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Allergen Immunotherapy

Purpose

Your individualized course of allergy shots (immunotherapy) is designed to decrease your allergic sensitivities. The vast majority of allergic patients (80-90%) will experience substantial reductions in their symptoms over time (months to years). Many also reduce or eliminate the need for other medications. Together with avoidance of offending allergens and medication allergy shots represent one of the recommended treatments for allergic rhinitis, allergic conjunctivitis, atopic dermatitis and asthma. Allergy shots are not useful for food/drug allergies or non-allergic conditions like infections.

Treatment Duration

The length of a treatment course varies on a case by case basis but in general a course requires 3 to 5 years of maintenance treatment for completion. Initially there is a build-up phase where the injections are given more frequently but as the High Dose, or maintenance dose, is reached the frequency of injections may be adjusted. The total duration of therapy can vary considerably from patient to patient. During your treatment you will be re-evaluated frequently by your physician. These visits will occur at least annually.

Schedule of Administration

Your series of injections begins at a low dose selected by your physician based on your skin test results and history. Over time the shots build gradually until you reach your High Dose. This High Dose is called the maintenance dose and you will stay on it for the duration of your treatment course unless it is changed by your physician. Maintenance therapy can be continued if you are pregnant BUT notify your OAAC physician when you become pregnant.

The build-up phase of the allergy shots can occur in different formats. Your physician will help you decide which is right for you. Most common is the weekly building schedule. Various accelerated schedules include: 2 or 3 time a week shots, clusters of several shots given on the same day and finally RUSH therapy where many injections are given on one day and then weekly shots follow until you are at your High Dose. RUSH therapy is associated with significantly more side effects (see below) and is not for every patient. However, it does bring you to the High Dose level in a month rather than slowly over many months. This is an advantage for some patients.

Safety

All allergy shots carry some risks for severe anaphylactic reactions. Therefore the injections need to be administered in a medical facility under medical supervision on a regular basis. Weekly or twice weekly shots from our clinic carry a risk of anaphylaxis of 0.015 to 0.02% of injections compared to nationally published risks of 0.1 to 0.3% of injections. RUSH therapy carries a nationally published risk of almost 40% of shots whereas our RUSH risk is closer to 10% of injections. This marked increase in risk however makes RUSH therapy unacceptable for many patients.

Recent News

REAL-WORLD PRESCHOOL PEANUT ORAL IMMUNOTHERAPY EFFECTIVE AFTER ONE YEAR OF MAINTENANCE
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REAL-WORLD PRESCHOOL PEANUT ORAL IMMUNOTHERAPY EFFECTIVE AFTER ONE YEAR OF MAINTENANCE

The study, published in the AAAAI’s journal The Journal of Allergy and Clinical Immunology: In Practice, reports findings for participants who received a follow-up oral food challenge after one year on peanut daily maintenance.

MILWAUKEE, WI – Data published in The Journal of Allergy and Immunology: In Practice (JACI: In Practice), an official journal of the American Academy of Allergy, Asthma & Immunology (AAAAI), demonstrated that peanut oral immunotherapy (OIT) is effective after one year of maintenance in preschool participants who received a follow-up oral food challenge (OFC).

Preschoolers (9-70 months old) enrolled in the real-world study were administered increasing peanut doses in a clinic every two weeks over 8-11 visits until reaching the 300mg peanut protein maintenance dose. After spending approximately 12 months taking maintenance doses, patients were invited to complete a peanut follow-up OFC.

A total of 164 patients completed build-up and three dropped out of maintenance, leaving 161 patients available for follow-up OFC. A total of 117 of the 161 eligible patients received the follow-up OFC. Among them, 92 (78.6%) were able to tolerate a cumulative peanut protein dose of 4,000mg. A total of 115 (98.3%) tolerated a cumulative 1,000mg dose at follow-up, which would protect against accidental peanut exposures.

“The main takeaway for parents is that in this study, OIT provided protection from accidental exposures for 98.3% of preschoolers,” said Lianne Soller, PhD, corresponding author of the study and University of British Columbia allergy research manager. “These data, in combination with our previous data demonstrating safety of peanut OIT in preschoolers, suggest that this therapy could be considered for this age group as an alternative to the current recommendations to avoid peanut.”

Also of note was that epinephrine use during maintenance dosing remained low with only two participants requiring it, and only 10.5% of participants experienced allergic reactions at all. During the maintenance phase, only one patient needed to go to the emergency department due to an allergic reaction.

“Our study is the first to report on effectiveness of peanut OIT in preschoolers in a real-world setting, as opposed to a clinical trial setting,” said Dr. Soller. “We plan to continue to follow-up with this cohort long-term so we can continue to strengthen and solidify our recommendations regarding peanut exposure and oral immunotherapy.”

You can learn more about the current state of oral immunotherapy at the AAAAI’s website, aaaai.org.

The American Academy of Allergy, Asthma & Immunology (AAAAI) represents allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic and immunologic diseases. Established in 1943, the AAAAI has more than 7,100 members in the United States, Canada and 72 other countries. The AAAAI’s Find an Allergist/Immunologist service is a trusted resource to help you find a specialist close to home.

The post REAL-WORLD PRESCHOOL PEANUT ORAL IMMUNOTHERAPY EFFECTIVE AFTER ONE YEAR OF MAINTENANCE appeared first on Oklahoma Allergy and Asthma Clinic.

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