Allergic rhinitis, also known as “hay fever” or “allergies” can significantly impact one’s quality of life. Whether seasonal or year-round (perennial), allergic rhinitis causes a constellation of symptoms such as nasal congestion, sneezing, watery nasal drainage, post-nasal drip, itchy nose, and often is associated with allergic conjunctivitis which causes itchy, watery eyes. In some patients this process leads to further conditions such as nasal polyps or chronic sinus infections. Additionally, approximately 30% of allergy sufferers have asthma, which can be exacerbated by uncontrolled allergic rhinitis.
In the fight against allergic rhinitis we have essentially 3 modes of therapy. First is avoidance. For patients with allergies to tree, grass, and weed pollen, avoidance would mean moving to a location where those pollens don’t exist, such as the moon – obviously avoidance can be difficult if not impossible for some allergens. For patients with indoor or year-round allergies avoidance is somewhat easier, but might mean parting company with Fido or Whiskers if the allergen is pet dander. The second mode of therapy is medication, which may include any combination of the following: steroid nasal sprays such as Nasonex, antihistamines such as Zyrtec, anti-leukotrienes such as Singulair, and anti-histamine nasal sprays such as Astelin. The third mode of therapy, immunotherapy, is not only the most effective allergy treatment, but the least understood.
Immunotherapy is a treatment in which small, regular doses of the allergens that trigger allergy symptoms are given to a patient. This is sometimes referred to as desensitization. Most people know immunotherapy as allergy shots, in which small doses of offending allergens are injected under the skin in the “subcutaneous” tissue on a weekly basis. There is a recently emerging form of immunotherapy administration known as sublingual immunotherapy, or SLIT, in which daily doses of allergens are dropped under the tongue by the patient in their own home.
Allergy shots (SCIT) have long been and continue to be the “gold standard” in immunotherapy. The shots are composed of a variable number of allergens tailored to the allergy test of each individual. If a patient tests positive to a panel of 20 allergens, then all 20 allergens are used in that patient’s shot. Typically allergy shots are administered in the doctor’s office, weekly, for a period of 3 to 5 years and then discontinued. Commonly the benefit from allergy shots lasts another 3 to 5 years after stopping the shots, but then the changes in the immune system revert back and symptoms again increase. So unfortunately immunotherapy most commonly does not confer lifelong immunity and usually must be restarted depending on the return of allergy symptoms.
Allergy shots, while generally safe, have a rare but potentially fatal risk of anaphylaxis in which the allergic response is so severe that one’s mouth and throat swell causing suffocation in addition to shock or extremely low blood pressure. This risk is exceptionally small when using the protocols practiced by COA’s allergy department. Nevertheless, because of this risk, shots must be performed in our office where emergency intervention can be accomplished in the event of an anaphylactic reaction.
Sublingual immunotherapy, or SLIT, is a relatively new mode of immunotherapy in the U.S. that is generating a lot of interest. SLIT is currently not approved by the FDA for the treatment of allergic rhinitis, but its “off-label” use has been occurring for decades in Europe and less widely by many allergists in the U.S. Despite not having FDA approval, the American Academy of Otolaryngic Allergy, or AAOA, has established a protocol for its members to follow who desire to offer this type of immunotherapy to their patients. SLIT is administered by the patient on a daily basis in their own home by placing several drops under the tongue with a medicine dropper. SLIT appears to have little to no risk of anaphylaxis, and there has never been a reported death from anaphylaxis due to SLIT. Opponents of SLIT feel that this may be because SLIT is less effective than allergy shots. However, many studies have shown that SLIT is an effective form of immunotherapy, several showing equal efficacy to allergy shots.
From a practical standpoint, some considerations need to be made by patients in choosing their allergy treatment. Although medications are generally less effective than immunotherapy, many patients receive satisfactory symptom relief from one or a combination of drugs. Whenmedications fail to control one’s symptoms immunotherapy should be considered. Immunotherapy does require an increased commitment by patients, both from a time and cost perspective, but the benefits of immunotherapy are well worth that commitment for most patients. Allergy shots are typically covered by insurance companies. A weekly co-pay is usually required which varies by insurer. Often that increased cost to the patient can be neutralized after 6-12 months when patients can wean off some or all of their medications, thus saving monthly medication co-pays. Sublingual immunotherapy may be much more convenient to patients than shots since they are given by the patient at home. Since SLIT is used off-label, insurers will not pay for it, thus it can only be administered on a cash pay basis; generally the cost is equivalent to a patient’s out of pocket requirements for allergy shots. From a convenience and time savings perspective, SLIT may be the right choice for some patients, particularly those who live far away from the clinic or who travel frequently.
The ENT allergy physicians at COA provide safe and effective allergy diagnosis and treatment, including medical and surgical treatment of some of the consequences of allergic rhinitis including chronic sinusitis and nasal polyps. Regardless of whether medications, allergy shots, or sublingual immunotherapy is the right therapy for you, we can help you get relief from your allergies so you can enjoy life in beautiful Colorado.