The dread / the reality
Most parents dread a visit to the allergist because of the possibility of allergy shots or desensitization. We understand you can be frightened about "shots" based on your prior experience with large needles and heavy oily irritating materials, because they hurt. But allergy shots are more like diabetes injections – very small, short needle that many children can't feel at all. The reality is that allergy immunization is not a traumatic event – but you would have to see it to believe it.
Why would you consider this?
Allergy immunization is the only known way to "cure" allergy – a better word to use is "remission". Since allergy is a slowly developing process, immunization may stop the progression and put a halt to the problems. Even treated with medications, most allergic children continue to develop new sensitivities each year. You may be able to control the symptoms with increasing antihistamines and steroids, but the disease progresses. While children often have a natural period of lower symptoms during the teenage years, it invariably begins to return in the twenties reaching a peak by about fifty. Whatever you have heard about "outgrowing" allergy, it never happens with this genetic trait. Faced with this slowly developing chronic process, many parents may weigh benefits and risks and consider immunization a good investment for long term health. For girls it's even more important since during child bearing years, medications are so restricted. Like learning a new language, the younger child is more successful than the adult.
How does it work?
The immune system has mistakenly decided to defend against pollen or mold by releasing the itchy chemical histamine when you breathe it. The immune system produces hayfever in the nose, asthma in the lungs, and eczema on the skin. Most of the time the process begins with mild skin problems and will develop into either allergy or asthma at a predictable rate. Allergy immunization or shots uses exactly what you are allergic to in increasing doses. As you are able to tolerate a large dose in the arm – they will also tolerate a large dose in the nose and lungs. That stops the cycle of swelling in the nose and sinuses that lead to infections and may also improve or stop asthma. If you keep getting allergy shots for a period of time (in some patients up to 5 years), the effect becomes learned and immunization can be stopped. But in addition to inducing remission, most of the time we can stop new allergies from forming and break the lifetime progression. It's common for us not to see the children much, once immunization is complete. When we suggest immunization we are looking far down the road to adult health.
Rush immunotherapy (RIT), first described in 1933, is a technique of advancing an allergic patient to a maintenance dose of an extract very quickly, potentially in one working day using an injection every 30 minutes over a four hour period with a 1-2 hour observation period at the end. While RIT has been used in the past for time crucial treatments for insect sensitivity, it is now receiving renewed interest. The major drawback to rapid maintenance and RIT has been an increased level of allergic reactions during the initial phase, at times there can be severe allergic reaction. Because of this risk only a small number of practicing allergists perform this in the office. However, improvements in safety issues gained by pre-medication on the first day may reduce the risk considerably. Furthermore, many physicians and patients believe the benefits involved in the treatments exceed the risks.
What are the goals?
Allergy immunization, like any educational technique – any vaccination, doesn't work well for everyone. Think about this like you would music lessons – you start- you practice and at the six month recital you decide if it's worth it. Most of the time we wind up with about 85% of people getting about significant reduction of symptoms. We reassess on a periodic basis, and if progress is not evident, we may stop, and wait for the next improvement in technology. However, most people will get some degree of improvement. You should talk to your doctor in detail about what your expected responses would be.
Does it have to be every week?
No, we can sometimes stretch it out. If you need off for vacation or you just forget, don't worry. There are many different schedules and you should talk to your doctor about the schedule that would be best for you. In general, there is a "build-up" phase are the start of allergy shots that require small doses to be given frequently. As you progress, the doses get larger and over time the interval between injections gets longer. A typical routine may include, injections twice a week for several weeks, then once weekly for a few weeks, then every other week, followed by the final or maintenance injection once a month. Once the maintenance injection dose and dosing interval is achieved this needs to be maintain to get the lasting results of allergy immunotherapy as discussed above.
