It is the most effective method in the treatment of allergic rhinitis, allergic asthma, allergic conjunctivitis (eye allergy) and bee allergy. Today, the only treatment modality that has the potential to stop the progression of allergic rhinitis to asthma is allergen-specific allergy vaccine. With allergy vaccine, a treatment approved by the World Health Organization (WHO) by allergists, allergic diseases can be stopped and their progression can be prevented.
Allergy vaccine therapy (Immunotherapy) is based on a century-old idea that our bodies can be desensitized to certain allergens that trigger allergy symptoms that stimulate the immune system. Allergy vaccines (immunotherapy) caused by the controlled and regular administration of allergens are the most effective method in the treatment of allergic rhinitis, allergic asthma, allergic conjunctivitis (eye allergy) and bee allergy.
In allergic rhinitis, the best treatment method that eliminates the complaints of the disease is vaccine therapy (immunotherapy), as well as the only treatment method that can prevent the progression of the disease and the development of asthma.
Allergic Diseases Treatment
In the treatment of allergic diseases, it is necessary to avoid the allergen that disturbs the patient and to apply protection methods. In addition, although drug therapy is important when necessary, it is seen that the most effective method of treatment is immunotherapy. No matter how much we try to be careful, it may not be possible to avoid allergens. However, allergy vaccine has an important place in the treatment of allergic diseases since it does not change our allergic sensitivity in the drugs we use outside of the precaution.
While common allergy medications often control symptoms; If you stop taking the medications, allergy symptoms will return after a short time. Allergy vaccine can permanently eliminate allergy symptoms seen during allergic attacks and play a preventive role in the development of asthma or the emergence of new allergies.
Allergy vaccine may reduce sensitivity to allergens and then cause the symptoms of allergy to disappear permanently, usually after treatment is over.
How is the effect of Allergy Vaccine (Immunotherapy)?
Allergen-specific immunotherapy (IT) has been defined in many ways, including other terms such as hyposensitization and desensitization.
With the allergy vaccine, immunoglobulin E (IgE) mediated allergic diseases caused by allergens in the immune system are controlled. It is an immunomodulatory treatment method that reduces sensitivity to allergens, and increasing doses of antigen (allergen) are given to eliminate the immune response that causes allergy.
In allergy vaccines, the patient is initially given low doses of the antigen of the allergen that causes allergies, then higher doses are increased, and IgG antibodies (blocking antibodies) are formed in the immune system instead of IgE antibodies that cause allergies.
Considering the long-term effects of allergy vaccines, there is a decrease in the release of inflammatory mediators, a decrease in specific IgE (sIgE) levels and a decrease in allergen-specific airway hypersensitivity, and clinical improvement occurs with all of these. By causing changes in the balance between cells that cause allergies and their activities, it provides the cell-mediated immunity necessary for a protective immune response against the development of allergy/asthma.
After the application of allergy vaccine in allergic rhinitis and asthma, it is seen that the complaints decrease and the need for medication decreases accordingly. In the skin prick tests we use in the diagnosis of allergies, it is also seen that the response is reduced, that is, the sensitivity to the allergen that causes allergy disappears over time. There is also a decrease in stimulation (provocation) tests performed with allergens.
It is known that allergic rhinitis progresses over time and turns into allergic asthma. Although the drugs used in the treatment are effective in eliminating the complaints, these drugs do not change the course of the disease, that is, they do not prevent the progression of allergic rhinitis to asthma. Allergy vaccines are the only treatment that can change the course of the disease. Many studies show that allergen-specific immunotherapy has the ability to treat allergic disease and has a long-term protective effect.
Allergy vaccines have been shown to prevent sensitization to new allergens, especially when administered in childhood. In people with allergic nature, allergic sensitization increases over time, and there is an increase in sensitivity to allergens such as pollen, house dust, mold or cat and dog allergens that did not cause complaints before. Although the complaints start seasonally in those with pollen allergy, over time, sensitivity to house dust, mold or other allergens may begin and complaints may continue throughout the year. Therefore, the allergic response is reduced with allergy vaccines, and the development of sensitivity to other allergens can be prevented.
The selection and dosage of allergens in allergy vaccines are very important for efficacy. Insufficient amount of allergen or vaccination with unsuitable allergen reduces the effectiveness of immunotherapy. Therefore, allergy vaccination should be made by allergists (allergists) who are trained in this subject.
