FEATURE
(23) The use of sublingual therapy is typically two to three months
before pollen exposure.(23) The long term effectiveness of subcu-
taneous immunotherapy in inducing tolerance and in producing
long term remission for grass pollen allergic patients is well studied.
(27) A landmark study by Durham published in 1999 in the New
England Journal of Medicine showed that patients on grass im-
munotherapy for 5 years had a prolonged remission of symptoms
for at least three to four years and reduction of skin test reactivity
to grass. (27) Immunotherapy, unlike medications, offers a more
effective long-term treatment free of ongoing medications for mul-
tiple years. Contraindication to immunotherapy includes the use of
beta-blockers (including ocular beta-blockers for glaucoma), which
block the effectiveness of epinephrine that may be required to treat
a systemic reaction. Likewise, elderly patients that may not be able
to tolerate epinephrine are not good candidates. Individuals with
unstable asthma, recent MI, or angina should not be given immu-
notherapy. Immunotherapy has been shown to be cost effective in
comparison to pharmacothera py when one considers the projected
cost of treatment. (3, 28)
CLOSING REMARKS
Management of upper airway symptoms is more complicated than
one might expect and while allergic rhinitis affects millions of
people in the United States, you must also consider other non-IgE
mediated causes in the differential diagnosis. The next time you
see a patient that says, “It’s just my allergies” remember to ask them
when their symptoms are the worst and what happens when they
eat certain fresh fruits or vegetables. Inquire about their home
allergen environment and ask who else has allergies in the family.
You will be able to tell them the best ways to identify what aller-
gens are causing their symptoms and based on allergy testing what
lies ahead in the future. Review the most effective environmental
control measures and what pharmacologic treatments are likely to
work best to control their symptoms. Finally, let them know the
effectiveness of immunotherapy as a disease modifying treatment,
which can lead to a more long-lasting remission of symptoms even
years after they discontinue immunotherapy. Most of all tell them,
“It’s not just allergies” and there are new breakthroughs in treatment.
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F. Tolis Simon, MD holds board certifications in both Allergy & Im-
munology and Internal Medicine. He is a third generation allergist in
Louisville, KY, and has been practicing for 20 years. He is in private
practice at Bluegrass Allergy and Asthma in Jeffersontown, KY, and
also works part-time at the Family Health Centers, Inc. Dr. Simon is an
associate faculty member at both the University of Louisville and the
University of Kentucky.
AUGUST 2018
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