulatory cells and IL-10 which modulates IL-4 production and mast cell activation. These effects begin within 4 weeks of starting treatment and continues to increase during the treatment course.
What age groups can use Allergy Immunotherapy?
Immunotherapy is very effective in those under the age of 40 but its efficacy is reduced in older people.
- Grazax (grass pollen) and Oralair (grass pollen) are licensed for use from 6 years of age.
- Acarizax (dust mite) is licensed for use from 5 years of age.
- Itulazax (tree pollen) is licensed for use from age 18 years.
How is Allergy Immunotherapy carried out?
- Skin Prick Allergy Testing is carried out to identify the culprit inhalant allergy.
- The first dose is taken under medical supervision. A sublingual tablet is dissolved under the tongue.
- Subsequently, the patient takes one tablet daily with annual review here at the clinic.
- The treatment duration is typically 3 to 5 years but improvements are expected within the first 6-12 months.
What are the advantages of Allergy Immunotherapy?
- It provides long term and even lifelong symptom relief.
- Reduces nose, eye and chest sensitivity to allergic irritation.
- Reduces or eliminates the need for medication.
- Allergen desensitisation is not a drug and can therefore be continued during pregnancy.
- Grazax is available on the drugs payment scheme. Acarizax is currently being considered for inclusion.
Immunotherapy Safety and Efficacy
- Safety: Sublingual Immunotherapy (SLIT) is considered a very safe treatment. It has a well-established safety profile when administered correctly under medical supervision. The first dose is taken under medical supervision in Allergy Ireland due to the very small risk of an allergic reaction. The rest of the treatment course is taken at home with annual review at the clinic. Most side effects are minor and short lived (e.g. mouth itching, swelling of the lip). These symptoms are almost always prevented by using a daily anti-histamine for the first 4 months of treatment. It is uncommon for pre-existing allergic rhinitis, asthma or eczema to be exacerbated by immunotherapy. A reduction in dose in these cases usually suffices and allows the treatment to continue.
- Efficacy: It is highly effective for the vast majority of patients, significantly reducing allergy symptoms, medication use, and improving overall quality of life long after treatment stops.
Contact Us to Schedule Your Consultation
If hay fever symptoms impact your quality of life, schedule an appointment for assessment and personalised treatment,
Contact us today to arrange your appointment with one of our specialist allergy doctors.
Additional Considerations before starting Immunotherapy
It sounds exciting and is a real alternative to drops, sprays, inhalers and anti-allergy tablets. And yes, it has the potential to provide a long term solution to be a long term problem. But there are some side issues that you should first consider.
- How good are you (your child) at following daily routines with medicine? Is it a battle? By starting another daily therapy is there the possibility you’re adding an additional problem?
- If the treatment is going to last 3-5 years, how committed are you and your child to that length of therapy? If your son is an obedient 12 year old today could he be a rebellious and possibly anti-medicine 15 year old as therapy progresses? It is important to consider how attitudes may change with time and maturity.
- Immunotherapy targets the allergic factor in nose, sinus, skin and chest conditions. However, sometimes there are other triggers in these conditions. For example, smoking can aggravate rhinitis symptoms so if you don't stop smoking this will reduce the overall impact of using immunotherapy.
Our doctors ensure that before rushing into starting treatment we consider all of the issues outlined above so that you make an informed decision that's right for you.
Further Information