Immunotherapy

Immunotherapy: Allergen Desensitisation

Allergy management previously always entailed avoidance of the offending allergen in combination with treatment of the symptoms. For example, when asthma is triggered by dust mite sensitivity special mattress covers and low allergy pillows are advised while the coughing and wheezing is suppressed with inhalers etc. However, while such measures and treatments are indeed very effective (and often life-saving) they do not alter your allergic status. In other words you are still allergic to dust mites and still get into trouble if the avoidance measures and treatments are relaxed or stopped. For almost all allergy sufferers this means many years (even a lifetime) of taking nose and chest inhalers and even steroid tablets for severe flare-ups.

Now a relatively new therapy (or rather an old therapy updated) offers the chance to desensitise you to your allergy and may even eliminate your symptoms. Allergen Immunotherapy is where you take exactly what you are allergic to but in a modified form. At Allergy Ireland we use the following licensed Immunotherapies:

  • Grazax (Grass Pollen)
  • Oralair (Grass Pollen)
  • Acarizax (Dust mite)
  • Itulizax (Tree pollen)

Allergen immunotherapy blocks the allergic reaction well upstream of the inflammatory response and may even prevent nasal allergy (rhinitis) progressing to lung allergy (asthma). Moreover its beneficial effect persists long after the end of the course of therapy. It is especially helpful with seasonal pollen hay fever, as well as perennial nose, eye and chest allergy due to a dust mite and pollen combination.

Allergen immunotherapy:

  • Reduces symptoms significantly
  • Reduces nose and chest sensitivity to allergen irritation
  • Reduces the amount of medication needed for comfort and relief
  • Reduces the risk of developing other allergies (especially important in young children with, say a dust mite allergy, where there is concern that pollen or animal hair allergy may also develop in time)

How is immunotherapy administered?

A sublingual tablet is dissolved under the tongue once daily. Treatment may take between 3 to 5 years in the case of dust mite allergy or 3 to 5 seasons for grass pollen allergy. This may sound like a long time but if it significantly improves symptoms, reduces the use of other medicines and possibly even results in a final cure it is worth the time and effort.

Safety

Immunotherapy is considered an very safe treatment option. The initial dose is taken under doctor supervision in the Allergy Ireland clinic. Common side effects which can occur include itching in the mouth, swelling of the lips, abdominal cramps. Rarely, cough, nasal irritation or asthma may be exacerbated. If this does happen please make sure to let us know so that the next dose can be adjusted.

What age is it safe to use immunotherapy?

Grazax (grass pollen) is licensed for use over the age of 5 years.

Acarizax (dust mite) is licensed for use in 12-65 year olds. 

Itulazax (tree pollen) is licensed for use in 18-65 year olds.

Based on our experiences in Allergy Ireland, we would feel that the benefits are most pronounced in young patients.

The Downside

Q: OK, it sounds exciting and a real alternative to drops and sprays and inhalers and anti-allergy tablets. And yes, it does seem to offer some long term solution to what is definitely going to be a long term problem. But are there side issues I should be considering?

A: Absolutely, and here are some problems we have to consider and which we would like you to 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 extra problem rather than solving the existing condition?

If the treatment is going to last 3-5 years, how committed are you (your child) to that length of therapy? If your boy is an obedient 10 year old today could he be a rebellious (and possibly anti-medicine) 15 year old as therapy progresses? If he’s a reasonable 15 year old today can you be sure he’ll be a reasonable 20 year old? Maybe he’ll have run off with an heiress and be living on some tropical island and all your Staloral investment will have been in vain. While this is a tongue-in-cheek scenario it’s important to know how attitudes change with time and maturity. You know your child best so only you would know if these, or other, sorts of issues might be relevant.

Immunotherapy only targets the allergic factor in nose, sinus and chest conditions. Often there are other triggers to allergic ill health. Cigarette smoking, for example. If you smoke forget about immunotherapy, it just won’t work. If your child is a passive smoker the same rule applies. If your agreeable 14 year old teenage girl takes Staloral or Oralair or Grazax without fail every morning but decides to follow the herd and start smoking at 17 or 18 then the benefits of immunotherapy may be lost. The regime demands patience, commitment and attention to other trigger factors to ensure best results. Don’t rush into starting treatment. Consider all the issues mentioned and any others you may think of over and above those above.