Allergy immunotherapy (AIT)

So my child and I started the second year of Allergy immunotherapy (Already the third. I updated the article in January 2020). My son is allergic to birch. We collect the dosage slowly, under the supervision of a doctor.

I learned about Allergy immunotherapy (AIT) three years ago, when I first encountered allergies in my baby. Since then I have not stopped collecting information about this method.

All that I learned, I will try to systematize in this article.

The material turned out to be voluminous, therefore, first of all, the content:

What is Allergy immunotherapy
Why do AIT
Types of allergies treated with immunotherapy
What drugs are used for AIT
Who is appointed AIT
Contraindications
What tests should be passed before immunotherapy
When do AIT begin?
How is the course of immunotherapy
When is immunotherapy interrupted
AIT and vaccinations
Immunotherapy for children
AIT for pregnant and lactating mothers
Why therapy may not work

What is Allergy immunotherapy

The most important thing to know is that AIT treats only with a reaction to the major allergen proteins.

You can find out which proteins, major or minor, an allergy sufferer reacts to by analyzing allergic components using the ImmunoCup method or the ISAC allergy test, Allergo Expert 300 and ALEX allergy explorer.

These analyzes are very important for predicting the result of AIT and for the proper selection of therapy.

Next, we turn to the theory.

Allergen-specific immunotherapy or AIT is the only respiratory allergy treatment method, which has been used for over 100 years.

The effectiveness of AIT is confirmed by studies of the World Health Organization (WHO).

Immunotherapy is needed to dull the body’s response to an allergen. For this, allergen doses are gradually introduced into the body of an allergic person.

The reaction of the body changes under the influence of a small dosage of the allergen. As a result, its susceptibility to this allergen is significantly reduced.

That is to say quite simply.

For those whom allergies made teach chemistry, I’ll explain a little differently.

During AIT, the immune system receives minor but constant doses of the allergen. This reduces the level of E-immunoglobulins (IgE) responsible for the allergic reaction.

Instead of IgG immunoglobulin, AIT activates the production of G-immunoglobulin IgG4, which blocks the allergic reaction. IgG4 is the only laboratory test that measures the performance of Allergy immunotherapy.

Ideally, the level of specific IgE immunoglobulin should decrease, and the level of IgG4 should increase. However, the main findings of an allergist are based on the patient’s symptoms.

The total duration of the course of Allergy immunotherapy is from 3 to 6 years.

Why do AIT

Currently, AIT is the only way to treat allergies, which not only relieves symptoms, but also eliminates the causes of allergies.

The main task of Allergy immunotherapy is to reduce the number of drugs that an allergy sufferer takes.

Immunotherapy can bring allergies into remission, that is, weaken the manifestations of the disease, up to the complete disappearance of symptoms.

Allergy immunotherapy should be started after the appearance of the first symptoms of an allergy. The sooner treatment is started, the longer the remission. Remission can last up to 20 years, and 5% of allergy sufferers after AIT forget about allergies forever.

AIT can also be a preventive method for allergies to other allergens.

Immunotherapy interrupts the growth of allergies and prevents light allergic reactions from developing into more serious ones, for example, bronchial asthma, Quincke’s edema or anaphylactic shock.

With a competent doctor’s approach and patient responsibility, a positive effect from AIT is achieved in 95% of children from 5 to 11 years old, in 80% of adolescents from 11 to 14 years old, and in 70% of people over 14 years old.

Types of Immunotherapy

Types of Immunotherapy

The main methods of therapy are several. At the consultation, an allergist, having studied our history, recommended to my son drops under the tongue. We did not even consider injections because of the panic fear of the baby before the needle.

The most popular types of AIT:

  • Injections;
  • Sublingual (drops under the tongue and tablets).

The effectiveness of the sublingual method and the injection are equivalent.

The effectiveness of sublingual therapy depends on the total dose taken. The sublingual method is not recommended if the oral mucosa of an allergy sufferer responds to many food crossings.

The injection method has more side effects, including serious ones.

Features of sublingual immunotherapy:

  • painless;
  • treatment can be done independently at home;
  • a visit to a doctor – an allergist is required at the first dose of the drug and to control treatment;
  • the probability of severe reactions is almost zero;
  • requires daily use (see instructions);
  • a variety of dose-setting options (from the ability to split the medication several times before spitting out the drug).

Side reactions:

  • sore throat;
  • itching in the mouth;
  • swelling in the hyoid area, which does not interfere with swallowing;
  • ear pruritus;
  • sneezing
  • cough;
  • the appearance of nasal congestion;
  • exacerbation of atopy (in my child, atopy first appeared on the background of AIT);
  • diarrhea;
  • headaches;
  • nausea and vomiting.

