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Allergy Immunizations

Three dark figures, masked and robed in black, hover over the steaming cauldron. They slowly move around chanting foreign words like alternaria, hair of cat, Timothy grass, and weeds from rags. Finally, the mixture stops boiling. The custodians of the secret mixture wait for the brew to cool before it is ladled into little bottles. Is this how allergists get their vaccines?

Of course not! But modern allergic treatment, termed immunotherapy, or allergy shots, is frequently misunderstood and, in truth, confusing. Let's set it right. Treatments of allergies are no more secretive than any other aspect of medicine. Since allergy shots have been around for almost 80 years, much is known about them. We now know how and why they work. We also know what is the best material to use and the best way to treat patients. Allergy shots have come a long way since the early 20th Century when allergy materials had to be made by the allergist—not quite like the opening paragraph of this article, but they were still crude mixtures. In this article, you will learn why allergy shots work, how they work, what improvements have been made, and what the future will bring to help allergic patients.

What is an Allergy?
What is an allergy? Allergies occur when a person reacts adversely to something most people tolerate. For example, most of us can eat eggs, but a certain group of allergic individuals have trouble if they eat eggs. This trouble can be hives, rashes, swelling of the tongue and mouth, asthma, or even shock, and very rarely, death. So allergies can be serious. Allergies can be from things we eat, things we breathe, and things we touch. The simplest approach is to avoid what makes us sick. That is the best treatment—don't eat eggs, in our example.

Avoidance and medications
But when it comes to allergies caused by substances we breathe in, they are very hard to avoid. Ragweed, a plant that produces lots of pollen, blooms in late summer and early fall. The pollen blows into people's eyes, noses, and lungs, causing allergy-induced hay fever, allergy-induced asthma, allergy-induced ear and sinus diseases, and even allergy-induced eye disease, called allergic conjunctivitis. (Looks like pink eye, but itches.) Ragweed is a seasonal allergy as are grass and tree pollens. But there are all-year or perennial substances that cause allergies. Examples are house dust mites, house pets, molds, and even cockroaches.

Immunizations
So we have avoidance, then we add medications, and when we want to use our own bodies to protect ourselves against allergies, we have allergy shots. Sometimes this has been called allergen immunotherapy; other times desensitization, but most people know it simply as allergy shots. By that we mean giving small amounts of the material that had been positive in the skin tests. So it is really important to first find out what you are allergic to. That is where the allergist enters the picture. Simple, not painful, and completed usually in two visits, skin tests define your allergies. Based on the skin tests, an allergy extract is prepared, not as in the opening witch's brew, but using standardized, purified, safe reagents that are controlled and approved by the FDA. (Food and Drug Administration.) We are most fortunate as we begin the new century that we have strong controls and measures of efficacy so that we know the material you receive in an injection is effective as well as safe. Allergy shots begin with small doses and gradually increase in strength until a maximum or a maintenance dose is reached. Patients start to feel better as the maintenance dose is reached. It varies from patient to patient and, therefore, your allergy specialist cannot tell you exactly what is the dose when symptom relief occurs. The most commonly used schedule is injections given once or twice a week. Sometimes injection rates are accelerated, or evenly dramatically accelerated, and immunotherapy can be accomplished in a matter of days. This is called rush immunotherapy and is something you may want to discuss with the allergy specialist. It is not for everyone.

Allergy-shot frequency
So now you are on allergy shots and you begin to feel better. Not only are your symptoms disappearing, but your need for medication is shrinking as well. At this time, your allergist will suggest spacing the shots out from weekly to every two weeks and eventually to once a month, and sometimes even up to six weeks apart. From recent research, it looks like you need to take allergy shots for a minimum of three years and then you may be protected for three or more years after the injections are discontinued. This study was done only using grass pollen, and when you have more complex allergies, the time for all or most of your symptoms to disappear may be different. Again, this is something to discuss with your own allergist since every patient is not the same.

Can You Eliminate Your Allergy?
So now you know something about allergy shots and how we use them, but what happens in your body to make your allergies go away?

When we give allergy shots into the tissues, the immune system recognizes the allergen in the shot and actually makes antibodies to what is being injected. For example, ragweed vaccine (a common cause of hay fever in the fall) is injected in small amounts and gradually increased. The immune cells make antibodies to ragweed, and these antibodies can even be measured. There are a lot of other changes that occur in the immune system as well. When ragweed enters the body through the nose or lungs, these new antibodies compete with the IgE (the bad guy) allergy antibodies for the ragweed particles or their breakdown products. When the new (blocking) antibodies meet the ragweed, the body disposes of it like garbage, without making you sick, while the old (IgE) antibodies don't have a chance to cause the allergic symptoms. In time, the whole immune system undergoes a shift from making IgE, (think bad guy) to antibodies of the good kind that do not cause allergies. This is why you stay well for years after allergy shots stop. The good guys have won.

Conclusion
So what's in the future? Allergy shots are improving—the material used in your injections as well as the dosing techniques. We also know that there will be another kind of antibody produced through genetic engineering that will seek out your bad IgE and neutralize it. This is the star wars defense for allergy diseases. It may revolutionize treatment. While star wars may be coming in the future, your allergy battles need to be won today, and immunotherapy-allergy shots, an old and reliable treatment, is there with a new face and a new army of fighters to make your allergies come under control and enable everyone to lead a healthier and happier life.