Allergen Immunotherapy

Question 1

How does allergen desensitization work?

Answer 1

Allergy shots work by administering increasing amounts of allergen in an attempt to alter the abnormal immune response to that allergen and relieve symptoms.

Generates IgG blocking antibodies that cover the antigen and block it from binding with IgE.

May stimulate regulatory T cells to down regulated the response to that allergen.

Question 2

Most common aeroallergens

Answer 2

Tree pollens
Grass pollens
Weed pollens
Animal danders
Dust mites
Molds
Cockroach

Question 3

Indications for allergy immunotherapy

Answer 3

• failure of medical and avoidance therapy
• Symptoms are secondary to the allergen in question AND skin or serum testing to the allergen is positive
• Allergy symptoms interfere with daily life
• For children with allergic rhinitis, therapy may decrease the development of asthma

Question 4

What disorders respond to subcutaneous injection immunotherapy?

Answer 4

• Allergic rhinitis + allergic asthma
• allergic asthma
• allergic rhinitis (+/- allergic conjunctivitis)
• allergic reactions to hymenoptera venom (insect)

Question 5

What are two factors when selecting patients for allergy immunotherapy?

Answer 5

Duration of allergic disease- new onset symptoms are more likely to resolve than lifelong symptoms

More likely to respond to treatment id asthma is triggered by allergens (vs. viral infections or exercise)- it all comes down to history.

Question 6

CI of allergy immunotherapy

Answer 6

• severe asthma and patients on a beta blocker
• patients with certain autoimmune diseases
• pregnancy (do not initiate but can remain on therapy)
• -HIV disease—> pts should be greater than 5 yo, must be reliable for follow up.

Question 7

Allergy immunotherapy dosing schedule (3 phases)

Answer 7

build up phase-
-1-3 injections per week for several weeks
maintenance phase-
-injections every 2-4 weeks
duration of therapy-
-3-5 years

Question 8

How to administer allergy immunotherapy

Answer 8

subcutaneously int the upper arm.
do not rub- it will increase absorption
concentrations vary person to person, start low and work up

Question 9

Tips for allergy immunotherapy administration therapy

Answer 9

• remember the 5 rights
• inquire about any health changes
• obtain peak flow before and 30 min after
• remain in clinic for 30 min post injection to monitor for side effects
• no vigorous exercise 1-2 hr before or after injection
• have crash cart ready

Question 10

What are some adverse reactions to allergy immunotherapy?

Answer 10

• Local (redness, pruritus, swelling)
• -treat common with ice, oral antihistamines
• -treat large induration with oral sterois, NSAIDs, oral antihistamine
• Systemic
• -range from mild rhinitis to fatal cardiovascular collapse
• -usually occurs within 30 min
• -treat with tourniquet above injection site, epi

**if significant reaction, consult with allergist

Question 11

Factors associated with fatal reactions

Answer 11

• uncontrolled asthma
• history of previous systemic reaction
• delayed treatment with epi
• dosing errors
• administration of pollen serum during peak pollen season
• beta blockers, ace inhibitors

Question 12

What is more effective- venom or allergy immunotherapy?

Answer 12

venom immunotherapy!

Question 13

Venom immunotherapy measures what?
Chronically elevated levels mean what?
what is the duration of the therapy?

Answer 13

baseline serum tryptase

• baseline levels >11.4 ng/mL may indicate a most cell disorder
• chronically elevated levels predict more severe reactions to stings, more frequent treatment failure, and great risk of relapse after stopping therapy.

Duration is 5 years or indefinitely