Allergen Immunotherapy – Desensitization
Allergen immunotherapy is a causal treatment for allergies that gradually trains the immune system to tolerate specific allergens, providing long-term relief from allergic symptoms.
Things worth knowing about "Allergen Immunotherapy"
Allergen immunotherapy is a causal treatment for allergies that gradually trains the immune system to tolerate specific allergens, providing long-term relief from allergic symptoms.
What is Allergen Immunotherapy?
Allergen immunotherapy (AIT) – also referred to as desensitization or hyposensitization – is the only disease-modifying treatment available for allergic conditions. Unlike symptomatic treatments such as antihistamines, AIT directly targets the immune system and induces lasting changes in how the body responds to specific allergens. It is used to treat allergic rhinitis, allergic asthma, insect venom allergies, and certain food allergies.
Mechanism of Action
In an allergic reaction, the immune system overreacts to harmless environmental substances known as allergens (e.g., pollen, house dust mites, insect venom). Allergen immunotherapy works by administering gradually increasing doses of the relevant allergen to help the immune system build tolerance. Key immunological changes include:
- Production of blocking IgG antibodies that dampen the allergic response
- Reduction of allergen-specific IgE antibodies responsible for immediate allergic reactions
- Promotion of regulatory T cells (Treg cells) that establish immunological tolerance
- A shift in the immune response from a Th2-dominated (allergic) to a Th1-dominated profile
Forms of Allergen Immunotherapy
Subcutaneous Immunotherapy (SCIT)
Subcutaneous immunotherapy involves injecting the allergen under the skin in increasing doses. Treatment is divided into a build-up phase with weekly injections and a maintenance phase with injections every 4 to 6 weeks. The total duration is typically 3 years. SCIT is the longest-established form of AIT and is considered the gold standard for insect venom allergies.
Sublingual Immunotherapy (SLIT)
Sublingual immunotherapy delivers allergens in the form of drops or dissolving tablets placed under the tongue. This approach can often be self-administered at home, making it more convenient for patients. It is widely used for pollen and house dust mite allergies. Treatment duration is also at least 3 years.
Indications
Allergen immunotherapy is recommended for:
- Allergic rhinitis (hay fever) caused by pollen, house dust mites, or mold spores
- Mild to moderate allergic asthma
- Insect venom allergy (e.g., bee or wasp venom) – potentially life-saving in cases of severe anaphylaxis
- Food allergies (e.g., peanut allergy) – conducted in specialized centers under close medical supervision
Who is a Suitable Candidate?
AIT is generally suitable for children aged 5 years and older, as well as adults. A confirmed allergy diagnosis through skin prick testing and/or specific IgE blood tests is required before starting treatment. Contraindications include severe uncontrolled asthma, certain immune disorders, initiation during pregnancy, and the use of certain medications such as beta-blockers.
Side Effects
Local reactions at the injection site, such as redness, swelling, or itching, are common and usually mild and self-limiting. Systemic reactions – including hives, asthma attacks, or in rare cases anaphylactic shock – can occur. For this reason, SCIT must always be administered under medical supervision, with patients observed for at least 30 minutes after each injection.
Treatment Success and Long-Term Effects
Clinical studies demonstrate that a successfully completed course of AIT leads to long-term reduction of allergic symptoms, even after treatment ends. Furthermore, AIT can prevent the progression from allergic rhinitis to asthma and reduce the risk of developing new sensitivities to additional allergens. The full benefit of the therapy is often not felt until 1 to 2 years into treatment.
References
- Pfaar O. et al. - Guideline on allergen-specific immunotherapy in IgE-mediated allergic diseases. Allergo Journal International, 2014.
- World Allergy Organization (WAO) - White Book on Allergy, 2013. Available at: www.worldallergy.org
- Global Initiative for Asthma (GINA) - Global Strategy for Asthma Management and Prevention, 2023. Available at: www.ginasthma.org
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