If reactions occur and pass on their own in the first 30 minutes after applying the medication, additional treatment is not necessary. If adverse reactions are repeated several times in a row, suspend AIT and contact an allergist to determine further actions.

Features of injection immunotherapy

  • treatment is carried out only by an allergist in a clinic where there is the opportunity to provide emergency assistance;
  • it is forbidden to conduct at home;
  • injections can be painful;
  • the application scheme at the stage of dose collection – 1 time per week, at the maintenance stage – 1 time per month (an
  • allergist can prescribe another scheme);
  • high probability of severe allergic reactions.

Side reactions:

  • redness and swelling at the injection site;
  • the appearance of nasal congestion;
  • headaches;
  • nausea;
  • weakness;
  • cough;
  • itching
  • an attack of bronchial asthma.

Reactions can occur both from half an hour to several hours, and the next day. The attending doctor should be aware of all side reactions without exception.

Types of allergies treated with AIT

Types of allergies treated with AIT

My little allergic person has a reaction to birch, cat and dust. As our allergist says, we are classic allergy sufferers. Three years ago in St. Petersburg they did not make AIT from cat hair. Now the situation has changed for the better. Although immunotherapy for animal hair is still not officially allowed in Russia, many allergists carry it with imported drugs.

To date, Russian allergists use Allergy immunotherapy to treat the following types of allergies:

  • allergy to pollen from the birch family;
  • for weeds – wormwood and ragweed (in 2018, the Danish drug Ragvisax was certified in Russia);
  • on meadow grass;
  • on a house dust mite;
  • allergies to pet hair and mold (allergists conduct immunotherapy for animal hair and mold, mainly using Spanish and German drugs);
  • stinging insect poisons (drugs are not officially certified, but can be found).

All over the world, immunotherapy is used to combat allergies:

  • the poisons of stinging insects;
  • on mold;
  • on the pollen of the birch family;
  • on weeds and wormwood;
  • on meadow grass;
  • on a house dust mite;
  • on pet hair.

What drugs are used for AIT

When we decided on therapy, we had to choose a drug that will be used for Allergy immunotherapy. Our main allergen is birch, and I have long chosen between the Spanish medicines Diater and the French Staloral. The decision was not easy. Spanish drugs are considered one of the best in the treatment of allergies, but I had to choose French ones, as they are easier to buy in our pharmacies.

Usually, allergens are used for immunotherapy, which correspond to the AU standard (Allergy units) developed in the USA, and the European BU standard (Biological units)

Quality drugs for Allergy immunotherapy are considered to be Spanish, French, Italian, German and Danish.

Less refined and worse quality Russian and Czech preparations.

French, Italian, Danish and Czech medicines for Allergy immunotherapy are certified in Russia.

There are several forms of products for AIT

Water- salt extracts

For the most part, these are drugs from Russian manufacturers. For example, the NPO MicroGen company produces injectable preparations of oak pollen, birch and other allergens.

This group also includes Kazakhstan medicines Antipollin for allergies to pollen from weeds and meadow herbs, wormwood, trees and house dust.  Antipollin  is registered as a dietary supplement.

Allergoids

Allergoids are chemically transformed allergens with low allergenic activity that cause a less pronounced reaction and reduce the likelihood of side effects. Allergoids enhance the body’s immune response. AIT can be carried out simultaneously with two types of allergoids as effectively as with one.

Each drug is completed with instructions, but the treatment regimen and minimum doses should be determined by an allergist.

Most imported drugs for AIT are allergoids.

Medicines of the Danish campaign ALK

  1. Aсarizax – an allergen of a tick of house dust (are allowed since 12 years).
  2. Ragvizaks – ragweed allergen (allowed from 18 years old).
  3. Grazax – grass pollen allergen (timothy grass) – allowed from 5 years.

Soon they promise to certify a birch allergen. All three drugs are available in the form of tablets that taste good and dissolve quickly in the mouth. Shelf life is 5 years. Do not store in the refrigerator.

acarizax

Medicines of the French campaign Stallergenes

Stallergenes produces a large number of different vaccines.

  • Allergens Staloral and Oraleur for sublingual ACIT;
  • Alustal and Fostal for similar AIT (Fostal is temporarily out of stock due to equipment upgrades).

staloral

 

 

Italian Lofarma

 

German Allergopharma

Allergopharma produces both injections and drugs for subligval ASIT. Allowed to take from 5 years.

Spanish: InmunoTek (Alxoid, Oraltek), Diater

There is a detailed article on Spanish products on the site.

 

Who needs Allergy immunotherapy

Treatment is prescribed by a doctor allergist only.

Immunotherapy is not prescribed to all allergy sufferers. First, for the appointment of AIT, an allergic person must have recurring allergy-related symptoms from season to season. For example, AIT can be prescribed to a child or adult with allergic rhinitis and cough, which can develop into mild or moderate degree of bronchial asthma.

