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Specific immunotherapy, commonly known as desensitization, consists in giving the allergic person gradually increasing and then maintenance doses of the vaccine containing the allergen to which he is allergic. Applied at an early stage of the disease, it inhibits the development of allergic inflammation, prevents the onset of bronchial asthma and restores the patient’s proper reaction to an intolerant allergen.
– We observe the effects of allergen immunotherapy after only a few months. In patients with seasonal allergic rhinitis, it significantly reduces the severity of clinical symptoms and reduces the doses of antiallergic drugs taken – emphasizes Dr. Radosław Gawlik, allergist from the Department of Internal Diseases, Allergology and Clinical Immunology of the Medical University of Silesia in Katowice.
In the opinion of prof. Bolesław Samoliński, head of the Department of Prevention of Environmental Hazards and Allergology at the Medical University of Warsaw, desensitization is the only method of treatment that brings back symptoms of an allergic disease, including asthma. – It also prevents its further development – adds prof. Bolesław Samoliński.
One hundred years ago in London
For the first time, specific immunotherapy (SIT) was used in St. Mary’s Hospital for the treatment of patients suffering from pollinosis. Two British doctors – John Freeman and Leonard Noon were the pioneers of this method. Currently, it is used in the treatment of allergic rhinitis (allergic to pollen, house dust mites, animal hair), systemic allergy to wasp and bee venom, episodic and mild bronchial asthma and some forms of atopic dermatitis.
First research, then desensitization
Before starting desensitization, a causal relationship between the patient’s complaints and exposure to a specific allergen must be demonstrated. It must be confirmed by positive skin tests or serum specific IgE levels. This relationship can be easily demonstrated in some patients. For example, if the symptoms of rhinitis occur at the turn of April and May, it is highly probable that they are allergic to birch pollen – explains Dr. Radoslaw Gawlik.
Contraindication to desensitization are autoimmune diseases, cancer, tuberculosis, severe cardiovascular diseases (coronary artery disease, arterial hypertension), chronic infections, severe asthma, severe mental disorders, taking beta-blockers, severe atopic dermatitis, and lack of working with your doctor. Desensitization treatment is not started in pregnant women.
Long-term treatment
Immunotherapy can be started from the age of 5. In the initial phase of treatment, i.e. for the first 2-3 months, the patient must visit the allergist’s office every 1-2 weeks. He receives a subcutaneous injection containing an increasing dose of the allergen. – In some vaccines, the last dose of the allergen is even 10 times higher than the initial dose – emphasizes prof. Bolesław Samoliński. In the next phase of maintenance treatment, the vaccine is given 4-6 weeks apart over a period of 4-5 years.
After each injection, the patient must remain under observation in the doctor’s office for at least 30 minutes due to the risk of symptoms of rhinitis, conjunctivitis or asthma, skin rash, weakness and dizziness. In individual cases, it may even develop anaphylactic shock. – An anaphylactic reaction in the course of treatment occurs very rarely, but if it does occur, the patient requires immediate medical intervention, because it is a direct threat to life – emphasizes Prof. Barbara Rogala, head of the Department and Clinic of Internal Diseases, Allergology and Clinical Immunology of the Medical University of Silesia in Katowice, president of the Polish Society of Allergology.
Redness, itching or swelling may appear at the place where the vaccine was given, even several hours after the injection. You must report it to the doctor at the next visit. The patient must be informed by the patient about all medications taken by him, upcoming immunization dates, planned trips, and even a change of job or a move. For the first day after the injection of the allergen vaccine, you should not bathe in hot water, use the sauna, drink alcohol and exercise more.
Subcutaneous or sublingual vaccine
An intensive search for new ways of administering allergen vaccines has been carried out for many years. Those that would have the same efficacy and safety profile as the subcutaneous vaccine, but were more convenient for patients. The research interests are focused primarily on oral, sublingual and intranasal immunotherapy. Preparations for oral immunotherapy are already registered in Poland (they are not used in the treatment of insect venom allergy). However, due to the lack of reimbursement and high costs for the patient, this method is rarely used.
– Among the non-injectable routes of allergen vaccine administration, the sublingual route has gained the greatest recognition. Numerous studies of this form of immunotherapy have made it recommended by the European Academy of Allergology and Clinical Immunology in the treatment of adult patients suffering from seasonal allergic rhinitis – informs Dr. Radoslaw Gawlik.
Contrary to subcutaneous immunotherapy, which must be carried out in allergy clinics under strict medical supervision, in sublingual immunotherapy the patient uses the drug (tablets or drops) at home. This is how they heal, among others, French and Italians. Americans are much more skeptical of this method, which is why it has not yet been approved by the Food & Drug Administration, the equivalent of our Office for Registration of Medicinal Products, Medical Devices and Biocidal Products. Perhaps because its mechanism of action has not yet been fully understood. Or maybe due to the lack of hard data, it is completely safe. One thing is certain – in sublingual therapy, obtaining a clear clinical improvement requires the use of a very high dose of the allergen.
– There is no guarantee that when treating at home, the patient will strictly follow the doctors’ recommendations or that he will not overdose the drug – says Prof. Barbara Rogalska.
Text: Mariola Marklowska-Dzierżak
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