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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.

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Stinging Insect Allergy Can Ruin Outdoor Activities
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Stinging Insect Allergy Can Ruin Outdoor Activities

When most people get stung by an insect, the sting site gets red, swells and itches. However, for those who are allergic to insect stings, their immune system overreacts to the venom in the sting. For some, a sting might be life-threatening. The reaction – anaphylaxis – is a medical emergency and could be fatal. Symptoms might include two or more of the following – itching and hives, swelling in the throat or tongue, difficulty breathing, dizziness, stomach cramps, nausea or diarrhea. Severe cases could bring a rapid blood pressure fall resulting in shock and loss of consciousness.

“If you’ve ever had a reaction to a sting, you may be allergic,” said OAAC’s Board-Certified Allergist Dr. Dean Atkinson. “If you’ve had an anaphylactic reaction, you should ask for a referral to an allergist to learn how to stay safe in the future.”

Indentifying Stinging Insects

“If you do get stung and have a reaction, pay attention to what the insect was so you can tell your allergist,” Dr. Atkinson said.

Honeybees and bumblebees only sting when provoked. Africanized honeybees also known as killer bees have been found in the Southwestern U.S. are more aggressive and may sting in swarms.  Domesticated honeybees live in man-made hives. Wild honeybees live in colonies or honeycombs in hollow trees or building cavities.

Paper wasps have nests made of a paper-like material that forms a circular comb of cells which open downward. Nests are often located under eaves, behind shutters, or in shrubs or woodpiles.

Yellow jackets have nests made of a paper-mache type material and are usually underground but can also be found in frame building walls, masonry cracks or woodpiles.

Hornets are usually larger in size than yellow jackets. Their nests are gray or brown, football-shaped and made of a paper material similar to yellow jacket nests. Hornets’ nests are usually found up in trees and shrubs, on gables or in tree hollows.

Fire ants build nests of dirt in the ground – sometimes the nests can be 18 inches tall in the right kinds of soil.

“Preventing stings is of upmost importance,” said Dr. Atkinson. “If you find a nest around your home, you should call an exterminator to have it removed.”

Insects usually sting when their homes are disturbed. If you encounter stinging insects flying around you, remain calm and move away. Avoid wearing brightly colored clothing and perfume outdoors.  The smell of food attracts insects. Be extra careful when cooking, eating or drinking sweet drinks like soda or juice. Insects can crawl inside straws or canned drinks. Keep food covered until eaten. Wear closed-toe shoes outdoors and avoid going barefoot.

Treating Stings

If the insect stinger is in your skin, remove the stinger within 30 seconds to avoid receiving more venom. A quick scrape of your fingernail will remove the stinger and venom sac. Avoid squeezing the sac – this will force more venom through the stinger and into your skin.

“Raise the limb and apply a cold compress to reduce swelling and pain,” Dr. Atkinson said. “Gently clean the area with soap and water to prevent secondary infections. Don’t break any blisters. You can use topical steroid ointments or oral antihistamines to relieve the itching.”

Dr.  Atkinson adds that if swelling progresses or the sting site seems infected, contact your physician.

“If you are severely insect-allergy allergic, carry auto-injectable epinephrine,” Dr. Atkinson said.  “Learn how to use it and keep it with you at all times. Also, some patients especially with frequent exposure to the outdoors start venom immunotherapy (allergy shots). It reduces the risk of a future severe reaction to less than 5 percent.”

Epinephrine is a rescue medication and someone will need to take you to the emergency room. Dr. Atkinson also suggests wearing a bracelet or necklace that identifies the wearer as having severe allergies.

“For those who have had a serious reaction to an insect sting, make an appointment with an allergist,” he said. “With proper testing, your allergist can diagnose your allergy and determine the best form of treatment.”

The post Stinging Insect Allergy Can Ruin Outdoor Activities appeared first on Oklahoma Allergy and Asthma Clinic.

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