Ashley Tobalsky

Allergen Immunotherapy
Allergen immunotherapy is established through a series of shots that contain certain pure

allergens at an increasing level in order to desensitize the patient and achieve life-long relief of

allergy symptoms. Patients eligible for this treatment are those who suffer from year-round

allergies, have controlled allergy-induced asthma, are allergic to bee stings, or can’t find relief

for seasonal allergies through prescription medications.

The practice of allergy-specific immunotherapy of desensitization dates back to 1911. At

the St. Mary’s Hospital in London, England, two doctors, Noon and Freeman, successfully

treated hay-fever sufferers by injecting them with pollen extracts. The practice continued to be

used even thought it was very controversial and unpopular. In 1986 the British Medical Journal

published a report cautioning against the use of immunotherapy in general practice and cited 26

anaphylactic deaths over 30 years. The deaths were a result of inappropriate treatment in patients

with uncontrolled asthma. The newly introduced risks of death led to even more controversy and

higher need for regulation of the practice. New regulations were soon introduced calling for

careful patient selection along with stricter observation periods, greatly reducing all risks of

death.

The recent episodes of death related to allergen immunotherapy include the death of a 13-

year old girl who received her last allergy injection in May of 1998. She died from anaphylactic

shock within 20 minutes after her injection because no one had stopped in to check on her.

Shortly after that case a 41-year old mother died, also from severe anaphylaxis reaction.

However, she was checked on, but the tiny clinic just didn’t have the correct treatment options

available (Putman and Badzek, 2005).

 These episodes, along with others, pushed for higher guidelines to be set by the American

Academy of Allergy, Asthma and Immunology (AAAAI) and the American College of Allergy,

Asthma and Immunology (ACAAI). These guidelines are established by board-certified

specialists in allergy and asthma treatment, and also other personnel who practice under the

direct supervision of allergists (ed. Cox, 2007).

The revised and currently used procedure begins when the patient finds an allergy

specialist that will recommend the treatment. Qualified patients with asthma should have

symptoms under control. Allergy tests are given to determine what the patient is allergic to and

which allergens will need to be included in the vile for each shot. This is done through either a

skin prick test or a blood test. The next step involves the patient’s insurance company’s

willingness to cover the cost of the treatment; whether they see it as necessary or experimental.

Once all is settled, treatment may begin. Depending on the clinic, the patient may receive

“traditional” treatment (conventional allergen vaccination) or “rush” treatment (rush allergen

vaccination). Rush treatment completes the first nine months of traditional treatment in one day.

Numerous shots are given in increasing doses while time is taken between each to supervise.

After the initial day it takes about two additional months to build up to the maintenance level. It

makes for a long day and a lot of exposure to allergens, but it saves money, about nine months to

a year of shots with the traditional treatment, and some studies prove that it’s safer.

A study of rush allergen vaccination (RAV) was presented at the annual meeting of the

American College of Allergy, Asthma and Immunology, Nov. 19, 2001 in Orlando, Florida. It

was done by several doctors, led by Dr. Smits, of allergy and asthma clinics in Indiana. Rush

treatment was tested on 137 patients, male and female ranging from ages 2-68 years old. They all

had a history of allergies and/or asthma, and patients with a history of anaphylaxis were
excluded. They were pretreated with prednisone and antihistamines up to two days before the

RAV.

The results showed some mild systemic reactions such as headache, abdominal pain,

dizziness, itchiness, chest/throat tightness, cough and shortness of breath; all of which are

consistent with the Conventional Allergy Vaccination (CAV) and easily treated with epinephrine,

prednisone, or other medications (Smits et al., 2003). Overall RAV proved more efficient and

also safer than CAV because of the pretreatment. The extended observation periods allow any

reactions to be recognized and treated immediately. A time period ranging from half an hour to a

full hour are taken in between sets of injections in order to watch for local (swelling around area

of injection) and general (itchiness, runny nose, tightness of chest/troublesome breathing)

reactions. If a significant reaction is noticed, treatment is given, injections may be stopped or the

dosage of the injection may be steadied instead of increased.

There is a wide range of costs for prescription drugs for the treatment of asthma and

allergies. The price of a daily dose generic antihistamine for one month, without a deductable

from insurance, is about $70. For a corticosteroid nasal spray, used everyday for a month, would

be $102 without a deductable from insurance. And if you have asthma along with your allergies,

you will also need a daily inhaler that can cost about $184 for a months worth of daily doses

without a deductable from insurance. This adds up to $356 per month; $4,272 per year, and don’t

think you won’t need it for the rest of your life. In fact, you may need to increase your doses as

time goes by.

Allergen Immunotherapy takes between three and five years to complete. After the first

or second year the majority of patients are able to wean off of their prescription allergy and

asthma medications. The first year of allergy immunotherapy injections has been estimated to
cost $800 for the initial year, and $170-$290 for subsequent years of maintenance therapy

depending on the number of antigens and vials required (Fineman, MD., 1999). According to

this, you can either pay thousands of dollars every year for prescriptions for the rest of your life

or you can pay hundreds of dollars over a five year period and then ultimately be done with all

costs of prescriptions and immunotherapy.

A study was done by doctors at the Division of Allergy, Department of Pediatrics, at

Cumhuriyet and Cukurova University’s Faculty of Medicine in Adana and Sivas Turkey. The

objective of this study was to evaluate the effect of one year of house dust mite immunotherapy

on the concentrations of three different immunologic markers. The effect on asthma symptoms

was also compared with medication treatment. The patients included 31 mite-allergic, asthmatic

children ranging from ages 6-16 years old. 19 were treated with allergen immunotherapy and the

other 12 were controls, treatment was the usual prescription medication (Cevit et al., 2007).

The results showed a significant improvement in asthma and allergy symptoms in the

patients undergoing the allergen immunotherapy. In the control group no improvement was seen

and their level of asthma and allergy symptoms remained constant.

As far as the risks and benefits of allergen immunotherapy we have learned that there are

indeed serious risks of this treatment that could lead to death if untreated. We also recognize that

these risks are easily avoided if guidelines and regulations are followed. The benefits of allergen

immunotherapy are exceptional as far as overall cost, no longer needing to pay for prescription

medication; and efficiency, potential of allergies being completely cured is high. If children are

treated early it could prevent new allergies from developing and also stop the onset of asthma.

And lastly, it is often found that the overall quality of life in patients treated with allergen

immunotherapy is improved resulting from a strengthened and more efficient immune system.
 Ashley Tobalsky
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