Allergen-specific immunotherapy can be carried out in five ways:
- parenteral, that is, subcutaneous injections;
- orally, that is, drops in the mouth;
- sublingually, that is, the resorption of the drug under the tongue;
- intranasally, that is, nasal drops.
The most common are considered parenteral and sublingual route of administration of drugs into the body. Subcutaneous administration of the drug should be carried out by a professional physician with subsequent monitoring of the patient’s condition. In terms of its effectiveness, subcutaneous administration is not inferior to sublingual or oral.
In the latter case, special solutions of allergens, dosed in the form of drops, are used, and sublingual administration involves the use of tableted forms of drugs for sublingual use. Proved high efficiency and safety of this method in the treatment of allergic diseases with sensitization to allergens house dust, mite and pollen allergens.
One of the advantages of this type of ASIT is a simple technique, including the possibility of self-use of allergens at home. However, the appointment of the drug and any change in health lies in the competence of the attending physician.
The holding of ASIT varies depending on the frequency and frequency of treatment:
- pre-season ASIT – suitable for patients with hay fever, appointed 3-4 months before the flowering of the plant, the patient is allergic to; it is assumed that by the beginning of flowering the maximum tolerated dose of the allergen will be reached; at the time of flowering, ASIT is suspended and resumed after a year;
- year-round ASIT – appropriate for allergies to household irritants; First, the maximum tolerated dosage of the allergen is achieved, and then maintenance doses are introduced until a positive trend is achieved.
In order to minimize the negative impact of the administered drug on the body, it is recommended:
- to carry out manipulations in the allergy room, where there is an opportunity for emergency medical care;
- stay under medical supervision for 30-60 minutes after each administration of the extract;
- report to the attending physician about all changes and, moreover, deterioration of health, especially if some methods of the drug are out of medical control;
- If you are taking allergen extracts yourself, strictly follow all the instructions and appointments of a specialist.
How is the effectiveness of ASIT determined?
Significant improvements in the health of allergies are sometimes observed after the first course of ASIT, that is, several months after the start of treatment. In most cases, therapy is prescribed by a series of courses and is carried out over several years.
There are a number of indicators by which a professional physician is able to determine whether the results of allergen-specific immunotherapy.
This is, above all, the results of laboratory tests, namely a decrease in the level of IgE in serum compared to the initial value (before treatment).
The consequence of the use of ASIT are:
- easing the symptoms of allergy – gradually with each course the symptoms subside, and after 3-4 courses with a certain interval between them, the symptoms disappear completely;
- reducing the need for symptomatic antiallergic drugs and the frequency of their use, up to the complete abandonment of them;
- the cessation of severe forms of allergy and the transition to lighter ones, if the allergy was not initially burdened, then its complete cessation is likely after several courses;
- improving overall well-being.
Who needs ASIT?
ASIT is rightly recognized as a scientifically justified method, the use of which in allergic reactions today reaches unprecedented heights. Nevertheless, the effectiveness of ASIT is assessed as high as possible in case of those allergic diseases that are characterized by the IgE-mediated developmental mechanism. The explanation for this lies in the nature of the allergy itself.
It is known that allergy is a consequence of changes in the human immune system, in which there is an excessive release of immunoglobulins (IgE) into the blood, antibodies of class E, specific to a specific allergen. It is contact with the latter and provokes an allergic reaction.
ASIT influences the regulatory cells of the immune system – T-lymphocytes. In the process of immunotherapy, activation of those lymphocytes, which are responsible for the formation of positive IgG, and a decrease in the activity of those lymphocytes, which are responsible for the formation of “allergenic” IgE, gain in strength. As a consequence, there is an increase in the production of immunoglobulins, blocking the association of the allergen with immunoglobulin, and ultimately the development of an allergic reaction does not find the soil.
Allergen-specific immunotherapy shows its effectiveness in the following types of allergic reactions:
- pollinosis and seasonal allergies;
- year-round allergic rhinitis;
- allergy to hymenoptera poison;
- bronchial asthma.
ASIT is usually performed against the background of basic therapy, which allows to achieve remission of the disease. Basic therapy does not reduce the effectiveness of ASIT, and carrying out the latter makes it possible to prolong the period of remission, reduce the frequency and severity of allergic attacks, and reduce the need for emergency response drugs.
The duration of ASIT usually takes from three years. For outpatient ASIT, allergen extract is administered annually for 4-6 months, and for inpatient treatment the duration of the main course takes 3-4 weeks and is supplemented by vaccination for 2-3 months already on an outpatient basis.
Who is contraindicated asit?
As any type of treatment, ASIT is not without contraindications and side effects, but there are relatively few of them, and the potential benefits are fully justified.
Absolute contraindications for ASIT are:
- oncological diseases;
- severe diseases of the immune system;
- severe cardiovascular diseases;
- severe mental disorders;
- severe diseases of the cardiovascular system;
- chronic diseases of the internal organs in the stage of severe decompensation.
- children up to 5 years;
- receiving beta blockers.
ASIT does not apply to the following types of allergies:
- atopic dermatitis;
- polyvalent allergy (developing as a result of contact with three or more cause-significant allergens);
- cold allergy;
- Quincke swelling, urticaria;
- allergic to fungi and mold;
- allergic to animals and their fur;
- allergic to non-pathogenic microflora;
- allergy to medications.
To reduce the likelihood of side effects due to the use of ASIT, it is recommended to start treatment for the period of remission of the disease or out of seasonality of allergy. If we are talking about year-round allergic reactions or, for example, about bronchial asthma, then ASIT is prescribed against the background of basic therapy, but at the stage of remission.
If ASIT is used in relation to seasonal forms of allergy (pollinosis, for example), then it is better to postpone its onset for the autumn-winter period; withdraw drugs is not necessary. For the period of treatment it is necessary to exclude (or reduce to a minimum) contact with the allergen.
Adverse reactions to ASIT are divided into local and systemic:
- hyperemia (redness),
- swelling and swelling,
- itching and burning
systemic develops outside the injection site and can be represented by a deterioration in overall well-being
- runny nose
- itching around the eyes
- difficulty breathing
- sore throat
- extremely rare angioedema,
- extremely rarely anaphylactic shock
The risk of side effects after ASIT will be minimal if the procedure is entrusted to a professional allergist and carried out in an allergological office or a medical hospital. Be sure to within an hour after the procedure, the patient should be under the supervision of a specialist. Among other things, in all circumstances, the patient must follow the exact instructions of the doctor and report any changes in his well-being.