Finding relief from allergies

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allergy shotThe prospect of weekly shots might send most kids running for the most convenient hiding place, but not 9-year-old Molly McGrady, who bounded into St. John's Allergy and Asthma Clinic with a smile on a recent Thursday afternoon.

"It doesn't hurt," Molly said of the weekly allergy shots she has been receiving for about a year. "I kind of look forward to it because my mom usually gives me a piece of candy afterwards."

The long-term benefits will be even sweeter, said her doctor, Gregory Lux.

"Allergy shots are like a vaccination program," said Lux, a board-certified allergist working at St. John's allergy clinic. "It desensitizes you to things that cause your allergies."

 

Effective treatment against allergies

During the treatment, called allergen immunotherapy, a patient is injected with diluted doses of substances called allergens — such as mold, pollen or animal proteins — that cause an allergic reaction.

Increasing doses are used and, over time, the patient's body learns not to react to the allergens carried in the shot.

After three to four years of immunotherapy, most patients will have developed significant tolerance. It also has been shown to prevent development of new allergies and can prevent children with allergies from developing asthma.

Immunotherapy is generally very effective at treating allergies to seasonal allergens such as pollen and indoor allergens such as dust mites and pet dander that cause allergic rhinitis — often called "hay fever" — and asthma.

Allergies to insect stings can also be treated effectively, Lux said, but food allergies currently cannot be treated with shots.

Shot therapy is not recommended for anyone younger than 5, those with moderate or severe asthma that is not controlled with medication, or anyone taking beta blockers for heart problems.

Despite the name, immunotherapy may not grant total immunity to allergens, Lux said. "But hopefully you're protected from common exposure. ... So if you responded to a pollen count of 100 before, after shot therapy you could handle a pollen count of 1,000 without problem."

First step: determine your allergens

The first step in long-term allergy treatment is a skin test, which helps the patient's doctor pinpoint the substances causing allergic reactions.

The test is relatively painless and can be done on patients of any age.

"We test babies and we test people in their 80s and 90s, because allergies can occur at any age," said Lux, who developed an allergy to dust mites in his 30s and went through immunotherapy a few years later.

Two types of skin test are commonly administered.

In the first, called a prick or scratch test, the doctor uses a disposable plastic applicator to scratch small amounts of purified allergen extract into the surface of the skin, usually on the patient's shoulder or forearm.

Applicators with multiple tips are often used when testing babies or young children, allowing the doctor to administer the test quickly and with little pain. Single-tipped applicators are used on adults, allowing for greater accuracy.

"Either one of those will give you a quick test for bad allergies," said Lux. "They just itch a little — it's a little tiny needle you hardly feel."

The second type of test, called an intradermal or syringe test, can be used if the results from the prick test are unclear. The doctor uses a small syringe to inject the allergen extract just under the surface of the skin. The syringe test is more time-consuming but also more accurate because the increased dose of allergen used can detect mild allergies or those caused by highly-concentrated exposure.

Positive reactions to either type of skin test manifest as raised bumps, similar in appearance to a mosquito bite.

"It itches, it stings a little bit, and it fades over the next hour," Lux said.

The winter season often is a good time to have testing done, because seasonal allergy sufferers are less likely to be taking oral antihistamines to control their symptoms, said Barrett Lewis, an allergist at Ferrell Duncan Clinic.

"Oral antihistamines will reduce the reaction from a skin test," which can lead to a false negative response, Lewis said. To reduce the chance that patients won't react to problem allergens, he recommends that they stop using oral antihistamines about a week before a skin test.

A recent skin test Lux administered to Orville Mulkins highlighted the 66-year-old's sensitivity to dust mites and several weed families.

Mulkins, who lives in Mountain Home, Ark., said he decided to get tested after his asthma and other allergy-related respiratory problems began to flare up several months ago.

"We're trying to figure out what it is he breathes in that causes it," Lux said.

Lux administered a syringe test on Mulkins' forearms because an earlier scratch test was inconclusive.

Mulkins' allergy to dust mite proteins — the No. 1 indoor allergen — was the likely culprit for his chronic problems, Lux said. The microscopic vermin establish themselves in fabric and upholstery.

