Allergic disorders such as allergic rhinitis, conjunctivitis, and asthma are caused by the release of chemical mediators generated from an interaction between triggering allergens, specific IgE (allergy antibody), mast cells, and basophils.

While avoiding offending allergens is always the first step in preventing and treating allergic disorders, this approach is often impractical or even, impossible.  For instance, dust mites are extremely difficult to completely eradicate, or a beloved pet just cannot be parted with.  While medications can be a very effective way to control allergic disease, many people still suffer allergic symptoms despite their use.

In many cases, immunotherapy, also known as allergy injections or desensitization, is the most effective form of treatment for allergic rhinitis, conjunctivitis, and asthma.  Immunotherapy alters and lessens the allergic reaction to triggering allergens by decreasing the production of certain IgE, and by initiating the production of other specific allergen-blocking IgG, which also interferes with the IgE.  Immunotherapy also stabilizes mast cells and basophils, as well as fostering other effects, which decreases the release of chemical mediators.

Prior to starting immunotherapy, an allergist must compile a detailed medical history and perform skin testing to identify offending allergens and the patient’s corresponding degree of sensitivity.   Typically, an effective immunotherapy program requires weekly injections for at least three to five years.  The injections are a specifically formulated and diluted solution comprised of inhalant allergen extracts to which one is allergic, such as trees, grasses, weed pollens, mold spores, dust mites, or animals.  The allergist will gradually build up one’s dose by increasing the amount of allergen concentration weekly until maximum concentration is reached, or side effects occur.  At this time, the dosage maintenance period is initiated.  During this period, one will receive a fixed amount of maximum tolerable concentration, with extended intervals between injections, from two weeks to one month apart, depending on one’s progress.

In many cases, sensitivity to the allergens decrease and symptoms improve during the course of immunotherapy.  The state of desensitization can be maintained for several years, or in some cases for life, with no need to restart injections.  However, in some cases, the reappearance of allergic symptoms may occur.  In such instances, the allergist will need to evaluate the patient’s symptoms and consider the possibility of restarting immunotherapy or other treatment.

In order for immunotherapy to work, the patient needs to commit to the program and follow the prescribed schedule of treatment, including close monitoring of a possible allergic reaction within the first twenty minutes of injection.  The patient should wait at least twenty minutes in the clinic after administration of immunotherapy, in the event of a rare, but severe reaction.  By staying on site, the allergist can assess any reaction and provide immediate qualified assistance if necessary, as well as adjust the next dose of immunotherapy appropriately.

In the last few years, new treatment options have been developed as a result of breakthroughs in genetic engineering and an overall better understanding of the IgE role in airway inflammation.  A new and more targeted form of therapy for allergic asthma specifically blocks IgE.  Xolair (omalizumab), a so-called “anti-IgE,” is administered once every two to four weeks by injection.  Xolair bonds with circulating IgE and blocks the initialization of allergic reaction.  Studies have shown patients with moderate to severe allergic asthma who are treated with Xolair have less frequent asthma episodes and are able to reduce or even discontinue the use of inhaled or oral corticosteroids.

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