Dear Dr. Kagen:
My allergist is encouraging me to receive allergen immunotherapy because he says it will probably be beneficial, but I’m skeptical. I’ve talked to people that have received this therapy, and they say the beneficial results only lasted from 1 to 3 years. Plus, their allergic symptoms initially increased following the administration of the allergen shot, and there’s also the risk of anaphylactic shock.
What’s the reported incidence of anaphylactic shock and adverse reactions?
Running back and forth to the doctor once or twice a week for a sustained period of time for what may be months is also a factor. How often are these appointments going to be, and how long do I have to undergo this therapy?
Is the disruption and time consumption of this allergen immunotherapy going to be worth the result?
Also, there is the monetary factor. My insurance won’t cover because this is a pre-existing condition. Do the results of allergen immunotherapy justify the cost? I’ve asked these questions twice, once of the doctor and once of the PA, and I seem to get vague, non-committal answers like, “The results are different for everybody,” and “It has to do with quality of life.” They say they have no in-patient stats. They say the results of the studies say the immunotherapy lasts 3 to 5 years. What exactly is it that lasts for 3 to 5 years or 1 to 3 years? I understand technically it’s the “beneficial effects,” but is that a 50% reduction of allergy symptoms, a 20% reduction, a 1% reduction? Is there an average?
The PA told me that, in her personal experience, people with severe allergies seemed to get the best results. (I have severe allergies to grasses & weeds, 4s on a scratch test; trees were 2s & 3s; dust, 2, mites 3; and some other stuff too, so I guess I have “severe” allergies.)
So what exactly is the potential benefit? What exactly is the average actual benefit? Is allergen immunotherapy obviously justified, or is it just an overrated treatment?
Can you please help me to better understand the benefits of immunotherapy so that I can make an informed decision?
Thanks for asking about allergen immunotherapy, Jorene.
Allergen immunotherapy, or “allergy shots”, is the only form of therapy available that stabilizes one’s symptoms and prevents the progression of the allergic disease.
Every other form of treatment just “cleans up the mess” after the allergic reaction has already occurred.
Recent studies establish that it also reduces the costs of caring for both adult and pediatric allergy and asthma patients by 40% – 50%.
Patients with allergic rhinitis (hayfever) who receive allergen immunotherapy decrease their risk of developing asthma as well.
The benefits of allergen immunotherapy include a better quality of life with a reduction in allergy symptoms, easier breathing, less need for rescue medications, fewer days missed from work and school and improved school performance.
In order for the allergy injections to work, it is most important that an exact diagnosis is made, and that all relevant allergens that aggravate your symptoms are present in your allergen immunotherapy treatments.
In the Kagen Allergy Clinics, we prepare all of our allergen materials, so we can control exactly what is in our patients’ materials. I believe the essential difference between allergists is their ability to formulate the specific and appropriate treatments for each patient.
The inconvenience of weekly allergen injections is temporary. Once you have reached a therapeutic level of allergen administration, injections can be separated by one or two weeks. In my experience, patients need to receive their injections no longer than every three to four weeks at maintenance levels.
The duration of therapy is specific for each patient. Most patients need to receive allergen immunotherapy for a minimum of three years and some for much longer periods of time.
Since the allergy patient is receiving injections of something they are allergic to, it is possible for an allergic reaction to take place. For that reason, allergy injections should be given in a doctor’s office and the patient should remain in the office for at least 30 minutes afterwards, for if a reaction occurs it’s usually within this time frame.
In our clinics, very seldom do patients require adrenaline treatment after receiving their allergy shots. During the past 30 years, only one of our patients required hospitalization due to an allergic reaction in our office, and it was not even caused by an allergy injection; it occurred in a new patient we were skin testing and she was tremendously sensitive. In experienced offices, allergen immunotherapy is very safe.
Patient selection for allergen immunotherapy is critically important. We recommend immunotherapy for patients who have allergy symptoms in more than one season of the year, provided there is an effective and suitable allergen treatment available. For example, there is no therapeutic allergen extract for ferret or horse dander induced allergies.
If a patient fails to improve after one year of adequate allergen immunotherapy therapy, we discontinue treatments. Approximately 90% of patients improve significantly on this form of treatment.
I hope that this answers your concerns about allergen immunotherapy.
Steve Kagen, M.D.