Secondly, an allergic person should have a confirmed reaction to major proteins – inhaled (non-food) allergens. Since with the help of Immunotherapy it is possible to cure the reaction only to major proteins. AIT does not cure the reaction to minor proteins of the allergen alone.

In our country, immunotherapy is usually prescribed for children from 5 years old. But many Russian allergists, like their European сolleagues, can prescribe AIT from 4 or 3 years old if they see that the allergy is rapidly progressing.

Contraindications

Contraindications

Immunotherapy is not prescribed:

  • Allergies with a reaction only to minor proteins;
  • If there were severe allergic reactions to a previous course of AIT;
  • With atopic dermatitis without respiratory manifestations of an allergen;
  • With food allergies (for example, fish. This type of immunotherapy is still at the research stage)
  • People with autoimmune diseases (except for compensated thyroid diseases and type 1 diabetes)
  • AIT will be ineffective in immunodeficiency;
  • Therapy is not prescribed for allergic diseases in the acute stage (temporary contraindication);
  • Temporary contraindications for uncontrolled asthma;
  • Allergy sufferers with cardiovascular diseases (it is not possible to use adrenaline safely);
  • Patients with tuberculosis and rheumatism in an active form;
  • With impaired renal and hepatic function, hepatitis, nephritis;
  • With blood diseases;
  • Patients with mental disorders;
  • Until 2015, AIT was contraindicated in patients after 55 years. Now there is no age limit;
  • Allergy sufferers with cancer.

It is impossible to combine immunotherapy with the treatment of adrenoblockers (Atenolol, Lokren, Vazokardin and others).

ASIT cannot be combined with the use of certain antidepressants (Isocarboxazid, Befol, Fenelzin and others).

What tests to pass before immunotherapy

What tests to pass before immunotherapy

The list of tests should be prescribed by an allergist.

Here, I will simply list the list of analyzes, without details about why they are prescribed.

  • Analysis of minor and major proteins of the allergen (if you have a polyvalent allergy, then it is advisable to pass a complete analysis of ISAC allergy test / Allergo Expert 300 / ALEX);
  • thyroid hormones (ultrasound);
  • detailed clinical blood test;
  • biochemical blood test (total protein, total bilirubin, glucose, ALT, AST, LDH);
  • before ASIT injections: blood test for infections – syphilis, HIV, hepatitis B and C;
  • general urine analysis;
  • check the liver and pancreas;
  • Vitamin D;
  • ECG;
  • Function of external respiration (as directed);
  • endoscopic examination and consultation with an ENT doctor (if year-round runny nose);
  • Ultrasound

How and when do immunotherapy start?

Before starting the therapy, we completely had to change our usual life. With tears, we parted with the cat, threw out carpets and other dust collectors, carried out flowers, presented the neighbors with an aquarium, installed fresh air ventilation and arranged to clean the air. All this in order to stabilize the condition of the child.

Allergy immunotherapy begins in remission of an allergic disease. An allergic person should have good nasal breathing (if there are nasal polyps, then it is allowed to conduct AIT with them). An allergic person should not have asthma attacks (asthma control should be achieved).

If the problem cannot be solved with the nose, the doctor can start immunotherapy on the “snotty” nose.

The effectiveness of sublingual ASIT will depend on the total volume of the drug for one continuous course of therapy. Therefore, it is important to reduce the risk of any unstable conditions that may affect the continuity of medication.

It is difficult to track a comfortable dose of the drug if an allergic person has an exacerbation of chronic diseases. An organism in this condition can react sharply to the smallest amount of allergen.

The time to start immunotherapy depends on the type of allergy. AIT for pollen allergens – autumn, winter. For year-round allergens (house dust, animals, etc.) – all year round (if there are no contraindications).

If immunotherapy is done with injections, then you need to follow a diet. With the sublingual method, diet is not needed (if there is no reaction).

Schemes of AIT

There is no universal scheme for ASIT. In each case, the therapy is selected by an allergist.

Classical scheme

Immunotherapy according to the classical scheme – a gradual set and support for a comfortable dosage. In the period from 6 to 10 months without a break.

The total treatment period lasts from 3 to 6 years.

Classical treatment rarely gives side effects or complications. Therefore, there is no need for round-the-clock medical supervision.

If the drug is taken by the sublingual method, then the treatment takes place at home. Injections are done in the clinic.

Short scheme

A short-term AIT is carried out only in a station where the patient can receive prompt qualified help.
All methods of a short-term ASIT regimen are compatible with antihistamines.

Fast scheme

Injections 2 to 3 times a day;

Lightning

Rush – method.

The necessary dosage of an allergen is given in a short time after three hours in the normal parts with adrenaline.

Shock method

Injections of the mixture with the allergen and adrenaline are given every two hours during the day.

