allergies
Dr. Dane McBride, a board-certified asthma and allergy specialist at the Asthma and Allergy Center on Franklin Road, tells this story:
A teenager came to him with asthma so severe he couldn’t play sports. Since his asthma was often triggered by allergies, McBride injected him every few weeks with a relatively new treatment, Xolair, that temporarily blocks the antibodies triggering allergic reactions. The teen, now in his twenties, is currently attending college on a partial sports scholarship.
Such is the power of the right allergy treatment at the right time.
Spring is one of two seasons (the other is early fall) when allergies get the best of people who are susceptible. In early March, allergies to tree pollens begin and continue for several months; by the first of May, grass pollens are added to the mix.
To make matters worse, we live in a valley, which according to McBride, may be the worst possible scenario for allergies. The mountains on either side create a kind of inverted bowl effect, whereby allergens and pollution get trapped and linger longer than they would otherwise.
There are three ways of handling allergies: (1) You can avoid the allergen that triggers them (e.g., avoid pets to avoid pet dander – but good luck avoiding trees and grass); (2) You can use over-the-counter or prescription medicines to block the allergy’s effects (more effective for some people than for others); or (3) You can reduce allergies through allergy immunotherapy, which uses progressively larger doses of allergens to immunize you against the allergens’ effects.
If the first two aren’t producing the relief you need, you may be ready to tackle the third.
Standard Immunotherapy
To anyone who’s struggled with allergies for years, the idea of wiping out the misery with immunotherapy scarcely seems possible. The standard version of this therapy, allergy shots, has been around for decades. But in the first 11/2 years of treatment, visits to the doctor’s office can be frequent. And although the shots confer immunity benefits after just a few months, it takes five years of them to consolidate the changes so that they will last for many years after the shots stop.
Even then, there’s no guarantee allergies are gone for good.
Nevertheless, the shots “have come a long way, baby” since their earliest years, says McBride. If you took allergy shots years ago and found them less than fully effective, know that doctors now use higher concentrations of allergen extract than they used initially.
“We found lower doses, though safer, don’t work or not for long,” McBride says. Typically doctors now push the concentration to the highest strength patients can tolerate safely: “We turn the volume down on the [allergies], and sometimes we turn the whole thing off.”
Are You in a Rush?
Yet even those for whom immunotherapy might be a good idea can’t always leave work twice a week for the first 16 weeks, or shoulder the cost if their insurance co-pays for each injection are high.
For such people, allergists consider administering what’s called “rush” immunotherapy. It still takes five years to build up lasting immunity, but the initial visits to the doctor’s office are fewer. Rather than building up to your target (maintenance) dose with shots once or twice a week for the first few months, you literally build up to the desired level in a few days.
McBride says his practice also offers a middle-ground approach called “modified rush” immunotherapy.
As you can imagine, accelerating the process this way creates a slightly higher risk of having a severe reaction to the allergens, so before the injections patients take steroids and antihistamines to forestall problems. Those who are highly reactive to allergens in the first place, or have heart disease or severe asthma, are not good candidates for an accelerated approach.
Antibody Antidote
Finally, for some folks there are injections of the aforementioned Xolair, which “knocks out the allergic antibodies” in the system, McBride says. The down side is that the treatment has to be repeated every two to four weeks ad infinitum, since within that time frame the body regenerates the offending antibodies. Not everyone is a candidate for such treatment, and not everyone would want it. But for those whose lives are being held hostage to severe allergies and/or allergic asthma, the inconvenience might seem like a fair tradeoff.
What Are Allergies?
Here’s how allergies work: When your immune system comes into contact with a substance to which it’s susceptible, such as grass pollen, it overreacts, treats the substance like an “enemy,” and releases antibodies to fight the invader.
The unnecessary antibodies then cause the immune cells to release chemicals, including histamines, that set off allergy symptoms: sneezing; watery eyes; runny nose; hives; headaches; itchy eyes, nose or throat, etc.
Your body can be allergic to many different substances, including pollen, animal dander, dust mites, certain foods, insect bites and drugs. An allergist can test to find out which allergens are triggering your symptoms.