вопросы и ответы про асит

This article will be a continuation of the main material on Allergen Immunotherapy (AIT), where I have organized all the information I know about immunotherapy.

I will present the text in the form of questions that have plagued me and continue to plague allergists, along with the answers I have received.

I hope this material will be useful. If you have doctors’ answers to other questions, please write them in the comments, and we will collaborate to expand the article.

Which treatment should I choose for allergies, AIT or ALT?

While all allergists talk about AIT (allergen-specific immunotherapy), I accidentally came across the method of ALT (Autolymphocyte Therapy) in an article on some website.

The article praised this miraculous method of allergy treatment and promised incredible results in a very short time.

In the morning, I was already sitting in the office of the most available allergist I knew, bombarding her with questions about ALT. The doctor considered ALT to be a method with unproven effectiveness and a high risk of autoimmune side effects.

My sleepless brain instantly conjured up a conspiracy of doctors who deny us simple mortals access to this magical source of health.

Well, I thought, let’s see what international allergists have to say. My acquaintance, an Israeli doctor, told me that ALT was developed in Russia in the 1990s as a promising cancer treatment method. During the therapy, the patient’s own purified lymphocytes are injected.

The use of ALT for allergy treatment began to be explored in Russia as early as 1992. In global medical practice, ALT is not used for allergy treatment, and in most medical publications describing the method, the word “Trial” is used, indicating that the development is in the experimental stage, and there is no compelling evidence of its effectiveness yet.

In summary, my conspiracy theory crumbled. Too bad 🙂

Why is it necessary to undergo analysis for minor and major allergen proteins before Allergen Immunotherapy (AIT)?

This is one of the most important questions about AIT, and according to the comments I have received, not all allergists are aware of the answer.

The key point is that immunotherapy can only help in the case of a reaction to the major proteins of the allergen. Minor protein reactions cannot be treated with Allergen Immunotherapy (AIT),.

If the body reacts to both minor and major allergen proteins, the effectiveness of AIT is reduced.

Determining the specific proteins to which the body reacts can only be done through molecular diagnostics. Skin prick tests, other skin tests, and conventional blood tests cannot provide information about minor and major proteins.

At What Age is it Best to Start Allergen Immunotherapy (AIT)?

I don’t like the label “typical allergic person.” It’s because there are very few ordinary, standardized cases in allergology. I believe allergists never get bored.

So, the question of the age at which it is best to start AIT should only be answered by the treating doctor based on the results of tests and observations of the young patient.

Many allergists don’t even refer to allergies as a disease. I have heard on multiple occasions that allergies stem from immune system errors, an incorrect reaction to irritants. And after all, errors are not diseases; everyone makes mistakes 😉

Now, the human immune system develops until around 7-8 years of age, and that is the best time to make corrections to the immune system.

If AIT corrects immune system errors during preschool age, the chances of achieving long-lasting and stable remission, and sometimes even lifelong remission, increase.

Unfortunately, adults have almost no chance of achieving long-term remission because their immune systems are already formed and can only undergo temporary corrections, after which AIT needs to be repeated.

Another decisive factor for a favorable prognosis of therapy is the overall duration of the immune system’s exposure to the allergen. If the exposure time does not exceed 4-5 years, the chances of achieving long-term remission after treatment also increase.

Is AIT prescribed to all allergy sufferers?

No, not to everyone. Like any worthwhile endeavor, Allergen Immunotherapy (AIT), requires substantial justification. Adequate justification would be allergic reactions that intensify from season to season.

Allergists prescribe AIT to prevent the development of asthma and reduce the use of medications that alleviate allergy symptoms. Therefore, a doctor will not recommend AIT if allergic rhinitis does not worsen each year and can be effectively managed with antihistamines.

Furthermore, immunotherapy can only be helpful if the allergic individual has a reaction to the major proteins of the allergen.

Also, AIT is not prescribed to individuals suffering from food allergies alone.

Can Allergen Immunotherapy (AIT), cure reactions to 3 or more allergens at once?

This is also a common situation. Firstly, for polyvalent allergy sufferers, if the doctor has doubts, it is better to undergo an analysis using the Allergochip, which reveals the entire process of the allergic reaction and identifies the main protein responsible for triggering the allergy.

