OakLeaf Medical Network Healthy Viewpoints, Winter 2003
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Richard Crane, MD, FACS

Allergy Immunotherapy Treatmen

Richard Crane, MD, FACS, FAAOA
Otolaryngology/Ear, Nose and Throat Medicine & Surgery, ENT Allergist
Western Wisconsin Ear, Nose and Throat
Eau Claire

Respiratory allergies and asthma affect 30 to 50 million Americans.  When asked, patients often compare their life with allergies to be similar to people with congestive heart failure, depression or heart attack recovery.

Allergy is an over-reaction by an individual’s immune system to protein-containing allergens, substances that are normally harmless to the body. Allergic symptoms are an effort by the body to mistakenly defend against these allergens.  Symptoms include sneezing, congestion, itching, runny nose, wheezing and trouble breathing.

Allergic symptoms during certain seasons, or in specific environments, will usually suggest the cause.  Skin or blood tests can confirm the diagnosis and identify the culprit allergens. Three forms of treatment are commonly used: 

 • Avoidance, but this may not  be possible for most pollens   and molds. 

Medications such as anti-histamines, decongestants, anti-leukotrienes, topical nasal steroid sprays and inhaled asthma  medications often provide relief of symptoms.

Allergy immunotherapy, or desensitization, is very effective and can reduce or eliminate the need to constantly take medication for symptom relief.

Immunotherapy (IT) is the closest treatment to a cure and can often provide relief when medication has not been effective or has caused too many side effects.  Children and teens with nasal allergies have a higher risk of developing asthma.  When given IT, only 24% of children went on to develop asthma, compared to 42% who were treated with allergy medication alone.

Immunotherapy is by injections just under the skin.  A serious allergic reaction could result if an allergic patient was given a large dose of allergen in the beginning.  However, relief of symptoms will not occur until a large enough dose of allergen is administered. Therefore, IT is given in two phases.  The patient’s immune system learns to tolerate higher doses of allergen if the starting dose is low and then gradually increased at weekly intervals.  This is the build-up phase. Once a higher dose has been reached, this level of allergen is given with each weekly injection.  This is called the maintenance phase.

The frequency of injections can usually be stretched out to every two and perhaps, every three or four weeks.  Allergy symptom relief usually begins during the latter half of the build-up phase, so the shorter the build-up phase, the faster symptom relief occurs.

In the US, allergy diagnosis and treatment is provided by two groups of specialists: general allergists (GEN allergists) and otolaryngologic or Ear, Nose and Throat allergists (ENT allergists). Both obey the same scientific allergy principles, but have important differences in testing and immunotherapy techniques.

Skin testing by GEN allergists is done by the needle prick test method.  ENT allergists use a dilutional or titration,  intradermal (ID) test. Unlike the prick test, the dilutional ID test can determine not only what a patient is allergic to, but also how allergic they are to each allergen. The dilutional ID test is also more sensitive in detecting milder allergies. 

Many patients have been told that they do not have allergies after prick testing, only to discover that they do after dilutional ID testing.

Dilutional ID testing has been standardized and is done the same way by all ENT allergists. There are probably a dozen or more ways that prick testing is performed and interpreted. Both testing methods have essentially the same safety profile.

Because dilutional ID testing gives accurate information as to how allergic a patient is to each allergen, the starting IT serum can be safely mixed stronger, shortening the build-up phase required for symptom relief.  Immunotherapy should be given for 3 to 5 years to be most effective. Most patients feel their symptom relief has been better using IT than  when they are on medication. Immunotherapy is generally equal in cost to medication management over a five-year period.  When IT is stopped after 3 to 5 years, there is often continuing symptom relief  for many years.

Immunotherapy,  when done by ENT allergy techniques, can offer significant symptom relief, delay or prevent the development of asthma, and significantly improve quality of life.  Many of our IT patients tell us they wish they had started allergy IT sooner.

Dr. Richard Crane has been practicing Otolaryngic (ENT) Allergy for 20 years.  He is a Fellow of the American Academy of Otolaryngic Allergy (AAOA) and is one of only six ENT Specialists in Wisconsin currently practicing Allergy.  He believes practicing  Allergy maximizes his skills as an ENT physician and surgeon.  

~ To schedule an appointment with Dr. Crane, Western Wisconsin Ear, Nose & Throat Center, call 715.831.0289