Immunotherapy

Immunotherapy, can your ‘allergicness’ be altered

Currently allergy management involves avoidance of what you are allergic to combined with treating the symptoms. For example, in asthma due to 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 manoeuvres 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 with special anti-allergy drops and tablets for severe flare-ups.

Now a new therapy (or rather an old therapy updated) offers the chance to significantly reduce your ‘allergicness’ and maybe even completely stop reactions. Immunotherapy is where you take exactly what you are allergic to but in a modified form. At present the most convenient products are drops Staloral (made by Stallergenes) or tablets Oralair (Stallergenes) and Grazax (Alk-Abello) placed under the tongue and held there for two minutes.

In medical jargon, allergen immunotherapy blocks the allergic reaction well upstream of the inflammatory response and may even prevent nasal allergy (rhinitis) deteriorating to lung allergy (asthma). Moreover its beneficial effect persists long after the end of the course of therapy.

Allergen immunotherapy is especially helpful with seasonal pollen hay fever, as well as all year round nose, eye and chest allergy due to a dust mite and pollen combination. Animal hair allergy may be dealt with in this way but I still feel it’s wiser to avoid the animal.

Allergen immunotherapy:

  • Reduces symptoms significantly
  • Reduces the amount of medication needed for comfort and relief
  • Reduces nose and chest sensitivity to allergen irritation
  • 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?

With Staloral there is an induction phase where the dosage of drops is increased every day for 6 days to a maximum strength. This maximum strength is then continuously administered either daily or 3 times a week ongoing. Ongoing may mean between 3 to 5 years in the case of dust mite allergy or 3 (minimum) to 5 (ideal) seasons for grass pollen allergy. This may sound like a very long time to take treatment but if it reduces the use of other medicines, significantly improves symptoms and possibly even induces a final cure it is worth the time and effort (and expense).

(There are precise and exact instructions with the pack presentation.)

With Oralair and Grazax a tablet is placed under the tongue where it dissolves.

Safety

The allergy products used in immunotherapy have been thoroughly tested. Over 12 years, nearly 1 million treatments – corresponding to a total of 500 million doses – of Staloral have been administered. Not one serious, generalised body reaction has been reported. Any side effects reported were minor and of little significance (usually 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?

Staloral is licensed for use in children aged 5 years and over. My own feeling (based on past experience on using injection immunotherapy) is that the benefits are best seen in young patients. Patients 30 to 40 years may achieve results while 40+ such therapy is probably not going to offer any extra benefit compared to standard medicines.

Why recommend immunotherapy?

Because it’s the only therapy that offers the chance to significantly reduce or even stop anti-allergy medicines. More often than not anti-allergy treatments are used daily for years, even for a life-time. Anything safe and effective that might ease that considerable drugs burden is worth considering. The commitment to treatment is vital and this is important to understand as you will be embarking on a minimum of 3 and possibly 5 years of therapy.

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 I consider important and which I’d 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 (but ideally 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 money will have been in vain (unless this heiress offers a few Euros compensation). While this is a tongue-in-cheek scenario it’s important to know how attitudes change with time and maturity. You know your child better than me 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.

In short, immunotherapy is not a cure. The regime demands patience, commitment and attention to other trigger factors to ensure best results. Don’t rush into an order. Consider all the issues mentioned and any others you may think of over and above those above.