Desensitization – Allergen Immunotherapy Explained
Desensitization is a medical therapy for treating allergies by gradually exposing the immune system to allergens, reducing overreactions long-term.
Things worth knowing about "Desensitization"
Desensitization is a medical therapy for treating allergies by gradually exposing the immune system to allergens, reducing overreactions long-term.
What is Desensitization?
Desensitization, also known as allergen immunotherapy (AIT) or specific immunotherapy (SIT), is a medical procedure used to treat allergies. The patient´s immune system is gradually trained to tolerate specific allergens, so that it no longer responds with excessive reactions. Desensitization is considered the only causal therapy for allergies -- all other treatments merely relieve symptoms.
Indications
Desensitization is primarily used for the following conditions and allergies:
- Hay fever (allergic rhinitis) caused by grass, tree, or weed pollen
- House dust mite allergy
- Insect venom allergy (e.g., bee or wasp venom)
- Pet dander allergies
- Allergic asthma
- Mold allergy
How Does Desensitization Work?
During desensitization, the triggering allergen is administered to the patient in gradually increasing doses. This teaches the immune system to tolerate the allergen rather than mount a defensive reaction. There are two main forms:
Subcutaneous Immunotherapy (SCIT)
Subcutaneous immunotherapy involves injecting the allergen under the skin at regular intervals in an allergy clinic or medical practice. The treatment consists of a build-up phase with weekly increasing doses and a maintenance phase with monthly injections over a period of typically three years.
Sublingual Immunotherapy (SLIT)
Sublingual immunotherapy involves placing allergen drops or tablets under the tongue. This method can often be administered at home and is especially suitable for children or patients who prefer to avoid injections. The recommended treatment duration is also generally three years.
Mechanism of Action
Desensitization reprograms the immune system on several levels:
- Formation of regulatory T-cells that suppress excessive immune responses
- Shift of the immune response from an allergy-typical Th2 profile to a Th1 profile
- Increase in blocking antibodies (IgG4) that intercept the allergen before it triggers an allergic reaction
- Reduction in the activity of mast cells and basophils responsible for allergic symptoms
Who is Eligible?
Not every allergy sufferer is automatically a candidate for desensitization. The therapy is generally suitable for patients who:
- suffer from an IgE-mediated allergy (confirmed by skin or blood test)
- continue to experience significant symptoms despite antihistamine medications
- are at least five years old (depending on the therapy form)
- do not have severe cardiovascular disease or uncontrolled asthma
Duration and Outcomes
The therapy typically lasts three years. Studies show that many patients experience long-term relief or significant symptom reduction after successful desensitization. For insect venom allergy, the therapy can even be life-saving by protecting against anaphylactic shock. However, complete therapeutic success is not guaranteed for all patients.
Side Effects and Risks
Desensitization is generally well tolerated but may cause side effects:
- Local reactions: Redness, swelling, or itching at the injection site (with SCIT)
- Systemic reactions: Sneezing, runny nose, skin rash, or in rare cases anaphylactic reactions
- Oral mucosal irritation with sublingual administration
Due to the low but existing risk of anaphylaxis, SCIT injections should always be administered under medical supervision, and patients are typically observed for 30 minutes after the injection.
References
- German Society for Allergology and Clinical Immunology (DGAKI): Guideline on Specific Immunotherapy, 2022.
- 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, 2018. Available at: www.worldallergy.org
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