Allergy Shots (Allergy Immunotherapy)

What is Allergen Immunotherapy? 2. How does Immunotherapy work? 3. What are the concentration of allergens used? 4. What is the dose schedule of the allergens used? 5. How Should I Prepare for Allergy Shots? 6. Is Immunotherapy really effective? 7. Is immunotherapy effective for all allergens? 8. What should one expect after allergy shots? 9. In how much time I will get relief after starting allergy shots? 10. Is Immunotherapy safe for children? 11. I am pregnant, can I have immunotherapy? 12. How long should I continue taking allergy shots? 13. How can I know about my allergy profile? 14. I am afraid of injections. Is there any other way? 15. Are there any recent advances in Immunotherapy? 16. What is the cost of allergy shots? Allergy shots also called immunotherapy were once considered as the last resort and were lesser preferred treatment for allergic disorders like allergic rhinitis and asthma. But the result of the latest study by Imperial College School of Medicine in London show that Allergy shots may offer long term and sustained benefit. "They may never relapse into symptoms as severe as what they had originally," Samantha Walker, one of the study's authors told The Associated Press. "In carefully selected patients, this form of treatment is extremely effective." The researchers said their findings and other studies suggest that starting immunotherapy sooner after an allergy appears, particularly in children, could prevent the allergy from becoming severe and prevent development of additional allergies. Here are answers of the questions which you may ask about Immunotherapy.
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What is Allergen Immunotherapy?

Allergen immunotherapy is a form of asthma treatment aimed at decreasing your sensitivity to substances that cause allergic attack. These substances are called allergens. Allergy testing is done to identify the offending allergens. Vaccine is prepared against these allergens. Shots of vaccine are given subcutaneously twice weekly for few months, slowly the duration is increased to one month. This is continued for 4 to 5 years.
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How does Immunotherapy work? Allergen immunotherapy desensitize your to specific allergens. Vaccine is given subcutaneously in gradually increasing doses. Body responds by developing an immunity or tolerance to the allergens. As a result of these immune changes, immunotherapy can lead to decreased, minimal or no allergy symptoms when you are exposed to the allergens included in the allergy vaccine.

What are the concentration of allergens used? After knowing your allergy profile, a diluted solution is made of allergens for which you are most susceptible. This is known as vaccine. Usual starting concentration is 1:5000 (one part allergens and 5000 part diluents). The concentration is later increased to 1:500 and then 1:50 as vaccination progresses.
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What is the dose schedule of the allergens used? Initially about 09 doses of 1:5000 vaccine are given twice a week in increasing volume. Starting dose is usually 0.1 ml increased by 0.1 ml each time to 0.9 ml. Then 1:500 dose is started with the same dose schedule. After completion 1:50 conc. is started. Total of 9 doses are given at weekly interval. Next 9 doses are given at 15 days interval. Then maintenance dose is started at 0.9 ml to 1.0 ml once a month for 3 to 5 years.

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How Should I Prepare for Allergy Shots? For two hours before and after you are given allergy shot, do not exercise or do vigorous activity. Exercise stimulate increased blood flow to the tissues and may promote faster release of antigens into the bloodstream. This can cause allergic reaction or even anaphylaxis.
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Is Immunotherapy really effective? If the selection of the allergens are correct, the therapy schedule is followed the therapy is usually effective. The allergens (specially pollen/ plants) which are selected must be those that are found where you live.
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Is immunotherapy effective for all allergens? The effectiveness of immunotherapy varies depending on the severity of a person's allergies and the number of substances to which the person is allergic. Immunotherapy is usually effective for allergies to stinging insects, pollens and dust mites, fungus and moulds. It is also effective for pet dander. Immunotherapy is not recommended for hives or food allergies, as it's efficacy is not proved.
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What should one expect after allergy shots?

Redness, swelling and irritation at and near the site of the injection is normal. These symptoms usually go away within 4 to 8 hours after receiving the allergy shot. Usually, the patient is monitored for about 30 minutes after receiving an allergy shot to make sure that they don't develop side effects such as itchy eyes, shortness of breath, runny nose, or tight throat. If they develop these symptoms after leaving the doctor's office, they should take an antihistamine and go back to doctor's office or to the nearest hospital or emergency center.
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In how much time I will get relief after starting allergy shots? Relief usually starts during first year of treatment. But best results only come in 2nd year. By the end of third year people are usually desensitized to the allergens present in the vaccine.
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Is Immunotherapy safe for children? It has been found that a child of five year can take allergy shots. This is the youngest recommended age to start immunotherapy in the United States Immunotherapy in young age can prevent allergies from worsen during later life. They also prevent development of new allergies.
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I am pregnant, can I have immunotherapy? A number of reports have appeared describing immunotherapy without apparent adverse effects on human pregnancy. Though anaphylaxis during pregnancy is a potential risk for mother and fetus. Patients already receiving immunotherapy may be maintained at their current level or at

somewhat reduced doses. However it is generally advised not to begin immunotherapy during pregnancy.
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How long should I continue taking allergy shots? Usual span of allergy shots is five years. But this may be increased if patient lives in highly allergic environment. Allergy shots many times cause significant reduction in the symptoms of asthma or allergic rhinitis, causing reduction in requirement of medicines. Patients who are benefited may continue vaccination for longer periods.
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How can I know about my allergy profile? Allergy testing is done to know to which substances person is allergic to.
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I am afraid of injections. Is there any other way? Oral immunotherapy is now available. Oral immunotherapy works in the same way as allergy shots by giving increasing doses of allergen to gradually build up a person's tolerance. The allergen extract is taken as drops, usually placed under the tongue for about 2 minutes and then swallowed. These drops can be taken at home.
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Are there any recent advances in Immunotherapy? In addition to the traditional allergy shots, several new immunotherapy procedures have been proposed, many are still in experimental stage:

Rush immunotherapy: This approach involves a more rapid, or rushed, build-up to the maintenance dose of extract. During the initial phase of treatment, increasing doses of allergen are given every few hours rather than every few days or weeks. There is a greater risk of a side effects with this approach. That is why rush immunotherapy is usually done in a hospital under close medical supervision. In some cases, pre-treatment with medications can reduce the risk of an allergic reaction during rush immunotherapy. Enzyme potentiated desensitization (EPD): Enzyme potentiated desensitization, also called low-dose immunotherapy. Very small doses of allergen are used along with an enzyme called beta-glucuronidase. EPD is can be used to treat a broad range of allergens without the need for weekly shots. This includes allergies to foods, which generally are not successfully treated with traditional allergy shots.
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What is the cost of allergy shots? Before you go for allergy shots one must have allergy testing to know about the allergens he or she is allergic to. The initial skin test costs around $1000 in USA. Most insurance companies cover 60% to 100% of the cost. It also depends on what type of allergens you are being tested for (house dust mite, foods, grasses, pollens etc). In India allergy testing costs $ 30 for Intradermal test to $ 100 - 250 for blood test called a radioallergosorbent test (RAST). A series of allergy shots in USA will cost approximate $1,480 to $2500 after six years. Researcher Timothy J. Sullivan III, MD, of Emory University, calculated that the patient would pay $800 for the first year of allergy shots (the most expensive year). In following years, when allergy shots are done monthly or even less frequently, those costs drop to between $290 and $170. Over six years patient can save $1,300 to $2,900 with allergy shots then with drugs for the same period, that study shows.