Comments on: Clarifying Misconceptions About Allergen Immunotherapy

By: House of Lords Reports on Allergy And Allergic Disease KIDS CHILDREN BABY

House of Lords Reports on Allergy And Allergic Disease KIDS CHILDREN BABY — Sat, 08 Nov 2008 12:25:34 +0000

[...] the disease burden for some allergies. Dr Lourdes de Asis has provided an excellent overview of allergen immunotherapy and reports that where it is used appropriately: Immunotherapy is successful in up to 90-95% of [...]

By: Dr. de Asis

Dr. de Asis — Wed, 06 Jun 2007 04:00:19 +0000

Thanks for the tip HCW! Yes, unfortunately I think it’s the same practitioner.I’ve linked the “Tragic Misinformation” post to Orac’s post so readers of that post can see what big business “neutralizing extracts” and “chelation therapy” can be.

By: MLO

MLO — Wed, 06 Jun 2007 02:46:02 +0000

Great post – one nitpick – “whare”? Should be “what” I think. Not saying my typing is perfect or anything!

Who on earth was arguing with you, an allergist, about immunotherapy? Do they not understand that it is a well-established and effective therapy for the majority of patients? Not me, but I’m odd. Allergist and I agreed to quit immunotherapy when I went into systemic reactions several times during treatment.

Pax,

MLO

By: HCW

HCW — Tue, 05 Jun 2007 15:57:07 +0000

Thanks again, that’s really helpful. I’ve seen this over at Respectful Insolence (Orac) – http://scienceblogs.com/insolence/2007/06/thars_gold_in_that_thar_chelation_1.php – would it be the same Dr Kalpana Patel you referred to in the ‘tragic example’ post?

By: Dr. de Asis

Dr. de Asis — Tue, 05 Jun 2007 14:27:16 +0000

Thanks for the comment Shinga and HCW. The clinical indications for allergen immunotherapy are listed in this table from the AAAAI Practice parameters (http://www.jcaai.org/PP/images/1TT5.gif) and as summarized below:
“Aeroallergen immunotherapy should be considered for patients who have symptoms of allergic rhinitis or asthma after natural exposure to allergens and who demonstrate specific IgE antibodies to relevant allergens. Evaluation of the patient should include a medical history and an appropriate physical examination. The severity and duration of symptoms also should be considered in evaluating the need for specific allergen immunotherapy. Symptom severity can be defined by subjective as well as objective means. In addition, specific allergen immunotherapy should be considered if the patient wishes to avoid long-term pharmacotherapy. Time lost from work, visits to the emergency department or physician’s office, and response to conventional medications are also important objective indicators of disease severity.

Patients with allergic rhinitis who can not sleep because of symptoms or whose daytime symptoms interfere with their work or school performance should be considered strong candidates for specific allergen immunotherapy. The effect of the patient’s symptoms on quality of life and the patient’s responsiveness to other forms of therapy, such as allergen avoidance or medication, should also be considered. Adverse effects of medication also should favor a decision to initiate allergen immunotherapy. Immunotherapy is usually not more costly than pharmacotherapy over the projected course of treatment.

Allergen immunotherapy for allergic rhinitis may have benefits that continue after immunotherapy is stopped. Preliminary results suggest that it may reduce the risk for the development of asthma in children.123,124,125,126 These benefits of immunotherapy should be discussed with patients and may provide a clinical indication for initiating immunotherapy in selected patients with allergic rhinitis.

Coexisting medical conditions should also be considered in selecting patients who may benefit from allergen immunotherapy. Patients with moderate or severe allergic asthma and allergic rhinitis should be managed aggressively with a combined regimen of allergen avoidance and pharmacotherapy; these patients may also benefit from allergen immunotherapy.6,7 Patients with severe or uncontrolled asthma may be at increased risk for systemic reactions to immunotherapy injections.150

Special Precautions in Patients With Asthma
Summary Statement 18. Patients with severe, poorly controlled asthma are at higher risk for systemic reactions to immunotherapy injections. (C)

Patients with severe, poorly controlled asthma are at higher risk for systemic reactions to immunotherapy injections than patients with stable, well controlled asthma.132,150 One survey found that deaths from immunotherapy were more common in symptomatic (as compared with asymptomatic) patients with asthma.136″

Patients who are mentally or physically unable to communicate clearly and patients who have a history of noncompliance may be poor candidates for immunotherapy. If a patient can not communicate clearly with the physician, it will be difficult for the patient to report signs and symptoms, especially early symptoms, suggestive of a systemic reaction.

Pstients with poorly controlled asthma or have lung capacity less than 1.5 L are generally not considered for AIT except under extreme circumstances. Patients who cannot comply with the AIT schedule should also not be considered since adherence to the schedule is necessary for therapeutic success.
I hope this was helpful, if you need more info, please let me know.

By: HCW

HCW — Tue, 05 Jun 2007 08:14:24 +0000

Thanks Dr. de Asis. Are there particular patient groups for whom you would recommend AIT and, equally, patients who should avoid it? It is a treatment that is very difficult to access in the UK, so most of us don’t know who should or shouldn’t be considering it.

By: Shinga

Shinga — Mon, 04 Jun 2007 22:31:37 +0000

This is very timely for a number of reasons, Dr. de Asis. I’m grateful that you’ve put up such a clear account of the issue because there is so much misunderstanding around it.

Regards – Shinga