Who Can Benefit from Allergy Vaccines (Immunotherapy)?
Allergy vaccine therapy involves injecting the patient in increasing doses of allergens that cause allergy symptoms. It is appropriate to start the treatment after determining the appropriate allergens and concentration together with allergy skin tests and other examinations performed by allergists.
Studies have shown that allergy vaccines can be effective in the following diseases:
- Allergic asthma
- Allergic rhinitis and conjunctivitis
- Insect Allergy (Bee Allergy)
- Atopic dermatitis (in some groups)
Allergy vaccines have been shown to be most effective in allergic rhinitis, asthma and bee allergy. Apart from these, there are studies showing that it has an effect on patients with atopic dermatitis as well as house dust mold or pollen allergy.
Currently, immunotherapy is not recommended for food allergies, and although research on oral desensitization for food allergies continues in the United States, strict avoidance of the food that causes allergies is currently recommended.
Although allergy vaccines are not generally recommended for children under the age of 5, it is appropriate to be evaluated by pediatric allergists. Allergy vaccine, which can be started after the age of 5, can be safely administered in adult ages. In elderly patients, other diseases such as heart disease should be evaluated first and a decision should be made accordingly.
The following situations may be considered by the allergist and the patient in the initiation of allergy vaccinations.
Length of allergy season and severity of symptoms
To what extent medications and/or environmental controls are sufficient to control allergy symptoms
Long-term desire to not use drugs or to get rid of side effects related to drugs
The patient’s readiness for treatment (allergy vaccine treatment is initially weekly and then monthly) to be able to adapt adequately to long-term treatment
Evaluating the cost / benefit ratio between the negative impact of allergies on work and school life and the cost of vaccines and drugs
After considering all these, it would be appropriate to start allergy vaccinations.
How are allergy vaccinations (Immunotherapy) done?
When a decision is made about whether to be treated with allergy vaccine (Immunotherapy), it is also necessary to determine how immunotherapy will be performed. Allergen-specific immunotherapy can be applied in different ways (subcutaneous, sublingual, oral, nasal, bronchial, and lymphatic), but nowadays only studies on subcutaneous (SCIT) or sublingual IT (SLIT) have shown sufficient efficacy. Therefore, it is used routinely. Immunotherapy can be given subcutaneously (SCIT) and sublingually (SLIT) or in tablet form.
Allergy vaccine administered subcutaneously under the skin is now widely used. Sublingual sublingual drop vaccines have begun to be abolished, and tablet-form vaccines have taken their place. Tablet-form vaccines can only be made for grass pollen, as is also used in our country, and do not contain other pollens or molds or cat and dog allergens. In Europe, house dust allergy, vaccines in tablet form have been developed and are currently not available in our country.
In allergy vaccines, your body is given a certain allergen in gradually increasing doses to develop immunity or tolerance against the allergen.
There are two stages in subcutaneous subcutaneous vaccines, which are widely used in our country;
Initial phase: At this stage, allergen is given to our body with injections containing an increasing amount of allergen, once to twice a week. The length of this phase and how often the injections will be given may vary according to the patient. However, it usually takes between 2 and 6 months. At the end of the initial phase, it is aimed to reach the highest allergen concentration we can give.
Maintenance phase. This phase begins when the effective dose is reached. The effective maintenance dose is adjusted according to the level of your allergen sensitivity and the least possible side effects. The maintenance phase, dose intervals range from two to four weeks, and the duration of treatment will be as long as 3-5 years. Your allergist will decide what range is best for you.
Effectiveness in allergy vaccines occurs with the start of the maintenance phase. During the maintenance phase, you may notice lessening of symptoms, but it is necessary to take a maintenance dose for at least 12 months to notice an improvement. If allergy vaccinations are successful, maintenance therapy should generally continue for 3 to 5 years. It is appropriate to decide to stop allergy vaccinations by consulting an allergist. It should not be forgotten that the complaints will return when the vaccine is stopped in patients whose complaints have decreased after 12 months.
Allergy vaccines have been shown to reduce many allergic complaints. It can also prevent the development of new allergies and the progression of allergic rhinitis from allergic diseases to asthma. The effectiveness of allergy vaccines seems to be related to the length of the treatment program, as well as depending on the allergen selection and dose. If you have not seen improvement after 12 months of maintenance treatment, it would be appropriate to be re-evaluated by allergy specialists.