Haven’t taken the test yet? Hurry to the laboratory 🙂
Now you will need a knowledgeable allergist who can interpret and understand the test results and develop the appropriate treatment strategy.

For example, the doctor may suggest treatment targeting one allergen, carefully monitor the reaction, and gradually introduce the second and sometimes even third allergens. This approach is mostly used in Europe.

In the United States, it is widely practiced for allergists to immediately offer patients therapy with multiple types of allergens in one vial, like an allergy cocktail.

The tests showed a reaction to both major and minor proteins of the allergen. Can AIT be performed?

Yes, it is possible. However, the presence of a reaction to minor proteins reduces the effectiveness of AIT. If the tests show a reaction to several minor proteins, such as profilins or LTP (more details about them can be found here), AIT may be declined.

Is Allergen Immunotherapy (AIT), necessary for cough variant allergy?

If a person reacts to an allergen with a cough, and the symptoms progress while tests confirm bronchial hyperreactivity, immunotherapy is mandatory to prevent the development of allergic asthma.

Bronchial hyperreactivity is confirmed or refuted through tests such as pulmonary function tests (PFT), bronchophonography, or measuring nitric oxide in exhaled air.

If there are mild reactions such as nasal congestion, tearing, and sneezing but no cough, allergists usually continue monitoring and do not rush with AIT, especially in children. During the so-called “exit ages” of 8, 14, and 18 years, children have a chance to achieve remission without medical intervention, thanks to their own hormones.

Who is a polyvalent allergy sufferer?

An individual is considered polyvalent when they have confirmed reactions to allergens from different groups (for example, birch, mold, and cats).

If the body reacts to multiple allergens within the same group, such as birch, hazelnut, oak, and beech, then that allergy would not be considered polyvalent.

Will AIT help if there is both a food allergy and a reaction to pollen?

The answer to this question can be aided by the results of molecular diagnostics, which reveal the cause of the reaction – the specific allergenic protein. When the protein is known, predicting the outcomes of Allergen Immunotherapy (AIT), for someone with a food allergy becomes much easier.

There may be cases where a food allergy is triggered as a cross-reaction with the main allergenic protein. Let me illustrate with an example.

Suppose the tests show a reaction to the major birch protein Betv 1 – PR10, and the allergic individual reacts to apples, peaches, or pears. In this case, it is likely that the immune system dislikes the PR-10 protein, which is present in birch pollen and these fruits.

This allergy will subside when the allergic individual treats the reaction to PR-10. In other words, if we treat the reaction to birch, the itching from apples will cease. Unfortunately, immunotherapy doesn’t always help with cross-reactions to food.

When a food allergy is not caused by a cross-reaction, a more thorough examination is prescribed to confirm the presence of true allergy to the food and exclude food intolerance.

Acupuncture, osteopathy, and yoga as allergy treatment options

Acupuncture, osteopathy, and yoga – all these wonderful methods alleviate symptoms, improve well-being, and generally make life easier for allergy sufferers. However, they cannot cure true allergies.

Should allergens (pollen) be avoided during Allergen Immunotherapy (AIT),?

I am aware of two opinions among allergists regarding this matter. Some recommend avoiding the allergen during immunotherapy.

Other doctors allow testing the effects of AIT in the first year of therapy to assess whether there are improvements or not. I adhere to the first strategy.

Should the allergy class decrease during AIT?

The allergy class and the total immunoglobulin E (IgE) level may not change during AIT. That is why doctors evaluate the results of AIT based on symptoms rather than laboratory tests.

Do they conduct AIT for cat and dog allergens?

Yes, they do. However, the medications are not certified in Russia.

Can abdominal pain and nausea occur during Allergen Immunotherapy (AIT),?

Abdominal pain, nausea, and diarrhea are common side effects that can occur during sublingual immunotherapy (under-the-tongue drops). The reason is that the medication may reach the stomach. If the symptoms are occasional and resolve within an hour, there is no cause for concern. It is necessary to consult a doctor when the symptoms worsen or recur.

To reduce the likelihood of experiencing symptoms, do not swallow the medication.

