Allergic Diseases, S.C. Steven H. Cohen, M.D.
Home Doctor First Visit Office Policies Medical Info Asthma Allergies Bronchodilators Stinging Insects Itch Cough Allergy Vaccine Therapy Mold Clinical Trials Contact Us FAQs Links	Allergy Vaccine Therapy “I am pretty sure that, if you will be quite honest, you will admit that a good rousing sneeze, one that tears open your collar and throws your hair into your eyes, is really one of life’s sensational pleasures.” Robert Benchley Allergy Vaccine Therapy (AVT) is the new terminology for what we used to call allergy shots, or immunotherapy. It is the one form of allergy treatment that has the ability to be curative. Other forms of treatment, such as medications, are used to diminish the symptoms we see in our patients. They are not able to change the natural history of the disease. Symptoms will return in subsequent years for people with seasonal disease, and persist in patients with perennial disease. If specific allergen avoidance is possible, medication may be helpful. However, some inhalants, such as animal dander, may be more difficult to avoid because of the number of pets in society and the likelihood of people carrying dander on their clothing. Allergy vaccine therapy is often the treatment of choice in patients with allergic asthma, allergic rhinitis and conjunctivitis, and stinging insect sensitivity. Prior to beginning this form of treatment, however, the patient is instructed on avoidance techniques based on history and skin testing. If avoidance is ineffective or difficult to do, medications are added to the regimen. When all else fails, allergy vaccine treatment is indicated. Allergy vaccine therapy is based on its ability to actually modify the immune response in those with allergic disease. The immune system in allergic patients produces an inappropriate response to otherwise innocuous antigens we encounter in daily life such as pollens, dust mite antigens and animal danders. There is a genetic predisposition to this immune response. The incidence of allergy in the general population is about 20%. If a patient has one allergic parent the incidence rises to about 40 to 45%, and if both parents are allergic the incidence is in the 70 to 75% range. There are also exposure factors that are important. Recent observations suggest that children who grow up in more natural environments, and exposure to infective agents is not purposefully avoided, have an immune system that is TH1-driven to protect them from infection and the immediate environment. Children who grow up without pets, who are vaccinated to protect from every infectious disease, and who live in more sterile homes have an immune system which is more TH2-driven, and they are more likely to develop allergic problems. These observations continue to undergo further examination. The biological basis for allergy vaccine treatment lies with the response that occurs in an allergic person when presented with an allergen. IgE is released into the system by B cells and attaches itself to mast cells and basophiles via a specific receptor. The mast cell contains histamine granules and has the ability to produce additional mediators, cytokines and chemokines, upon stimulation. An energy-dependent reaction can be initiated which leads to the release of histamine and the formation of the other mediators and factors that intensify the allergic reaction and lead to the clinical symptoms we call allergic disease. When allergy vaccine therapy is given in small and increasing amounts the immune system is stimulated in many ways. This includes stimulation of specific suppressor T cells that migrate to the IgE-producing B cells and down-regulate or suppress their IgE production. As the amount of total and specific IgE decreases over time, the likelihood of allergen/IgE binding on mast cells decreases and the symptoms decrease. In patients who respond favorably, the suppressor cells may exist for many years providing prolonged protection. Dosage is important because if the dose is raised too rapidly the likelihood of a reaction, either local or systemic, is increased. Who needs Allergy Vaccine Therapy? The most common allergic respiratory disease is allergic rhinitis. This disease is more than an uncomfortable situation. Allergic rhinitis is associated with co-morbid illnesses including ear infections in children, an increased incidence of sinus disease in children and adults, and an increased incidence of asthma. A further complication of allergic rhinitis is disordered sleep. Upwards of 75% of allergic rhinitis patients have trouble getting to sleep, sleeping through the night, and frequently wake with difficulty. Allergic rhinitis is the number one reason for days missed at work and the number two cause of “presenteeism”, or showing up to work but not being able to function. Allergic patients treating themselves with OTC antihistamines (frequently sedating) have an additional reason for not functioning. Patients found driving while under the influence of sedating antihistamines may be charged with DUI in Wisconsin. Allergy vaccine therapy may prevent all of these complicating problems. Patients with allergic asthma are likewise candidates for this treatment. Asthma patients are frequently unable to avoid outdoor allergens unless they forgo outdoor activities completely, which is unreasonable. Indoor manipulation of the environment may be helpful but may be costly and difficult. Asthma is a far more serious illness, and aggressive treatment including medications and allergy vaccine therapy is commonly needed. Stinging insect allergy is also treated with injections if the patient has a history of severe allergic reactions. The literature proves the effectiveness of this form of treatment. What Does Allergy Vaccine Treatment Entail? Allergy vaccine treatment is accomplished by giving increasing amounts of relevant antigens to the patient by injection, initially on a weekly basis and then decreasing the frequency over time. The “build-up period” is about one year for the weekly injections. Our goal during this time is for the patient to begin to notice improvement (decreased symptoms) while using current medications or, possibly, decreased medication use with continued good symptom control. The ultimate goal of treatment is two consecutive seasons with little or no symptoms using little or no medication. Treatment usually takes three to five years in total. There are individuals who have the appropriate response, remain asymptomatic for a number of years and later will have a return of symptoms. Many of these people will consider a monthly maintenance program once they respond. Because of the possibility of reaction, treatment should always be given in the presence of a physician or a trained health professional with adrenalin available. “It was as if a morning-glory had bloomed in her throat and all that blue and small pollen ate into my heart violent and religious” Anne Sexton “A nose, kind sir! Sure, Mother Nature, with all her freaks, ne’er formed this feature. If such were mine, I’d try and trade it, and swear the gods had never made it” Susanna Moodie “I said something which gave you to think I hated cats. But gad, sir, I am one of the most fanatical cat lovers in the business. If you hate them, I may learn to hate you. If your allergies hate them, I will tolerate the situation to the best of my ability.” Raymond Chandler The Sneeze I sneezed a sneeze into the air It fell to the earth I know not where But hard and froze were the looks of those In whose vicinity I snoze. Anonymous Ode to Allergy Vaccine Therapy Sneeze, wheeze, allergies It often hurts me in the knees I get my shots to make me better And follow my schedule to the letter My doctor says I’m doing well It goes so slow that who can tell? But I have faith that come the fall I’ll feel good when the ragweed’s tall If I get my shots the winter through Come spring the sneezes will be few No runny eyes or runny nose I’ll feel well from my head to my toes You know the needles aren’t my favorite The post-shot wait - I do not savor it But I’m a good patient, steady and true I’ll be right there when my next shot’s due.      11121 W. Oklahoma Avenue    West Allis, WI 53227    Tel: 414.545.1111