Mulkins' recent symptoms likely occurred after constant exposure left his respiratory system irritated and vulnerable.

"This allergy has been there a long time, but it's allowing other things down in his chest," Lux said. "And if you live with dust-mite allergy for 10 or 20 years, you're likely to develop asthma."

Shot treatment can reduce that chance by about 50 percent, he said.

Kimberly Russell, of Nixa, started immunotherapy in February after experiencing similar chronic illness.

"I had a lot of allergy problems," Russell said. "The thing I was mainly allergic to was mold, but also some trees and grass ... pretty much everything but cats and dogs."

As a result of near-constant exposure, Russell suffered from chronic sinus infections, bronchitis and even pneumonia. She decided to start immunotherapy after finding out she was asthmatic as well.

Seven months into therapy, she's already noticed improvement.

"It's made a considerable difference in my asthma, and I haven't had a sinus infection since January," she said.

Next step: get your shots

Once an allergist has determined the substances to which a patient is allergic, a cocktail of allergen extracts is created for injection.

Shots are generally given once a week during the first three to six months, called the build-up phase, during which increasing concentrations of serum are used.

A strict, once-every-seven-days schedule is not necessary, as long as a shot is received at least once every 14 days.

"You can miss a week," said Lewis, from Ferrell Duncan Clinic. "But if you're talking about missing three weeks we'll probably have to delay moving up to the next dose."

The patient reaches the maintenance stage once the maximum dosage is reached, then the frequency of shots is gradually reduced to once or twice a month.

"The goal now is to get to as high a dose as quickly as possible, so you can do two years of maintenance and get it over with," Lux said. "And the stronger the dose, the longer they last."

Only doctors should give the shots

In the past, some patients were allowed to administer shots at home, but current guidelines disallow home immunotherapy because of the possibility of an allergic reaction to the higher dose concentrations being used.

"It's not the frequency of reactions, but the possible severity of the reaction," said Lewis.

Local reactions such as redness or swelling at the site of the injection are fairly common.

Systemic reactions are relatively rare, but can include increased allergy symptoms such as sneezing, nasal congestion or hives.

In rare cases, a patient may experience anaphylaxis, which can cause swelling of the throat, nausea, dizziness and other symptoms.

For that reason, shots should only be given at a doctor's office, where patients are asked to wait 20 to 30 minutes after an injection for monitoring.

Lewis and Lux said their staffs also check patients for allergy symptoms before administering a shot.

"You have to be careful that they're not having breathing problems or blood pressure problems," said Lewis. "Asthma that's out of control on a given day is another reason not to give an injection that day."

Maintenance is no big deal

After completing a three- to five-year program, the majority of patients won't need additional immunotherapy for a decade or more.

"I went back on them seven years later because they wore off on me," Lux said. "I took them another four years and hope they'll last for 20."

A reduction of symptoms is usually experienced by the time a patient has completed the build-up phase, but may take as much as a year on the maintenance dose.

"It's usually about six months before you expect to see some improvement," Lewis said. "The thing to keep in mind is that it's not going to help after two and three injections."

Trevor Sturges, 13, has been taking allergy shots for about two years and now comes to Lux's office every two weeks for a maintenance shot.

Ragweed, dust and mold were the main things causing him problems, but Sturges, who is active in football, basketball and golf, said he rarely has allergic reactions now.

"I thought (football season) would be bad, but he didn't have one bad day," said Trevor's mother, Patti Sturges. "When he can lay in the grass and not sneeze and cough, that's a real improvement."

Laramy Hankins, 12, said he occasionally gets dry eyes and a stuffy nose from his ragweed allergy, but nothing like the symptoms he experienced before starting immunotherapy three years ago.

"I used to be so bad that if I took a five-minute nap I couldn't open my eyes when I woke up," he said.

He now comes in just once a month for shots, which "are no big deal."

"Your arm can be a little sore later, if they stick the muscle the wrong way," he said. "But they've only done that once in, like, forever."

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I wish I could be convinced by this article. However, it doesn't cover any alternative treatment view. The only proposed treatment is shots, shots and shots. And in 10 years or so - correct, more shots.