What Is Allergic Rhinitis?
When the immune system overreacts to foreign substances such as pollen, causing symptoms like a runny nose or bloodshot eyes called allergic rhinitis. It is a chronic IgE (immunoglobulin E)-mediated respiratory illness affecting individuals' quality of life. Some people experience worsening asthma, and it is termed allergic asthma. The common allergic-inducing agents are grass, pollen, animal dander, insect stings, or mold.
Antihistamines used to treat allergies provide temporary relief from symptoms. Immunotherapy is considered when the usual treatment for allergic rhinitis fails. However, the effects of immunotherapy are long-lasting as they gradually change immune response to allergens.
What Is Immunotherapy for Allergic Rhinitis?
Immunotherapy allergy treatment helps reduce or eliminate symptoms caused by gradually altering the immune system’s response to allergens. As a result, the immune system does not respond to allergens as earlier, and the symptoms gradually decrease. It is the most effective treatment for allergic rhinitis.
The frequency of immunotherapy treatment is based on the healthcare provider’s treatment approach, preference, and type of immunotherapy. Most patients undergoing immunotherapy observe symptom improvement during the build-up phase. However, observing symptom improvement in some patients takes a few years or longer.
How Is Immunotherapy Administered for Allergic Rhinitis?
Before beginning immunotherapy treatment, the healthcare providers perform an anti-allergy test to determine the substances an individual is allergic to. Depending on the body's reaction, immunotherapy is administered to one or more specific allergen substances, making the individual less reactive. There are three main approaches to administering immunotherapy which are:
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Allergy Shots: It is also called subcutaneous immunotherapy. Allergy shots are the oldest and most established form of immunotherapy. The injection contains a small amount of substance the individual is allergic to and is mixed with delivery fluid. It is injected beneath the skin. The health care provider gradually increases allergen dosage. Allergy shots are given to allergy patients as weekly doses for four to six months during the build-up phase. Later, a single shot is given every month or two months for three to five years.
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Sublingual Immunotherapy: It is a type of immunotherapy available in tablet form. The tablet is placed under the tongue for several minutes until it dissolves. The Food and Drug Administration (FDA) has approved sublingual immunotherapy allergen treatment for ragweed, grass, and dust mites. Sublingual therapy is not a good option for other allergens.
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Allergy Drops: Allergy drops are available for treating allergic rhinitis. The advantage of allergy drops is that as there are more allergens, drops can be formulated based on the patient's need. The FDA does not approve allergy drops.
Based on the type of sublingual immunotherapy or allergen immunotherapy, the frequency differs. An individual may take immunotherapy three times a week or daily for three to five years. Some immunotherapy types can be taken seasonally.
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Oral Therapy: It is a newer form of immunotherapy that involves consuming allergens in small amounts. Oral immunotherapy helps treat food allergies. The oral therapy only treats food allergies but does not treat airborne allergies, which cause allergic asthma and rhinitis. The principle of treatment with oral immunotherapy is similar to other forms of immunotherapy. As the individual ingests a significant amount of allergen, their body gradually adjusts. The only oral immunotherapy approved by the FDA for food allergy is peanut allergen powder (a formulation of peanut powder). However, some healthcare providers use a similar approach with eggs and other allergens, even without FDA approval.
However, there is a lack of consensus on whether immunotherapy is the best option for individuals with food allergies. It is still in the experimental stage and not widely available.
Oral therapy should be taken daily at first and later, followed by less frequent dosing. The maintenance phase for immunotherapy lasts several years or indefinitely.
What Are the Benefits of Immunotherapy for Allergic Rhinitis?
Individuals with moderate to severe allergic rhinitis must undergo immunotherapy treatment. It is also helpful for individuals trying to avoid allergy triggers and whose current medication is ineffective.
The benefits associated with immunotherapy are:
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Enhanced Quality of Life: Immunotherapy is beneficial in individuals whose allergic rhinitis or asthma interferes with quality of life. Additionally, it benefits patients with severe eczema.
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Symptom Reduction: Symptoms of allergic rhinitis significantly reduce following immunotherapy treatment. Therefore, it reduces the need for medication and eliminates treatment costs and side effects.
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Reduces Complications: Individuals with severe allergic reactions, such as difficulty breathing with insect stings or food, find a reduced risk of dangerous complications.
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Long-Lasting Benefits: Individuals undergoing a complete course of immunotherapy observe symptom reduction for eight to 10 years or longer.
Immunotherapy provides long-term relief from hay fever and other allergens by reducing immune response to triggers.
Who Should Avoid Undergoing Immunotherapy?
Immunotherapy is not advisable for all. Therefore, it is avoided in patients with the following conditions:
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Pregnancy.
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Younger patients below 5 years or older adults above 65 years.
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Uncontrolled asthma.
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Individuals taking beta-blocker medication.
Immunotherapy is not recommended in individuals with skin allergies, especially after touching poison ivy. It is also unsuitable for individuals who develop intense, red, and itchy skin or for individuals who develop extreme swelling around the throat due to allergies.
What Are the Side Effects of Undergoing Immunotherapy?
The side effects of immunotherapy depend on the type
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Side Effects of Allergy Shots
Common side effects with allergy shots are mild swelling, itching, and redness at the injection site. Rarely, itchy red bumps on the skin or wheezing develops. If an individual develops anaphylaxis with symptoms like throat swelling, low blood pressure, rash, vomiting, and trouble breathing, it can be life-threatening.
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Side Effects of Sublingual Immunotherapy
Sublingual immunotherapy does not cause severe complications like anaphylaxis. However, it causes side effects such as itching and burning in the mouth. Occasionally it may cause nausea, belly pain, and diarrhea.
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Side Effects of Oral Immunotherapy
Common side effects are stomach pain, itching or burning in the mouth, runny nose, and wheezing. Although anaphylaxis is rare, there is a possibility of developing complications in oral immunotherapy.
Conclusion
Immunotherapy is one of the most effective treatments for allergic rhinitis. It acts on the underlying cause and alters the immune system to tolerate allergens better. The immunotherapy effects last longer compared to other treatment methods for allergic rhinitis.
