Immunotherapy – Allergy


What is immunotherapy for allergies?

Allergen immunotherapy is a treatment for allergies. It involves exposing the patient to small, increasing doses of an allergen. This helps to build up tolerance to the allergen. Building up tolerance reduces or eliminates allergy symptoms.

How does allergen immunotherapy work?

Allergen immunotherapy works by introducing gradually increasing amounts of the allergen into a patient’s immune system. This is done on a regular schedule, until a maintenance level is reached. Tolerance for the allergen typically continues after immunotherapy ends. However, the long-term success rate varies from person to person.

Does immunotherapy work for allergies?

Environmental allergen immunotherapy

Immunotherapy for environmental allergens is proven to be successful for:

  • pollen
  • mold
  • animal dander
  • house dust mites
  • cockroach allergens
  • insect venom hypersensitivity.

In addition to reducing allergy symptoms, immunotherapy may help prevent new allergies. It may also stop the progression of allergic diseases, from allergic rhinitis (hay fever) to eczema and asthma. It can help control asthma by interrupting the allergic response that sets off symptoms.

Peanut allergy immunotherapy

Peanut allergy immunotherapy is also effective for building up a tolerance for peanut. There are two types of allergen immunotherapy. 1) oral immunotherapy, or a capsule with peanut powder with a dosage that is gradually increased over time until a level of tolerance is obtained; and 2) the peanut patch, which is still in clinical trials and is not yet FDA-approved.

Talk with your allergist to determine if peanut allergy immunotherapy is right for you or your child.

Photo of woman receiving a shot in the arm from a medical professional

What types of allergen immunotherapy for environmental allergies is available?

The type of immunotherapy options available for you depends on the specific allergen.

The two types of environmental allergen immunotherapy are:

  • Allergy shots
  • Under-the-tongue tablets

What are allergy shots?

Allergy shots are also known as subcutaneous immunotherapy or SCIT. They are the most familiar form of immunotherapy used for environmental allergens. Often several different allergens can be combined in one injection. This helps to build tolerance to multiple allergens at once.

Shots are administered in a board-certified allergist’s office once or twice weekly. That schedule will continue for about 6-12 months. Your allergist increases the level of allergen extract in your injections until the maintenance dose is reached.

How long do you have to take allergy shots?

Depending on your response to therapy, your allergist may then decrease the frequency of your shots from once a week to once a month. If you are doing well after 3-5 years and no longer need most or all allergy medications, your allergist may stop immunotherapy.

How common is anaphylaxis to allergy shots?

Serious allergic reactions to allergy shots are rare. However, the procedure should be conducted in an allergist’s office equipped with epinephrine auto-injectors in case a serious reaction, or anaphylaxis, occurs. Always remain at the doctor’s office for a full 30 minutes following the injection and be aware that a reaction can happen hours later.

Anaphylaxis symptoms are difficulty breathing, tightness in the throat, hives or swelling. They may also include nausea, vomiting, fainting, diarrhea, or abdominal pain. If these occur, immediately administer the epinephrine auto-injector and seek emergency treatment.

Are allergy shots permanent?

Allergy shots lead to a long-lasting reduction of symptoms for many people. Ohers may lose their immunity at some point and choose to resume allergy shots.

If you completed allergy immunotherapy and are now experiencing difficult-to-control allergy symptoms, see your allergist for testing and treatment options. It might not be old allergies returning. It is possible you developed a new allergy. This sometimes happens after moving or starting a job in a different environment. Age is not a barrier to starting or restarting immunotherapy.

What is sublingual immunotherapy?

SLIT tablets approved by FDA treat grass and ragweed pollens and house dust mites. Each SLIT tablet covers one type of allergen.

Allergy tablets may not be the best option for people with multiple allergies as they only treat one at a time. Allergy shots can treat multiple allergens at once.

Also, if you have severe or uncontrolled asthma, you are not eligible to take the tablet.

How is SLIT administered?

The first SLIT dose is always administered in the doctor’s office, similar to allergy shots. Ten patients can take the tablets at home. But epinephrine auto-injectors must be available in case of a severe allergic reaction, or anaphylaxis.

  • Patients using SLIT tablets for grass and ragweed pollen should start taking them 4-12 months (depending on the tablet given) prior to the start of their pollen season. They should be taken throughout the entire pollen season, for best effectiveness. Tablets for certain grass pollens are available for children as young as 5 years old. Ragweed tablets are for patients 18-65.
  • Patients using SLIT tablets for house dust mites should take them year-round. It can take 8-14 weeks of daily dosing to experience a noticeable benefit. The tablets are indicated for patients 18-65 years of age.

Another form of SLIT involves drops of liquid allergen extracts held under the tongue. This is not approved for use in the United States. The treatment is typically not reimbursed by health insurance.

How are SLIT tablets administered at home?

When taking a SLIT tablet at home, you place the tablet under the tongue. Then you old it there without swallowing for at least a minute. After taking the tablet, you can’t eat or drink anything for at least five minutes.

The tablet is highly allergenic, so it’s important to wash your hands after taking it. If you rub your eyes immediately after handling the tablet, you could risk an allergic reaction.

