Immunotherapy With Dr. David Fischer
Prevention and Treatment An allergist gives answers to our most common questions during allergy season.
Antihistamines can treat some of the symptoms caused by allergies, but more severe symptoms will likely require treatment with topical medications such as nasal sprays and eye drops. An allergist can also provide immunotherapy for those failing the medication plan or wishing to avoid an ongoing need for medication use.
Mediaplanet: How can I tell if I’m having a cold or allergy symptoms?
David Fischer: Some symptoms that people with allergies get are similar to colds, but there are some things to potentially tell them apart. Despite the term “hay fever,” fevers and chills are absent with allergies but present with colds. Allergy symptoms will continue for weeks, whereas cold symptoms will clear up within a week. The symptoms of runny nose, cough, fatigue and itchy eyes could accompany either diagnosis, but itching deep inside the ears or of the palate (roof of the mouth) typically points more to allergy as a cause. If someone tries an allergy medication —other than Benadryl and without a decongestant — a positive response is also suggestive of allergy, as they do nothing for colds
MP: What are the benefits of seeing an allergist vs. using over-the-counter allergy drugs to control my symptoms?
DF: Seeing an allergist can help settle whether the symptoms are from allergy in the first place. Once allergens are identified, avoidance strategies can be discussed as well as a medication plan put together. Antihistamines can treat some of the symptoms caused by allergies, but more severe symptoms will likely require treatment with topical medications such as nasal sprays and eye drops. An allergist can also provide immunotherapy for those failing the medication plan or wishing to avoid an ongoing need for medication use.
MP: What is immunotherapy and what is the difference between subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT)?
DF: Immunotherapy is the process whereby the allergen someone is allergic to is reintroduced to the allergic individual either subcutaneously — under the skin as a needle (SCIT) — or more recently in Canada as sublingual tablets (pills under the tongue) called SLIT.
In both instances, the allergen is presented to different types of immune cells than the ones in the nose and eyes. Terms like “desensitization” refer to the process that increasing the dose via needles helps someone gradually acclimatize to the specific allergens chosen.
Both styles have been shown to provide symptom relief but the risk profile differs.
SCIT can cause red itchy arms and there is a 1/1000 risk of anaphylaxis — a potentially severe systemic allergic reaction — to the injection. It generally requires multiple weekly needles to get to a maintenance dose and is meant to run for three to five years.
SLIT is a daily tablet under the tongue for months at a time. There's a 1/10,000 risk of anaphylaxis, with the first dose to be administered in a physician’s office and the other doses taken at home. Its most common side effect is an itchy mouth or throat that subsides over time. SCIT can be done for quite a number of allergens, but SLIT in Canada is only approved for grass, ragweed, and dust mite. Although the dust mite tablets have received approval, the tablets are not yet available.
MP: Will immunotherapy help permanently eliminate my allergies?
DF: For patients who embark on immunotherapy and benefit from it — not all do — a significant proportion of patients doing SCIT or SLIT will have sustained unresponsiveness after stopping the process after three to five years of use. That improvement can be life-long, but some people will eventually backslide. SCIT and SLIT, however, are the only allergy therapies that have this possibility.
MP: What else can I do to survive allergy season — lifestyle changes or home remedies?
DF: There have been many suggestions as to home remedies for seasonal allergies often revolving around local bee products like honey or pollen. It sounds like the SLIT story, but bees mainly collect the pollens of flowers — which people are not allergic to — so it’s unlikely to benefit anyone. Additionally, I have seen anaphylactic reactions to pollen (Royal Jelly is especially troublesome). During the season, it’s recommended to not hang laundry outside, use air conditioning to your advantage to keep windows closed, and change the furnace filters. Swimming outside can also significantly worsen symptoms so it would be advisable to wear goggles and nose plugs to avoid getting pollen lying on the surface of the water directly into your nose and eyes.