Sick and tired of managing your allergy symptoms? Immunotherapy might be a treatment option to consider.
Sniffling the whole day in the office because you’re allergic to the inevitable dust mites? Does your life depend on nasal sprays, inhalers and antihistamine medications? There can be a long list of medication accompanying an allergy diagnosis. These medications help to manage allergy symptoms and improve your quality of life. In the long run, or even perhaps throughout your life, the total cost of medications can get rather high, especially if you’re fully dependent on them. Moreover, some who experience allergy symptoms may not be able to notice much of an improvement despite trying various conventional treatments.
The good news is, there is light at the end of the tunnel for patients with allergies who feel like there is no hope for relief. President of the Malaysian Society of Allergy and Immunology, Consultant Clinical Immunologist, Allergist and Consultant Paediatrician at Pantai Hospital Kuala Lumpur, Dr. Amir Hamzah Abdul Latiff introduces an alternative to conventional allergy treatment, known as Allergen Specific Immunotherapy.
Modulating your system
The reason allergies occur is because there is a hypersensitive reaction involving your immune system. In other words, you experience an allergic reaction when your immune system reacts to something that is quite harmless to other people, such as dust mites.
“What immunotherapy does is that it modulates your immune system. A simpler way to put it is that immunotherapy ‘reeducates’ your immune system,” explains Dr. Amir. “The immune system is ‘reeducated’ to become tolerant to allergens.” Allergens are substances which cause an allergic reaction such as pollen, dust mites, pet dander and molds. Immunotherapy ‘teaches’ your immune system to gradually accept the allergens and to understand that it is not a harmful substance to the body.
Dr. Amir explains that immunotherapy is similar to the concept of vaccination. In order to build your body’s immunity against a certain type of harmful virus, vaccinations are administered to protect your health. For example, for influenza, the influenza virus is present in the vaccine. Of course, the virus in the vaccine goes through a medical process to ensure that it is the right dosage and safe to be administered. This is known as an attenuated vaccine.
“The influenza vaccine will be processed to ensure that it doesn’t cause a disease. It is just enough to alert your immune system so it can learn to protect your body against influenza,” Dr. Amir shares. However, at times, your immune system ‘forgets’ about the particular virus. This is the reason why immunisation boosters are available for your body to build the antibodies that it needs. “It ‘wakes up’ your immune system,” he adds. In the case of immunotherapy, your immune system is clinically exposed to allergens that you are allergic to.
The education process
Immunotherapy is not a ‘one-off’ treatment. Dr. Amir shares that it will take time for you to fully experience the end result. “It takes about three to five years,” he explains. This may sound like a very long time for a treatment to take complete effect but Dr.Amir explains that, “Your immune system needs to learn about the allergen, remember it and to have sufficient knowledge about it, in order to adapt to it.”
Here’s how the education process during immunotherapy unfolds: like vaccine, your body will be exposed to a specific dose of allergens. The process will usually start with small doses. This will be gradually increased as long as your body is able to adapt and accept it without having an allergic reaction.
“In immunotherapy, the allergens are clinically administered usually either via a subcutaneous injection (under your skin, like an insulin pen) and sublingual which are tablets, spray or liquid drops which will be administered orally,” explains Dr. Amir.
At the initial stage, the patient will have to undergo immunotherapy every week. The aim of this stage, which can take between a few months to a year or even more, is all about safety. Dr. Amir says that, “We will look at the safety profile of the patient. Imagine, if one’s asthma attack is triggered due to dust mites and during immunotherapy, the body is exposed to dust mites. This can cause an asthma attack. Hence, this is why we start with small doses.”
After each immunotherapy session, the patient will then be monitored for about half an hour. “This is because, an allergy is an immediate type of hypersensitivity. The reaction will occur within two hours but most of the time, it’ll occur within half an hour.”
The same process is repeated until the patient reaches one of two stages — the highest tolerable dose that the body will accept or the ideal dose. “Once the patient reaches either one of these stages, the maintenance dose will be administered monthly for about one to five years,” says Dr. Amir.
So, how will you know if the treatment has been effective and if your immune system has ‘graduated’ from learning to adapt to the allergen? Dr. Amir explains that the effectiveness level of the treatment is evaluated based on a clinical score. This means that, the patient’s symptoms are evaluated along the way. Your doctor will also take into account your body’s reliance on conventional treatment.
“For example, some patients start out having to use inhalers about two to three times a week. As the patient undergoes immunotherapy treatment, he or she will not have to rely on the inhalers so often. The patient may also experience fewer allergic symptoms like wheezing, watery eyes, itchy skin and so on,” he elaborates. The results of the treatment’s effectiveness will also be confirmed in an allergy test.
Testing for confirmation
Before a patient undergoes immunotherapy, it is important to have an allergy test. “Some patients may experience allergy-like symptoms. However, it may not be an allergy at all. Hence, an allergy test is important,” emphasises Dr. Amir. “If you have an allergy, an allergy test will identify the type of allergen you’re having a reaction to and this will be the guide during immunotherapy.”
Dr. Amir explains that immunotherapy would be ideal for patients between the ages of 5 to 65 years. “Immunotherapy should be considered only after the patient has tried our conventional anti-allergic treatment,” he says. “Immunotherapy is a good treatment option if you’ve tried other methods but nothing really worked.” Dr. Amir also reminds patients to be cautious when seeking treatment as immunotherapy should only be administered clinically be an immunologist or an allergist who specialises in it.
Immunotherapy in Malaysia
Immunotherapy is a treatment which has been endorsed by the World Health Organisation (WHO) as a treatment for allergic rhinitis since 1998. To find out more about immunotherapy in Malaysia, you can visit the MSAI website at www.allergymsai.org.