You have been referred for an allergy consultation with a physician who specializes in the diagnosis and treatment of allergies. Your visit to the Center will include a detailed medical history, physical exam, and possible testing to determine if you suffer from allergies. These tests may include skin testing, blood tests, and breathing tests called Spirometry. Your allergists will determine if these tests are needed after a full review of your medical history and physical exam. Please plan on spending a minimum of one hour at the Center.
One of our physicians may order a skin test to determine what you are allergic to. A skin test is a test that measures your level of IgE antibodies in response to certain allergens or triggers. Using small amounts of solution that contain different allergens, the physician will either inject under the skin or apply the allergens with a small scratch. A reaction would appear as a small red area. A reaction to the skin test does not always mean you are allergic to the allergen that caused the reaction. This will be determined by your physician.
Skin testing is usually not performed on children who have had a severe life-threatening reaction to an allergen or have severe dry skin (eczema).
What is Immunotherapy?
Immunotherapy is a treatment used to relieve allergy symptoms of hay fever or allergic asthma by administering injections of substances such as pollens, mold spores, dust mites, animal danders or insects to which an individual has been found to be allergic by skin testing. The mechanisms of its effect are the subject of ongoing research. However, immunotherapy initiates processes that seem to “turn off” the abnormal immune reaction that we term “allergy”.
When an allergic person is exposed to an allergenic substance (such as cat dander), he or she may develop symptoms of sneezing, runny nose, nasal congestion, watery eyes, chest tightness or wheezing. Various cells that line the nose and the airways actually release chemicals termed mediators that cause these symptoms. An inflammatory reaction accompanies this process and leads to persistent symptoms. Immunotherapy probably works to interfere with the actions of these cells and to thereby diminish the effects of the chemical mediators that cause allergic symptoms.
How are injections given and for how long?
During the build-up phase, increasing doses of allergy injections are given once or twice a week until a predetermined target or “maintenance” dose is achieved. This usually takes 4-5 months (18-24 visits). Once this maintenance dose is reached, shots are usually administered every 1-3 weeks over the ensuing several years of treatment. Clinical improvement with immunotherapy usually occurs in the first year. In a small percentage of patients, there is no improvement and, in this case, immunotherapy is discontinued. However, if symptoms do improve, injections are usually continued for at least 4 to 5 years of maintenance therapy. At that time, you and your doctor will make a joint decision about whether to gradually taper and discontinue injections or to continue treatment.
Reactions to Immunotherapy
Local reactions (swelling, itching or tenderness to the site of the injection) may occur in most patients receiving injections. These local reactions usually subside in a day or less. Large local reactions and generalized (systemic) reactions may occur in 1-5% of patients receiving allergy injections and usually occur during the build up phase, although they can occur at any time during the course of treatment. These reactions necessitate a dosage adjustment. These generalized reactions may consist of any or all of the following symptoms: itchy eyes, nose or throat, runny nose, nasal congestion, sneezing, tightness in the throat or chest, coughing, or wheezing. Also, some may experience lightheadedness, faintness, nausea and vomiting, hives and, under extreme conditions, shock. Reactions can be serious but rarely.
Allergy injections must be administered at a medical facility with a physician present, since occasional reactions may require immediate therapy. As an added precaution, you must wait in the medical facility where you receive you injection at least 30 minutes after each injection so that in the event of generalized reaction you can be quickly treated and observed, thereby decreasing the likelihood of a more severe reaction. Patients must wait 60 minutes after receiving insect venom injections.