Home Health and Fitness Seasonal allergies can be treated with several kinds of exposure therapy : Shots

Seasonal allergies can be treated with several kinds of exposure therapy : Shots

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Washington, DC’s iconic cherry blossoms bloomed earlier than usual on March 28 this season. Mild winters lead to longer pollen seasons, which is bad news for allergy sufferers.

Drew Angerer/Getty Images

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Drew Angerer/Getty Images

Washington, DC’s iconic cherry blossoms bloomed earlier than usual on March 28 this season. Mild winters lead to longer pollen seasons, which is bad news for allergy sufferers.

Drew Angerer/Getty Images

You’re not the only one who sniffles and sneezes.Mild winters like the eastern US, As temperatures rise, some plants produce more pollen.

For the millions of Americans battling allergies, over-the-counter antihistamines, often combined with steroid nasal spray, is sufficient to temporarily suppress symptoms. But 41-year-old Abigail Boltnick wanted a way to prevent allergic reactions long-term.

“Seasonal allergies were terrible,” Boltnick says. Her tests showed she was allergic to grass and weeds, and I remember her feeling sick when the pollen count increased. “A runny nose, her eyes itchy, all the time,” says Boltnick, who lives in the Washington, D.C. area.

Allergy vaccinations were an option, but with young children and busy work schedules, it was inconvenient to drive to the clinic each week to get vaccinations. So her allergist suggested an alternative to her. sublingual immunotherapy called SLIT, a form of exposure therapy. She was given a self-administered intravenous drip. “She loved the idea of ​​not having to go for a shot and being able to do it at home,” Boltnick says.

5 drops, personalized serum

The serum comes in a small bottle with a pump on top. Once a day, she puts five drops under her tongue.”It’s easy,” says Bortnick. Since she can’t eat or drink for 30 minutes, she aims to drink at the same time each day so as not to interfere with her meals.

She started dropping her allergies a few years ago and has seen significant improvement. I noticed that I had more energy, probably because I slept better due to less congestion and inflammation. And although she’s still taking Claritin at the height of grass pollen season, her symptoms aren’t as severe.

Allergy shots and SLIT are both forms of allergy immunotherapy. The patient is exposed to a very small amount of the specific thing they are allergic to, gradually over time with the goal of training the immune system to withstand them. to make SLIT allergy drops the same way you make allergy shots. For each patient, the serum is individually tailored to contain a specific mixture of allergy-causing irritants.

“Part of the beauty of this therapy is its convenience,” he said. Dr. Rachel Shriver, an allergist in Rockville, Maryland, who treats boltonics. Schreiber says patients typically stay on SLIT for several years. “We reassess each year to determine if treatment should continue,” she explains. Sometimes patients stop too soon and symptoms return, and in those cases, “it’s easy to start again,” Schreiber said, noting that many of her patients have improved over time. To do.

tablet too

There are two types of sublingual immunotherapy: drops mixed by allergists taken by Bortnick and dissolvable tablets that can be used for single allergens. The Food and Drug Administration has approved 4 tablets including 1 tablet. Ragweed,One tickand 2 grass pollen allergy tablets containing for timothy glassThe tablets dissolve within a minute or two after being placed under a person’s tongue.American Academy of Allergy, Asthma and Immunology says pills have been shown to provide long term improvement.

The most common side effect of tablets is a temporary itching or burning sensation in the mouth that usually goes away quickly. Studies have shown that tablets have a good safety profile. However, because severe allergic reactions can occur, patients taking SLIT tablets are also prescribed an epinephrine auto-injector, known as an epinephrine auto-injector. epi penInsurance usually covers the cost of these tablets.

say “they are very effective” Dr. Howard Boltanskian allergist at Johns Hopkins, but the main drawback is that each SLIT tablet is only targeted for a single allergen. I prefer

Off label use

With over 35 years of experience, Boltanski recently launched SLIT Allergy Drops. (He Hopkins ENT Center in Lutherville, Maryland.) “The use of sublingual immunotherapy drops is increasing because they can contain multiple allergens not available in current FDA-approved tablets,” says Boltanski. , he says, as patients learn about the option, they come to prefer flexibility and convenience, which also helps explain the growing interest.

The downside is that SLIT allergy drops Not FDA approvedand therefore not covered by most insurance, Medicare or Medicaid.

Boltanski explains that when he makes his allergy drops, he uses the same FDA-approved extracts that he uses to make his allergy shots. The only difference is that instead of injecting the serum into the arm, it is placed in an IV bottle for the patient to administer at home. Boltanski is completely satisfied with using FDA-approved allergy extracts in an “off-label” manner.

In Europe, many doctors have been using this approach for years, says Boltanski. And as with SLIT tablets, doctors also prescribe his Epi-Pen to patients taking allergy drops, but he says serious allergic reactions are rare.

Exposure to allergens is highly controlled once patients begin sublingual immunotherapy. “We start by giving them small amounts of what they’re allergic to,” says Boltanski. “Gradually, as their bodies say they’re fine, we increase the dose a bit more,” he says. I have bottles of pollen, dust mites and cat extracts. .

“When we start someone on immunotherapy, whether it’s an IV or a shot, we approach it as a test at first,” says Boltansky. About 80% of patients respond well, and treatment usually lasts three to five years, he said.

Not all allergists offer SLIT allergy drops given their “off label” status and lack of insurance coverage. “be Wide effective range According to the National Academy of Allergy, Asthma, and Immunology, no effective dose of SLIT liquid formulation. Find a doctor experienced in testing and prescribing immunotherapy, a board-certified allergist, etc. Also, some certified otolaryngologists (also known as otolaryngologists) have expertise in SLIT.

Abigail Bortnick pays about $600 a year out of pocket for allergy drops. “I didn’t like that it wasn’t covered by insurance, but I thought the convenience factor outweighed the cost,” she says.

Boltanski said he would like to see more studies to show how effective SLIT allergy drops are in preventing symptoms. We expect it to be approved,” says Boltanski. In the meantime, physicians will continue off-label use for patients eligible for immunotherapy.

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