Trees. Cats. Dust. Grass. These are just a few of the things that can give us allergies. In fact, between thirty and forty percent of Americans suffer from allergies to some extent, and more than fifty million people use medication or see doctors about their allergies every year.
As an Ear, Nose, and Throat doctor, I am very interested in allergies. I see people with congestion, stuffy nose, drainage, sneezing and itching eyes every day. Some of those patients have other associated problems, like sinus infections or asthma. Getting a handle on these allergies can improve people’s lives immensely. I know, I am a former allergy sufferer myself.
“What’s that?” you ask. “A FORMER sufferer? Tell me more!”
Let’s talk about allergy shots, otherwise known as immunotherapy. Basically, that means injecting small amounts of whatever you are allergic to under the skin. The way your body processes the injections causes your immune system to make what are called “blocking antibodies,” which prevent the allergic reaction. My patients usually start to see some improvement after a few months and get to their best improvement in about one and a half to two years. If we stop the shots then, however, the immune system stops making the blocking antibodies. We get much better, lasting relief if we give shots for about five years.
Sounds great? It is, but there are some details that make it a little tricky.
First, our immune system can recognize and become allergic to up to TWO MILLION different complex molecules, like proteins. TWO MILLION.
Obviously, I am not going to test anyone for two million things. In fact, as a practical matter, we have to limit our testing to about fifty. We call the things for which we are testing ANTIGENS. So, we have chosen a panel of antigens that we have found by experience to be prevalent around here, including dust mites, dogs, cats and other critters, as well as some specific molds, grasses, weeds and trees that are common in the PNW. That’s the first thing. You need to get tested by a doctor who knows your environment. I test for different things than someone would in, say, Tucson.
Let me add that, since it is the antigens which we INHALE that are the most important for the type of patients I treat, I don’t do testing for food allergies or insect stings.
Anyway, the testing is done by scratching the surface of the skin or injection into the skin. That’s the best way for a couple of reasons.
First, it really tests the way you respond to the actual antigen. The stuff is literally purified, sterile, ground up bits of tree pollen. Or dog dander. Or what have you.
Secondly, the size of the reaction tells us how concentrated we can safely mix your shots. Blood tests, since they can only test reactions to a single protein, can miss allergies and they also do not reliably tell us how concentrated to make shots.
Once we know what things you are allergic to and how severe the reactions are, we can make up a recipe that will work to desensitize you to those things. We start with a weak mixture, and it takes about three months of weekly shots in the office to get you up to your plateau dose. After that, most patients choose to do their own shots at home or you can continue to come in weekly.
Because occasional reactions occur, everyone on shots needs to have an EpiPen®.
With regular shots, about 90 percent of our patients get significant improvement. I sure did!
Sometimes people really can’t do the shots, for various reasons. Immunotherapy can also be done with daily (at home) under-the-tongue drops. They don’t work quite as well, with only about 75-80 percent of patients showing improvement. And those who do improve usually don’t have quite as much improvement as our shot patients. Also, many insurance companies will not pay for the drops, so people have to pay out of pocket.
I could go on and on about allergies, but make an appointment and come see me if you want to learn more!