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Allergy immunotherapy, immunotherapy, "allergy shots" or "allergy vaccines" refer to the induction of resistance to a certain trigger for allergy through the gradual exposure to increasing amounts of the same trigger.
Inhaled allergen immunotherapy (in example to pollen of the olive tree) has been used for decades. When the doctor diagnoses in example allergic rhinitis and decides that the patient's best treatment is with "vaccines", he must inform the patient about a number of facts: it is a long treatment that has two stages, as follows.
It is important to note that this therapy is not suitable for those who can not comply with this schedule. For the decision to proceed, the patient should consider the risk of local reactions (swelling and pain in the arm, the place of injection), itchy rashes, rare events of shortness of breath. It is important to note that very rare and extreme reactions may occur such as anaphylaxis: a life-threatening condition with choking, blood pressure fall and rashes and that even deaths have been described in the medical literature. Having said that, immunotherapy treatment is a routine treatment that under the right conditions is safe. However, the therapeutic load and logistics and the risk of adverse effects dictate to consider other treatments before considering immunotherapy.
About food allergies, induction of oral desensitization has been used for some years in a number of medical centers in the world, including in Israel and though it is still considered an investigational treatment, the significant experience and impressive results accumulated are encouraging. In this treatment, the food allergic patient receives, during several hours and some days in the hospital, increasing doses of the food to which he is allergic while the allergic effects are treated, so after a few days a threshold of tolerance is reached. The patient will continue to receive this dose of food at home for about a month (again, while treating any adverse reaction, if at all). A month later, a repeat hospitalization is made in order to increase the dose and establish new threshold. Thus that after 3-4 months on average, a state of food tolerance is reached. In other cases the patient can at least raise the threshold for reaction so that the risk of allergy due to food contamination with the allergenic food decreases. This is by itself very important because it lowers the risk of life-threatening reactions.
Pregnancy is a very important consideration when selecting drugs, not to cause damage to the developing fetus.
There are various medications prescribed in several categories: some have been demonstrated to be safe during pregnancy and others have not shown evidence of fetal damage but have neither demonstrated complete safety. In these cases, the decision of the physician is derived from the balance between benefit against risk.
In the anti-histamine category, the following drugs may be safely used in pregnancy:
Chlorpheniramine, sold as Ahiston.
Loratadine, sold as Loratadine, Lorastin, Allergyx.
Cetirizine, sold as Zyllergy, Histazine.
As per the physician's judgment inhaled corticosteroids for asthma and allergic rhinitis corticosteroid spray may be used. Most of the experience accumulated to date indicates that these treatments are safe.
About systemic corticosteroids (oral, intramuscular injection or intravenous), the decision of using them follows the medical judgment of benefit against risk.
Immunotherapy is not started during pregnancy but a woman undergoing an immunotherapy treatment that becomes pregnant may continue with the treatment.
Corticosteroids, also called glucocorticoids, steroids or "cortisone" are very useful drugs in treating allergic reactions. Corticosteroids work directly in the nucleus of cells, in the pathways participating in the inflammatory response of allergic, thus reducing the allergic reaction. Corticosteroids are used in the following ways:
Local Treatment
Systemic "whole-body" Treatment.
EpiPen is an auto-injector containing adrenaline. EpiPen is an emergency treatment in cases of life-threatening allergic reaction (with difficulty in breathing, choking, drooping blood pressure). Patients at risk for these reactions should be equipped with an EpiPen auto-injector at any moment and need to know how to use it (injection into the thigh muscle, training by an allergist or by the doctor who prescribes EpiPen). At the same time that the EpiPen is injected the emergency services should be called as immediate evacuation to the nearest emergency room is imperative, because even if the patient improves after EpiPen injection, there may be a worsening in the next few minutes.
Along with the release of histamine, other molecules are released during allergic reactions, among them leukotrienes. Leukotrienes are responsible for part of the inflammatory response of allergy.
A group of allergy drugs, leukotriene receptor blockers, prevent the activation of this inflammatory response by leukotrienes.
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