With all of the talk about peanut immunotherapy these days, you'd think that the cure for these life-threatening allergies was right around the corner. While there is no quick fix, immunotherapy in one of the various forms may well be a viable option for treatment of food and environmental allergies.
As my son has acquired more allergies over the years, even with "total avoidance," I've been looking into immunotherapy recently. Although I'm not a physician, I'll share with you my "lay moms" understanding of some of the different types of immunotherapy.
When a person has allergies of any kind, the immune system behaves as if an innocent substance (pollen, peanut, pet dander) is a threat, and the body's response to this threat can be anything from watery eyes or a runny nose, to anaphylactic shock. Ideally, immunotherapy re-teaches the immune system to become less sensitive to these everyday substances.
There are several kinds of immunotherapy available including subcutaneous immunotherapy, oral immunotherapy, and sublingual immunotherapy. Let's take a brief look at each one.
SCIT is an acronym for subcutaneous allergen immunotherapy. SCIT is what is commonly referred to as "allergy shots" and is the most common form of desensitization treatment in the U.S. Specially prepared doses of antigens (the substances you're allergic to) are injected, and the amounts are increased over time until the patient is desensitized. Here in the U.S., allergy shots are used for environmental, seasonal or venom allergies, not for food allergies.
Oral Immunotherapy or OIT has gotten a lot of media attention lately as a potential "cure" for peanut allergy. Oral immunotherapy is done by steadily exposing patients to minute quantities of the allergen (for example, peanut in a carefully prepared powder) over months or even years, gradually increasing the amount of the allergenic substance over time. Oral immunotherapy is considered a promising treatment for food allergies, although there are serious risks and this treatment should never be tried at home.
SLIT is an acronym for sublingual immunotherapy. This treatment is similar to shots in that the prescribed antigen is given in increasing doses in an effort to desensitize the patient over time. A major difference is that the allergen extract is given to the patient in drops (or tablets) under the tongue (sublingual means "under the tongue.") This therapy is commonly used in Europe and may be an option for children or those who are needle phobic. Like allergy shots, SLIT often takes three to five years to reach the full effect; however some patients start to benefit from this treatment within a few months.
Although many of the antigens used for SLIT are FDA approved for allergy shots (SCIT), when used sublingually, this treatment is not yet FDA approved, which means that most insurance companies will not cover the price of the drops. Experts estimate that about twenty percent of all drugs prescribed in the US are "off-label" so it's not uncommon for drugs to be prescribed this way.
SLIT is not homeopathy. The antigen doses are meticulously prepared but are much higher than in a homeopathic formulation.
Which of these immunotherapies is available now? You may be surprised to know that all of them are although you may have to travel to take advantage of them.
I did an informal poll of some of my allergy mom friends across the country. Several have had their children treated with allergy shots with good results. The common thread was that it was somewhat inconvenient to go to the doctor's office. One mom I know has been giving her son shots at home. The downside to shots, (besides the needle) is that they cannot be used to treat food allergies.
I have a friend in Texas whose son is being treated by his allergist with oral immunotherapy. She adds an egg powder to fruit punch and her son downs the equivalent of one whole egg each day. Within a few months, he had "passed" a challenge to egg only to suffer anaphylaxis when he consumed egg while he was sick with a cold. They backed down the amount of egg powder after that and gradually started to increase it again. He is able to consume all egg products now but will only consume them when they are baked or cooked into foods like pancakes, cupcakes or cookies. He does not like the taste of scrambled or hard boiled eggs so he takes the egg powder daily to maintain his tolerance. His mother reports that it's been worth everything they've been through not to have to worry that he'll suffer anaphylaxis from a trace exposure.
Another friend in Pennsylvania, has started her son on sublingual immunotherapy drops. After only eight months, she is very pleased with the results. He has been able discontinue some (but not all) of his asthma medications. His recent blood work showed a significant drop in his total IgE levels as well as food specific scores so she is hopeful that in the long run, this treatment may help with some of his food allergies as well.
It's up to every individual to determine their level of comfort with any potential treatments. Each type of immunotherapy carries some degree of risk and the travel and expense for some types of treatment may put them out of reach for many. I will share with you that last month, we began sublingual immunotherapy for my son. So far, he's had no side effects. It literally takes about six seconds total per day so it's perfect for an allergy mom's busy schedule. Now if I could only find a six second treatment for his messy bedroom!
Published On: October 01, 2009