During AIT from venom of stinging insects, when therapy coincides with the time of their activity, antihistamines should be taken and bites should be avoided.

Each method, with the exception of the shock method, is carried out in two stages.

The first stage begins with the introduction of a small dosage of the drug, which will gradually increase to the optimum – tolerated.

At the second stage, the optimal – tolerated amount of the drug is administered regularly until the end of the ASIT course.

Dosage depends on the type and strength of the allergen, the method of administration and the individual reaction of the allergic person.

When immunotherapy is stopped

ASIT needs to be stopped for a while:

  • when high temperature;
  • during vaccination (more details below);
  • when severe reactions to treatment;
  • when exacerbation of bronchial asthma.

Sublingual immunotherapy may be interrupted in the following cases:

  • if there are wounds in the oral cavity (periodontitis, gingivitis, stomatitis);
  • if a tooth is lost or removed (wait until the wound heals).

When my child had loose teeth, the doctor allowed me to conduct AIT until the teeth fall out. If the break in therapy is less than 7 days, then you can continue taking medications according to the previous scheme (we stopped at what dosage, we start with that). If the break is more than one week, then the dosage should be discussed with the doctor.

AIT can be started again only with the permission of the allergist

AIT and vaccination

vaccination

Before vaccination, be sure to tell your doctor that you are planning an ASIT or are already being treated.

The doctor will find a solution on how best to do depending on the situation.
For example, if you are just planning to start AIT, then you can get the vaccine at least a month before the treatment.

If the vaccination time coincides with the set of the maximum dosage of the drug for ASIT, then it is better not to be vaccinated.

Vaccination can be done during the support course of Allergy immunotherapy, but provided that the immunotherapy was carried out without interruption for three or more years.

When AIT is performed by the sublingual method, the drug is stopped taking 3 days before vaccination, and treatment is resumed 2 weeks after vaccination.

For immunotherapy by injection, the scheme is determined by the allergist in each individual case.

Inoculating and taking the drug for AIT in one day is not recommended.

Allergy immunotherapy for children

Allergy immunotherapy for children

Usually, immunotherapy starts at 5 years old. The safety of ASIT for younger children has not been studied. Our allergist was not opposed to starting immunotherapy, on her own responsibility, to my son from 4 years old, since the child is at risk for asthma. But the allergy began in the baby from the age of 3, and for the appointment of AIT two observation periods are needed. Therefore, we postponed therapy until 5 years.

The doctor immediately warned me that for stable remission, the duration of therapy should be at least 3-6 years, as in adults.

Children are more often treated with AIT by the sublingual method. Since sublingual drops or tablets are convenient to use and they are safer. In addition, this method, unlike injections, injures the child’s psyche much less.

During AIT, parents should have a constant connection with the attending physician to clarify any issues. And there will be questions, I have no doubt about that 🙂

AIT during pregnancy and breastfeeding

AIT during pregnancy and breastfeeding

If a woman found out about pregnancy during immunotherapy, then AIT continues if:

  • the stage of prescribing the drug has been completed and the maintenance dose has been gained
  • the maintenance dose is well tolerated;
  • the sublingual form of AIT is used (drops or tablets).

The medicine does not cross the placenta, so the therapy is safe for the baby.

If pregnancy has occurred before AIT, then immunotherapy is not recommended. Since during ASIT, small doses of an allergen are deliberately introduced into the body, to which acute reactions can occur. For the relief and treatment of these reactions, drugs that are prohibited for pregnant women may be required.

For the same reason, pregnant women cannot continue AIT by the injection method, since the likelihood of acute allergic reactions during treatment with this method is higher than with sublingual.

The same rules apply to nursing mothers. You can not start AIT if a woman is just preparing to breastfeed. If the need for breastfeeding coincided with the successful completion of therapy, then AIT can continue and breastfeed.

Why therapy may not work

No need to take immunotherapy as a magic wand. We are all different, with our sets of allergens and symptoms. The task of AIT is not to completely eliminate the symptoms of allergies, but to reduce their intensity and reduce the number of drugs.

But there are times when Allergy immunotherapy may not work.

1. The diagnosis is incorrect
The most common cause of failure. Especially if a multivalent allergic person is diagnosed.

2. The body only responds to minor allergen proteins
Immunotherapy treats the reaction only to major allergen proteins. If the body responds to both major and minor proteins, the effectiveness of AIT is reduced. If the reaction is only to minor – AIT is useless. However, all this is true only for the present (2020). Research is underway and perhaps the situation will change soon.

3. Not enough time
Do not expect positive changes in the first year of ASIT – such cases are rare. Be patient for a few years.

4. Not enough medicine
If ASIT is carried out by the sublingual method, then the set of the desired dosage before the flowering season is critical.

 

Allergy immunotherapy
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