What is immunotherapy for allergies
Initially patients get allergy shots once or twice a week . During this phase individuals get injections that slowly contain more allergens. Once an effective dose is reached there will be longer periods of time between shots.
The time span between shots often ranges from person-to-person.
Learn more about allergy shots.
“This discovery reverses food allergies in mice, and we own numerous people with allergies volunteering their own cells for us to use in lab testing to move this research forward,” said professor John Gordon, lead scientist behind the discovery just published in the current issue of the Journal of Allergy and Clinical Immunology.
The findings open the door to test this new allergy treatment in “humanized mice”—mice with non-existent immune systems implanted with cells from a human immune system, for example, from a peanut-allergic person.
With Health Canada approval, the first human trial could start in about one year, Gordon said.
“If we can reliably ‘cure’ food allergies, or related conditions such as asthma or autoimmune diseases such as multiple sclerosis with this new therapy, it would be life-changing for affected individuals.”
Roughly 2.5 million Canadians self-report having at least one food allergy. Anaphylaxis, defined as a severe rapid-onset allergic reaction, can be life-threatening and treatment options are limited.
The discovery involves generating a type of naturally occurring immune cell that sends a signal to reverse the hyper-immune response present in allergic reactions. That signal triggers another “off switch” that turns off reactive cells further along the allergic pathway.
“We predict the treatment could be on the market within the next five to 10 years,” said Gordon, who is also a research leader in the Allergy, Genes and Environment (AllerGen) Network.
AllerGen—part of the federally funded Networks of Centres of Excellence program—aims to assist Canadians address the challenges of living with asthma, allergies, anaphylaxis and related immune diseases.
Gordon’s team will collaborate with other AllerGen investigators located at the U of S, McGill University, Queen’s University, McMaster University, and University of Alberta to pilot the new technique.
“This discovery portends a major breakthrough towards a therapeutic reversal of food allergen sensitivity,” said Dr.
Judah Denburg, scientific director and CEO of AllerGen. “The treatment prevents anaphylactic responses in what were previously fully sensitive mice, opening the door for translating this therapy into the clinic.”
There is compelling evidence this technique could be effective in humans. In 2010, Gordon’s team demonstrated they could reverse an asthmatic response in human cells in a test tube. Using three applications of a similar therapy in a 2012 study, the researchers effectively eliminated asthma in afflicted mice, within only eight weeks.
“Even if we only cure 25 per cent of subjects, we will dramatically improve the health of those individuals, and also reduce healthcare system expenses,” said Gordon, who worked with Wojciech Dawicki, a research associate and the primary author and lead researcher in this study.
Master’s student Chunyan Li and lab technicians Xiaobei Zhang and Jennifer Town also worked on the project.
Here’s how the technique works:
- The key component of this research is dendritic cells, which serve as the gate-keepers of the immune system and are present in tissues in contact with the external environment, such as the skin and the inner lining of the nose, lungs, stomach and intestines.
- Gordon’s pioneering treatment involves producing dendritic cells in a test tube and then exposing them to a unique stir of proteins, a vitamin A-related acid naturally occurring in the human gut, and to the allergen, in this case, peanut or ovalbumin (egg white protein).
The modified dendritic cells are then reintroduced into the mouse.
- Using this technique, the researchers were capable to almost eliminate the allergic reaction by converting allergen-sensitive immune cells into cells that mimic the response seen in healthy, non-allergic individuals.
The treatment reduced the observed symptoms of anaphylaxis, and lowered other key protein markers in the allergic response by up to 90 per cent.
Food allergy is a growing public health issue in Canada. Currently, there is no known cure.
According to the Canadian Institute for Health Information, an estimated 171,000 Canadians visited emergency rooms for allergic reactions from 2013 to 2014, the rate of anaphylaxis visits increased by 95 per cent from 2006 to 2014, and the severity of reactions is increasing.
