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Desensitization Therapy – Allergen Immunotherapy

Desensitization therapy is a medical treatment that gradually accustoms the immune system to specific allergens. It aims to provide long-term relief from allergic symptoms.

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Things worth knowing about "Desensitization Therapy"

Desensitization therapy is a medical treatment that gradually accustoms the immune system to specific allergens. It aims to provide long-term relief from allergic symptoms.

What is Desensitization Therapy?

Desensitization therapy – medically referred to as allergen immunotherapy (AIT) or specific immunotherapy (SIT) – is a causal treatment for allergies. Unlike symptomatic medications such as antihistamines, desensitization therapy addresses the root cause of the allergy: the immune system is gradually trained to tolerate the triggering substance (the allergen), so that it no longer reacts with an excessive immune response over time.

This therapy is considered the only treatment approach that can permanently alter the natural course of an allergy and establish lasting tolerance to the allergen.

Indications

Desensitization therapy is primarily used for the following conditions:

Hay fever (allergic rhinitis) caused by pollen (e.g., grasses, birch, hazel)
House dust mite allergy
Insect venom allergy (e.g., bee or wasp stings)
Pet dander allergy
Allergic asthma

How Does Desensitization Therapy Work?

The mechanism is based on the gradual acclimatization of the immune system. The allergen is administered in initially very small, then slowly increasing doses. This process leads to a reduction in the overreaction of the immune system and the development of immunological tolerance. Regulatory T-cells are generated, and the immune response shifts from an allergic (Th2-dominated) profile to a tolerogenic one.

Forms of Desensitization Therapy

Subcutaneous Immunotherapy (SCIT)

In SCIT, the allergen extract is administered as an injection under the skin (subcutaneously), typically into the upper arm. Treatment consists of a build-up phase with weekly injections and a maintenance phase with monthly injections over a total of three years.

Sublingual Immunotherapy (SLIT)

In SLIT, the allergen is administered as drops or tablets placed under the tongue. This form is often suitable for home use and is particularly appropriate for children or patients who prefer to avoid injections.

Duration and Course of Treatment

A course of desensitization therapy typically spans three years and includes:

Build-up phase: Regular administration of increasing allergen doses (weeks to months)
Maintenance phase: Continuation of the maximum dose for the remainder of the treatment period

For insect venom allergy, therapy may last up to five years or may be recommended as an indefinite long-term treatment in certain cases.

Side Effects and Safety

Desensitization therapy is generally safe but may cause side effects:

Local reactions: Redness, swelling, or itching at the injection site
Systemic reactions: In rare cases, allergic reactions such as urticaria (hives), shortness of breath, or – very rarely – anaphylactic shock

For this reason, subcutaneous immunotherapy must always be performed in a medical practice, and the patient must be monitored for at least 30 minutes after each injection.

Who is Suitable?

Suitable candidates for desensitization therapy are patients who:

have a confirmed IgE-mediated allergy
continue to experience symptoms despite allergen avoidance and medication
have access to an approved allergen extract
have no serious contraindications such as uncontrolled asthma or immune system disorders

References

German Society for Allergology and Clinical Immunology (DGAKI): Guidelines on Allergen Immunotherapy (2022)
Pfaar O. et al. - Guideline on allergen-specific immunotherapy in IgE-mediated allergic diseases. Allergologie (2023)
World Allergy Organization (WAO): White Book on Allergy, Update 2013 – www.worldallergy.org

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