Failure to Get Adequate Response in Allergy Vaccines May Be Due to Several Factors;
- If insufficient dose of allergen is applied in allergy vaccine
- If there is a missing allergen not detected during allergy assessment
- You are exposed to high levels of allergen
- Significant exposure to non-allergic triggers, such as tobacco smoke, chemical irritants
- In these cases, allergy vaccines should be re-evaluated.
What is the Risk of Allergy Vaccines (Immunotherapy)?
Allergy vaccine therapy should be performed by allergist physicians equipped with appropriate personnel and equipment to identify and treat reactions that may develop after injections. Ideally, immunotherapy should be administered in hospitals or centers where an allergist is available.
Is There a Risk?
The allergen extracts contained in allergy vaccines are standardized by preserving their active structure after appropriate processes. In order for immunotherapy to be effective, it is necessary to reduce the side effect profile and increase the immune system stimulation power in allergen solutions prepared at high doses with preserved antigenic properties.
Although the occurrence of side effects is reduced in allergy vaccines, a typical reaction may be redness at the injection site and swelling at the injection site. This can happen immediately after treatment or a few hours later.
Some patients may experience symptoms such as sneezing, nasal congestion or urticaria after allergy vaccinations.
Serious reactions to allergy vaccinations are rare. Systemic reactions caused by allergens given in allergy vaccines require urgent medical attention. Symptoms of an anaphylactic reaction may include swelling of the throat, wheezing or chest tightness, nausea and dizziness. The most serious reactions develop 30 minutes after allergy injections. For this reason, it is recommended that you wait in the presence of your doctor for at least 30 minutes after allergy vaccinations.
When an allergic reaction occurs, it can be eliminated with early intervention. Such reactions can be seen more especially in bee allergies. It is more common in the initial phase and less frequently in the maintenance phase.
If pregnant patients are receiving allergy vaccine and have no problems with maintenance doses, it is appropriate to re-evaluate it by allergists and to continue the vaccine treatment after dose adjustment. It is not appropriate to start allergy vaccine in pregnant patients. It is more appropriate to discontinue allergy vaccinations that are in the initial phase.
Who Can Do Allergy Vaccine (Immunotherapy)?
Although allergy vaccines are the only treatment method that can change the natural course of the disease, if it is not done correctly, it may cause allergic reactions or problems by not changing the progress of the disease.
Allergy vaccines are a long-term treatment of 3-5 years and the patient’s complaints should be controlled during this time. If there is an increase in symptoms or allergic reactions due to the vaccine, the treatment should be rearranged or discontinued. As a result, it is extremely important that it is done by allergy experts who are trained in allergies.
In order to become an allergy specialist, after completing their education in the department of internal diseases / pediatrics / chest diseases and dermatology in our country, they must receive training in the allergy department, which is a minor branch above the main branch, for 3 years after passing the allergy senior specialization exam. Allergy specialists are entitled to receive their diplomas as an allergist after receiving training in the diagnosis and treatment of all kinds of allergic diseases.
In allergy vaccines, which are the most effective treatment in allergy diseases, it is the duty of allergy specialists to choose the right allergen and start with the right doses, and then follow up.
As a result;
Allergy vaccines (immunotherapy) are the most effective method in the treatment of allergic rhinitis, allergic asthma, allergic conjunctivitis (eye allergy) and bee allergy.
Allergy vaccines are the only treatment that can change the course of the disease.
In allergy vaccines, your body is given a certain allergen in gradually increasing doses to develop immunity or tolerance against the allergen.
Today, only subcutaneous (SCIT) or sublingual IT (SLIT) application is performed.
Allergy vaccines that can be started after the age of 5 are the most effective treatment that can be applied in adult ages.
Treatment with allergy vaccines should be carried out by allergist physicians equipped with appropriate personnel and equipment.
Allergy Specialists (now called Immunology and Allergy Diseases Specialist) are doctors who have received special training in asthma and allergic diseases seen in those older than 18 years of age, and have received an Immunology and Allergy Specialist diploma and are also Internal Diseases or Chest Diseases or Dermatology Specialists.