Gordon said the new technique also shows promise for treating autoimmune disorders such as multiple sclerosis. “It would take extremely little to adapt the therapy for autoimmune diseases,” he said.
Funding for the research was provided by the Canadian Institutes of Health Research and the AllerGen Networks of Centres of Excellence.
For more information, contact:
Media Relations Specialist
University of Saskatchewan
Director of Communications and Knowledge Mobilization
AllerGen NCE Inc.
Treatment involves injecting the allergen(s), causing the allergy symptoms. These allergens are identified by a combination of a medical evaluation performed by a board-certified allergist/immunologist and allergy skin or allergy blood tests.
The treatment begins with a build-up phase. Injections containing increasing amounts of the allergens are given 1 to 2 times a week until the target dose is reached. This target dose varies from person to person. The target dose may be reached in 3 to 6 months with a conventional schedule (one dose increase per visit) but may be achieved in shorter period of time with less visits with accelerated schedules such as rush immunotherapy.
The maintenance phase begins when the target dose is reached.
Once the maintenance dose is reached, the time between the allergy injections can be increased and generally ranges from every three to four weeks. Maintenance immunotherapy treatment is generally continued for three to five years.
Some people own lasting remission of their allergy symptoms but others may relapse after discontinuing immunotherapy, so the duration of allergen immunotherapy varies from person to person.
Risks involved with the immunotherapy approach are rare, but may include serious life-threatening anaphylaxis. For that reason, immunotherapy should only be given under the supervision of a physician or qualified physician extender (nurse practitioner or physician assistant) in a facility equipped with proper staff and equipment to identify and treat allergic reactions.
The decision to start immunotherapy will be based on several factors:
- Length of allergy season and severity of symptoms
- Desire to avoid long-term medication use
- How well medications and avoiding allergens control allergy symptoms
Immunotherapy will require a significant time commitment during the build-up phase, and a less frequent commitment during the maintenance phase
Out-of-pocket costs vary depending on insurance coverage.
Yet, allergy shots can be a cost-effective approach to managing allergy symptoms and save patients money in the endless run. Click here for more information on this.
Merck has also applied for approval of a tablet, also licensed from ALK-Abello, to treat ragweed allergy. Greer is developing a liquid sublingual product for ragweed. Sublingual therapy for dust mite allergy might come after that.
Grazax and Oralair own been available in Europe for several years.
A variety of factors, including the time needed to do American clinical trials, explain why it has taken so endless for the drugs to reach the United States.
Some American doctors own not waited. A survey in 2011 found that 11 percent of allergists were using the extracts approved for injection as off-label sublingual treatments. That is the treatment Ms. Hickey is using.
Shots own to be given in a doctor’s office because they can, though only rarely, provoke potentially fatal immune system reactions, called anaphylaxis. Also, to avoid such reactions, the dose used is started low and gradually increased over several months.
The sublingual treatments can cause throat irritation as well as itching and swelling in the mouth, but almost never anaphylaxis.
So it is expected that, except for the initial dose, the treatments can be taken at home. And patients can start at the full dose immediately or almost immediately.
Still, some studies propose that the sublingual therapy may not be fairly as effective as injections. Also, the tablets contain only specific allergens, such as for grass; shots are customized by allergists to contain multiple extracts, such as for weeds, dust mites and so on, to match a patient’s allergies.
“It’s rare that somebody comes in and they are just allergic to one grass,” said Dr.
Rohit K. Katial, professor of medicine at National Jewish Health in Denver. “Generally, people who are allergic tend to be allergic to multiple things.”
What is immunotherapy?
Immunotherapy, also known as allergy shots, are aimed at retraining your immune system so your allergic reactions become less severe. Prior to starting immunotherapy, a doctor will identify allergens a patient is allergic to by conducting a skin prick or intradermal test. Immunotherapy works by gradually injecting doses of allergens in the form of a shot, which leads to the immune system becoming less sensitive to the substance.