If the therapy is conducted through injections, such side effects do not occur.

Is alcohol compatible with AIT?

A pressing question, especially for men 🙂 I have good news – alcoholic beverages do not interfere with the action of the medications. However, read the labels carefully, as the drink may contain allergens.

Is there AIT available for food allergens, such as milk?

Mass production of Allergen Immunotherapy (AIT), for food allergens is not yet common.

However, in Europe, within the framework of research, hospitals have started conducting sublingual immunotherapy (OIT) for food products (currently only for peanuts, milk, and eggs).

During the experiment, it has already been discovered that the biggest challenge is maintaining the results after completing the therapy. It is necessary to continue consuming the allergenic food product every day to maintain tolerance.

Are there hypoallergenic animals?

Science is advancing 🙂 Hypoallergenic cats without the major cat allergen Fel d1 have been developed at Texas A&M University. This achievement is credited to Professor Duane Kraemer.

The future lies in molecular diagnostics 🙂

When to expect the effect of Allergen Immunotherapy (AIT),?

First of all, I want to mention that the effectiveness of AIT is evaluated solely based on symptoms.

Usually, noticeable relief occurs after three full years of continuous immunotherapy. However, there are lucky individuals who may experience symptom relief already during the dose buildup phase.

If you are one of them, please remember that Allergen Immunotherapy (AIT), should not be discontinued if symptoms improve in the first season. The AIT course should be completed in its entirety.

The therapy should be undertaken for a period of three to five years. The longer the course, the more stable and long-lasting remission will occur after treatment.

Can antihistamines be used during AIT?

All allergists unanimously answer “yes” to this question. But I found this answer insufficient and asked, “Why?”

The responses of all doctors were similar: use them if necessary, as they will not affect the treatment outcome, just like Singulair and inhaled corticosteroids.

They all share a remarkable consensus on this matter; if only all questions were like that.

Should cross-reactive foods be avoided during Allergen Immunotherapy (AIT)?

Until recently, allergists insisted on following such a diet. If AIT was administered with sublingual drops, the diet was recommended throughout the entire therapy. If injections were given, there was a prohibition on cross-reactive foods on the day of injection.

With the advent of molecular diagnostics in Russia, the opinion of many allergists has changed. Currently, specialists, especially those who have the opportunity to improve their qualifications abroad, together with their European colleagues, believe that if there is no reaction to a food during the flowering period of the main allergen, there is no need to eliminate it from the diet.

When a reaction to a food occurs during the allergen’s flowering period, it is better to exclude it during Allergen Immunotherapy (AIT).

Interestingly, recent studies show that cross-reactive allergies do not develop in everyone and not always. The percentage of allergic individuals who have no cross-reactive reactions is higher than the percentage of those who suffer from cross-reactive foods.

Can Allergen Immunotherapy (AIT) trigger an asthma attack?

It can. This mostly occurs when AIT is administered by injection.

The advice here is straightforward – contact your treating physician immediately. The doctor will likely suspend AIT during the attack and reduce the dosage of the medication.

Can skin tests be performed during basic therapy (Pulmicort)?

Yes, they can.

How long after chickenpox can skin tests be conducted?

They can be conducted one month after chickenpox.

Is it possible to change the method of AIT, switching from drops to tablets or injections?

Changing the method is possible, but with the permission and supervision of a doctor. After the switch, you will have to start with the lowest well-tolerated dose again.

Can allergy symptoms worsen during Allergen Immunotherapy (AIT)?

They can. In such cases, the allergist will reduce the medication dosage and prescribe medications to alleviate the exacerbation.

What is the likelihood of an anaphylactic shock during AIT?

If AIT is administered by injections, the likelihood of anaphylactic shock is low, and it is practically excluded with sublingual drops.

In Russia, during the entire history of sublingual AIT, not a single case of anaphylactic reaction has been registered.

Eleven such cases are known worldwide.

How should the AIT medication be transported?

The AIT medication can be transported excellently in a refrigerated bag with an additional cooling element.

Can the medication Ruzam replace Allergen Immunotherapy (AIT)?

The actions of the immunotherapy medication

Popular Questions and Answers about Allergen Immunotherapy (AIT)
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