Erica Mills
Biology 1615
April 8, 2014
Allergy Immunotherapy Research Paper
Worldwide about 10% - 30% of people suffer from Allergic Rhinitis, otherwise known as
hay fever. Allergic Rhinitis is an allergic inflammation of the airways in your nasal passages.
This occurs when allergens, such as dust mites, mold, pollen, or animal dander is inhaled. In
people who suffer with Hay Fever, the allergen triggers the production of an antibody
immunoglobulin. This immunoglobulin binds to mast cells and basophils to produce histamine.
This will cause the person to sneeze, have itchy watery eyes, swelling and inflammation of the
nasal passages, and increased mucus production. There have been studies done that show that
immunotherapy has been effective in alleviating these symptoms.
In 1911 Leonard, Noon published a short paper that described his findings with allergenspecific immunotherapy using injections. In his study he used injections with short interval
dosage increases and then spanning them out longer for maintenance dosages. During this study
he also observed the reaction due to an over dosage or the allergen. This study suggested that
sensitization could be confirmed for immunotherapy for allergic rhinitis. This means that by
injecting a person with hay fever with allergens that they are specifically allergic to, in increasing
dosages, they can become immune. This would mean that people with hay fever could essentially
cure it, if not manage it.
Before starting Immunotherapy for Allergic Rhinitis you need to make sure you are a
good candidate for the injections. Allergy Immunotherapy is a serious and time consuming
process. Physicians try to control and treat the symptoms of hay fever first with OTC
medications, prescription medications, and isolation. If this does not work or is not viable,
meaning the side effects outweigh the benefits, then it is usually good practice to try allergy
immunotherapy.
Once it is determined that a patient is a good candidate, the physician needs to find out
the exact allergens you are allergic to. There are many different types of trees, grasses, weeds,
molds, animal dander, and dust mites that a person can be allergic to. This is determined by
performing a skin prick test. This test injects the patient with allergens under their dermis, the
first layer of skin, and is checked and ranked after some time. Each patient is mixed up an
individual vial of their serum to be administered. There is currently just one practiced protocol
for allergy immunotherapy. This is called the SCIT or Sub-Cutaneous Immunotherapy. There is
research currently being done for the SLIT protocol which is Sub-Lingual Immunotherapy.
For the SCIT treatment, the patient is usually administered a gradually increasing dosage
of their allergen extract until a “maintenance dosage” is reached. You will then continue on a
maintenance dose for about 3 years. The usually up dosing regimens are 12-16 weeks of weekly
injections and then 4-6 weeks of weekly injections of the maintenance dose. Although, there are
some cluster protocols which allow injections 2-3 times a week, this reduces the total time but
raises the risk of reaction. There are also rush desensitization protocols but they are used less
often. If you get pregnant, miss a dose, or have a bad reaction you may have to repeat a dose.
Most reactions occur within 20-60 minutes following the injection and it is standard practice to
keep the patient at the office for that time.
Only specialists with adequate knowledge and experience may perform SCIT. They must
be located in a clinical setting where cardiopulmonary resuscitation can be available if needed.
Most 12 week programs can be administered in an out-patient facility. All accelerated regimens
are administered under close supervision. SCIT can affect patients with allergies and can cause
fatal or near fatal anaphylaxis. SCIT is usually only administered to asthmatic patients if it is
well controlled and monitored.
The SLIT protocol was evolved from the SCIT protocol as a less invasive
immunotherapy. This is a newer protocol and is still undergoing testing, but the first signs are
positive. This involves putting the serum in either a solution or a tablet and placing under the
patient’s tongue for about 2 minutes, then having them swallow. This type of immunotherapy has
a smaller chance of serious reactions, such as anaphylaxis. The most common side effect is some
discomfort in the early stages of the procedure and can be treated with antihistamines. These side
effects usually diminish as the dosages are continued. The dosage timing is the same as the SCIT
protocol, although this is a new procedure and the optimum dosage, frequency, and duration of
the administration isn’t fully established. There have been positive studies that show that patients
were showing good results over one year after the treatment was stopped. This means that only
the first dose would need to be given while being observed, and the rest can be administered by
the patient.
There are also many different immunotherapy studies going on to help with other
ailments. There are protocols being researched to help people who suffer from insect allergies,
this is called VIT (hymenoptera venom immunotherapy). This can be used to save many people
from bad allergic reactions in the future. This desensitization is something that we’ve all
probably witnessed with medications such as ibuprofen. If you take it a lot, you need to take
more to get the same effect that you used to. The principles are the same with allergy
immunotherapy treatment. Medical science is constantly breaking ground for procedures to help
people. I am excited about the further development of the SLIT protocol since I am currently
undergoing the SCIT protocol. I think that it would be much easier and more convenient to not
have to get frequent injections and to be able to self administer the protocol at home.