If you suffer from sinusitis due to allergies you know the discomfort of sinus pressure and the just plain annoyance of sinus allergy symptoms. Immunotherapy is a well-known personalized treatment that is designed to treat your specific allergies.
When you are allergic to a substance, your body sees it as something harmful. These allergens, which are often harmless in people without allergies, can be breathed in (like pollen, dust, or tobacco smoke), swallowed (foods such as peanuts, or medicines), or enter through your skin (such as an insect sting).
Our body’s natural response to allergens is to increase a substance called immunoglobulin E, an antibody that causes protective cells to release other substances (such as histamine) to protect your body. If the body overreacts to substances in this way, symptoms can range from relatively mild to serious, including severe rash, chest discomfort, wheezing, or even loss of consciousness.
Allergies that affect the nose and sinuses, while annoying and uncomfortable, generally do not cause dangerous reactions. However, if you are an asthmatic, worsening allergy symptoms can increase your risk for an asthma attack. Allergic rhinitis and/or sinusitis (inflammation of the nose and sinuses) is usually due to pollen, animal dander, dust, fungal spores, and other substances that you breathe in. Symptoms can include watery, itching eyes, runny nose, cough, headache, and sinus pressure.
Common sense treatments include clearing your home of dust mites or mold and staying indoors when pollen counts are high, although avoiding these substances is not always possible. Allergic rhinitis or sinusitis can also be treated with over the counter or prescription medications. However, immunotherapy helps your body not to overreact to allergens, and is specific for substances you are allergic to.
1. Finding your Allergens
If you have symptoms of allergic rhinitis get checked out by your health-care professional. He or she can refer you to an immunologist (specialist in treating allergies) or otolaryngologist (ear-nose-and-throat specialist). The specialist will take a thorough history and do a physical examination to determine if there is another cause for your symptoms such as a viral or bacterial infection. If allergies seem to be the main issue, she can check you for any specific allergens that may be causing your problem.
Allergy testing is generally done by skin testing, but blood tests can be done if needed. Reasons include having a skin condition that makes skin testing less feasible, being on medications that would interfere with the test results, or your doctor determining that you’re so allergic to a substance that even the tiny amount used in an allergy test might cause a dangerous allergic reaction such as anaphylaxis. Testing for allergies is done via a skin scratch, prick, or puncture test (all basically the same). Tiny drops of purified, liquefied, and diluted samples of substances you may be allergic to are placed on your skin and then gently scratched or pricked into the surface.
Your doctor decides what to test for based on what you tell her may be setting you off, as well as the types of allergens that are prominent where you live or work. You may be tested for as many as 40 different allergens. Substances can range from various types of pollen, to dust mite, mold, or types of food. After about 15 to 20 minutes, the substance(s) you may be allergic to will cause a weal (a red itchy bump, similar to a mosquito bite) which the doctor evaluates and decides whether your reaction is more mild or more severe.
2. Creating your Personalized Therapy
Once your doctor knows what you are allergic to, she can prepare a personalized therapy for you if she decides that is the best treatment in your case. If allergy shots are recommended, your doctor will choose allergen extracts based on your history and the results of your testing. You’ll start on small doses that are gradually increased until your body gets used to the allergen and you stop having an allergic reaction.
If you have no side effects your doctor will continue you at that dose but will start giving it less and less frequently, as long as your allergy symptoms don’t return. At each treatment, your doctor or nurse will observe you for at least 30 minutes. They’ll also talk to you about what treatment you’ll receive in the unlikely case that you have a severe allergic reaction. Bad reactions, if they occur, usually happen in the first 30 minutes after the treatment.
3. Shots or Under the Tongue?
Immunotherapy for allergies has traditionally been given as injections, but the Food and Drug Administration has approved taking a tablet or liquid form of the extract under the tongue (sublingual) in order to treat some allergies (pollen, ragweed, and dust mites). The amount can be gradually increased over a short period or started at full dose. Discuss with your doctor whether or not sublingual treatment is right for you.
Some advantages may include shorter treatment, fewer allergic reactions, lower costs, and the ability to take the medication at home, once your doctor has seen you take the first dose and is sure you won’t have a severe reaction. But some experts feel that sublingual immunotherapy is not quite as effective as allergy shots.
Learn more about how Dr. Ran Rubinstein can help you with your allergies at Hudson Valley Sinus Center. Dr. Rubinstein has board certification in both otolaryngology and facial plastic surgery, and focuses on treating patients with sinus diseases and allergies.