You need to be diligent about taking it on a daily basis. If you happen to miss too many days in a row, you need to contact your doctor. It can be dangerous to restart immunotherapy on your own.

If you’re a parent giving your child a SLIT tablet at home, make sure you watch the child for 30 minutes after giving the tablet. Keep epinephrine auto-injectors close by in case of a severe allergic reaction.

Is environmental allergy immunotherapy right for you?

Talk with a board-certified allergist about how your allergy symptoms affect your activities and health, then consider whether immunotherapy might help more than allergen avoidance and/or medications.

Use the following questions to help guide you with your decision:

  • Have reliable allergy tests identified that you are allergic to an allergen that can be successfully treated with immunotherapy?
  • Is the allergen one that is difficult to avoid exposure to in everyday life?
  • Do your symptoms consistently interfere with daily activities?
  • Have your symptoms been difficult to control with allergy medications?
  • Do you have related conditions such as eczema, sinusitis or asthma that complicate your allergies?
  • Are you able to commit to the immunotherapy schedule?

Use Shared Decision Making with your allergist to determine if environmental allergen immunotherapy is right for you. Shared Decision Making encourages patients to take a more active role in their care. You work closely with doctors to select tests and treatments together. It’s evidence-based and balances risks and results with a patient’s preferences and values.

If you’re considering allergen immunotherapy of any type, don’t be fooled by third-party allergen immunotherapy. They offered by “certified allergy technicians,” sometimes in primary care offices. These allergy technicians are not fully trained, board-certified allergists. Many of the treatments they recommend are inconsistent with established standards of practice. These practices are designed to protect you as the patient. Some patients are even sent home with shots or pills to self-administer without fully understanding risks. administer without fully understanding risks.

What is food allergy immunotherapy?

In food allergy oral immunotherapy (OIT), patients are given the food they are allergic to. It starts with a tiny amount and then gradually larger amounts. This helps the body become desensitized to food. Currently peanut allergy OIT is approved. Other allergens including egg and milk are being studied for OIT.

Important: OIT should only be done under a doctor’s supervision; do NOT try OIT on your own.

What types of food allergy immunotherapy are available?

The two types of food allergy immunotherapy are:

  • Oral immunotherapy
  • Epicutaneous Immunotherapy

What is peanut allergy oral immunotherapy?

The U.S. Food and Drug Administration (FDA) approved the use of peanut allergy oral immunotherapy (OIT.) The treatment is called Palforzia™ – it’s made by Aimmune Therapeutics. It’s designed to reduce the frequency and severity of allergic reactions. This includes life-threatening anaphylaxis, in children ages 4-17 after accidental exposure to peanut.

How does peanut allergy OIT work?

Peanut allergy patients are given a capsule with peanut powder that can be mixed into food. When taking it, patients consume a controlled dose of peanut protein. The dose is gradually increased over time. Eventually a level of peanut tolerance is reached. So, if there’s an accidental exposure, it won’t trigger a severe allergic reaction.

This is not a peanut allergy cure. Patients must continue to avoid peanut products. They may need to continue undergoing OIT even after a tolerance level is reached.

The treatment is not for every peanut allergy patient, however. It’s important for patients and families to work together with a doctor to determine if Palforzia is an appropriate treatment.

How is Palforzia prescribed?

Palforzia is available only through a Risk Evaluation and Mitigation Strategy (REMS). Requirements of the REMS include:

  • The prescribing physician and patient must be enrolled in the REMS before starting treatment.
  • The initial dose escalation and the first dose of each up-dosing level must be administered in a certified healthcare setting. Epinephrine must always be immediately available to patients
  • Pharmacies/distributors must be certified with the REMS . They may only dispense PALFORZIA only to certified healthcare settings or to patients who are enrolled in the REMS.

Aimmune will provide resources to patients and families who, upon consultation with their physician, wish to seek treatment with Palforzia. These resources will include educational materials, a dedicated call center, co-pay program for eligible patients, and a Patient Assistance Program to provide Palforzia at no cost to eligible patients.

Can Palforzia be taken at home?

This is not a home treatment. It should only be done under the care of a qualified allergy specialist and at a medical facility. Epinephrine, the first-line treatment for a severe allergic reaction, must by readily available.

What is the peanut patch? 

The peanut patch is also known as epicutaneous immunotherapy (EPIT). It is a small patch containing a tiny dose of peanut protein that is applied to a patient’s skin daily. The therapy aims to desensitize immune cells in the skin to make the body more accepting of peanut.

The peanut patch is not yet approved by FDA; as of March 2020, it is under FDA review.

The goal of the peanut patch is to protect peanut-allergic individuals in case they have an accidental exposure to peanut. The patches contain very small quantities of peanut allergen – approximately 1/1000 of a peanut on it. Because the dose of allergen on each patch is so small, this approach is often well tolerated by patients.

Many are able to increase the threshold of peanut exposure that’s needed to trigger an allergic reaction. This means increased protection from an accidental exposure. This is likely because the dose in the peanut patch is very low and the dose does not change over time.

The peanut patch is a treatment that will require close supervision by a physician.

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