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Allergy Immunotherapy – Desensitization Explained

Allergy immunotherapy (desensitization) gradually trains the immune system to tolerate specific allergens, providing long-term relief from allergic symptoms.

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Things worth knowing about "Allergy Immunotherapy"

Allergy immunotherapy (desensitization) gradually trains the immune system to tolerate specific allergens, providing long-term relief from allergic symptoms.

What is Allergy Immunotherapy?

Allergy immunotherapy, also referred to as desensitization or allergen-specific immunotherapy (AIT), is a medical treatment that gradually exposes the immune system to increasing amounts of a specific allergen. The goal is to reduce or eliminate the overreaction of the immune system to substances such as pollen, house dust mites, insect venom, or animal dander. Unlike conventional antihistamines or corticosteroids that only relieve symptoms, allergy immunotherapy targets the underlying cause of the allergic disease.

Causes and Background of Allergies

An allergy occurs when the immune system mistakenly identifies a harmless substance as a threat and responds with an exaggerated immune reaction. This leads to the production of immunoglobulin E (IgE) antibodies, which trigger the release of inflammatory mediators such as histamine upon re-exposure to the allergen. Common allergens include:

Pollen (grasses, trees, weeds)
House dust mites
Mold spores
Animal dander and pet hair
Insect venom (e.g., bee or wasp stings)

Mechanism of Action

During allergy immunotherapy, the patient receives the triggering allergen in gradually increasing doses. This teaches the immune system to tolerate the allergen rather than overreact to it. On a molecular level, the following processes occur:

Increase in regulatory T cells (Treg) that suppress the immune response
Shift of the immune response from a Th2 profile (allergy-promoting) to a Th1 profile (protective)
Production of blocking IgG4 antibodies that prevent the allergen from binding to IgE antibodies
Long-term reduction in mast cell activation and histamine release

Forms of Allergy Immunotherapy

Subcutaneous Immunotherapy (SCIT)

Subcutaneous immunotherapy involves injecting the allergen extract under the skin, typically in the upper arm. Treatment begins with a build-up phase of weekly injections with increasing allergen doses, followed by a maintenance phase with monthly injections over a period of three to five years. This method is commonly used for pollen, house dust mite, and insect venom allergies.

Sublingual Immunotherapy (SLIT)

Sublingual immunotherapy delivers the allergen as drops or tablets placed under the tongue. This form is particularly well suited for patients with pollen or house dust mite allergies and can often be self-administered at home. However, its efficacy may be slightly lower than subcutaneous therapy depending on the allergen.

Indications and Suitability

Allergy immunotherapy is particularly indicated for:

Allergic rhinitis (hay fever) and allergic asthma
Insect venom allergy with risk of anaphylactic reactions
House dust mite allergy with chronic symptoms
Patients for whom allergen avoidance is not possible
Patients seeking a long-term solution rather than ongoing medication use

The therapy is not suitable for patients with uncontrolled severe asthma, certain autoimmune conditions, the initiation of treatment during pregnancy, or serious cardiovascular disease.

Treatment Process and Duration

Allergy immunotherapy is a long-term treatment. The typical process includes:

Allergological diagnosis: Identification of the specific allergen through skin and blood tests
Build-up phase (3 to 6 months): Weekly injections with increasing allergen doses
Maintenance phase (3 to 5 years): Monthly injections at the maximum tolerated dose
Follow-up monitoring: Regular medical check-ups to evaluate treatment success

Efficacy and Outcomes

Clinical studies confirm that allergy immunotherapy leads to a significant and lasting reduction in allergy symptoms for many patients. For insect venom allergy, the protection rate exceeds 95%. For pollen and house dust mite allergies, approximately 70 to 85% of patients respond positively to treatment. An additional benefit is its preventive effect: the therapy can prevent hay fever from developing into allergic asthma and reduces the risk of new sensitizations.

Possible Side Effects

Allergy immunotherapy is generally well tolerated but may cause the following side effects:

Local reactions: Redness, swelling, or itching at the injection site (common)
Systemic reactions: Sneezing, runny nose, skin rash (occasional)
Anaphylactic reactions: Very rare but possible -- therefore, a 30-minute observation period in the clinic is required after each injection

For this reason, subcutaneous immunotherapy must always be administered under medical supervision with access to emergency treatment.

References

Pfaar O. et al. - Guideline on Allergen-Specific Immunotherapy in IgE-Mediated Allergic Diseases. Allergo Journal International, 2014.
World Allergy Organization (WAO): Allergen Immunotherapy Guidelines, 2020. Available at: www.worldallergy.org
Roberts G. et al. - EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis. Allergy, 2018.

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