With time, individuals who get immunotherapy will experience less allergy symptoms.
By performing rush immunotherapy, a patient can reach maintenance dosing much quicker. The process is accomplished over one day. The patient takes medications to assist prevent allergic reactions for the three days prior to the procedure. At the finish of the day, the patient is where they would be if they had received 15 injections in the conventional build-up schedule (about halfway to maintenance).
The patient will still need to finish the final half of the build-up conventionally.
Allergic reactions are more common in rush patients, and it is not for everyone, but numerous patients appreciate the ability to reach maintenance more quickly because that is typically when allergic symptoms start to improve.
Sublingual immunotherapy (SLIT) is placing the allergen under the tongue everyday in order to build immune tolerance. There are currently sublingual immunotherapy tablets approved by the FDA and available by prescription.
They are approved for use in patients with ragweed allergy and grass allergy.Allergy shots are probably more effective, but because of the time commitment involved with the injections some people prefer a sublingual alternative that can be done at home.
After informed consent, subjects will be randomly assigned to ILIT group or placebo group in double-blind manner. In both group, causal allergen or placebo will be injected into inguinal lymph node through guidance by ultrasonography three times with 4-week interval.
In ILIT group, initial dose of allergen will be 1,000-fold diluted solution from maximal concentration of allergen extract for subcutaneous immunotherapy (Tyrosine S, Allergy Therapeutic, West Sussex, UK) in volume of 0.1ml. If skin is highly reactive in skin prick test, the initial dose will be 10-fold dilution from maximal concentration where diameter of wheal is less than that of histamine. After the first dose, allergen concentration will be escalated 3-fold at second dose, and 10-fold at third dose if there are no (or mild) local or systemic hypersensitivity reaction. The allergen concentration will not change at second or third dose if there is moderate local or systemic reaction.
The allergen concentration will decrease by 10 or 100-fold from previous concentration or further injection will be held if there is severe local or systemic reaction after sufficient explanation and discussion with subjects.
The investigators will assess allergic rhinitis symptom score before and 4, 12 months after the initial treatment. Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and Sino-Nasal Outcome Test (SNOT-20) will be used. Visual analogue scale (VAS) of symptoms including rhinorrhea, sneezing, nasal obstruction, postnasal drip, eye/nose/ear/palate itching, dyspnea, wheezing, chest discomfort as well as urticaria, angioedema, and itching on exposed skin during exposure to causal allergen in daily life will be also evaluated.
Skin prick test (SPT), intradermal test (IDT), blood sampling for serum entire immunoglobulin E (IgE), allergen-specific IgE, and allergen-specific immunoglobulin G4 (IgG4), nasal lavage for Th1, Th2, and Treg cytokines, and nasal provocation test (NPT) with Df and/or Dp allergen (in subjects whose AR symptoms are provoked by Df and/or Dp) will be also performed before and 4, 12 months after the initial treatment.
In addition, the investigators evaluated the change of subjects’ recognition of causal allergens, their avoidance, and AIT during this study. Using VAS, subjects were requested to score the rate of agreement with "Allergen provokes allergic symptoms in daily life", "Allergen avoidance can reduce allergic symptoms", "Allergen-specific Immunotherapy (AIT) can reduce allergic symptoms", "I can pay 50,000 Korean Won (KRW)/month for allergen avoidance", "I can pay 100,000 KRW/month for allergen avoidance", "I can pay 200,000 KRW/month for allergen avoidance", "I can pay 150,000 KRW for each injection of ILIT", "I can pay 300,000 KRW for each injection of ILIT", "I can pay 600,000 KRW for each injection of ILIT" before and after SPT/IDT, after NPT, 4 months and 1 year after ILIT.
Adverse events will be recorded and graded according to Muller classification and Ring and Meissner classification.
How effective are allergy shots?
Immunotherapy is a extremely effective way to manage allergies.
It is significant to consult with your allergist to see if immunotherapy is correct for you.