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What Is Allergen Immunotherapy (AIT)?

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Ear Nose Throat Specialists, PC -  - Nose and sinus allergy - Dr. Goldberg - What Is Allergen Immunotherapy (AIT)? - Allergy Symptoms -
AIT is a type of treatment used to reduce allergy symptoms and improve quality of life. This is done by giving regular and repeated doses of an allergen (a substance that causes allergies) or allergens. Examples of allergens that you can inhale include pet dander, pollen, ragweed, grass, and dust mites. By taking gradually increasing doses, the immune system builds up a tolerance and becomes less sensitive. Unlike other treatments, AIT can lead to lasting benefits even after stopping. This can reduce the need to take other medications, which provides cost savings and convenience. Additionally, there is evidence that AIT can prevent new allergies from developing, prevent asthma, and reduce asthma symptoms.

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What Do the Key Action Statements in the AIT CPG Mean for Me?

The key action statements in the AIT CPG give trustworthy and evidence-based recommendations to health care providers. The level of recommendations is based on the strength of the evidence in the medical literature. A strong recommendation should be followed by the health care provider unless there is a clear and compelling reason for a different approach. A recommendation should also be followed, but health care providers should remain alert to new information. They should also be sensitive to your choices as a parent or patient. Lastly, an option means that health care providers should be flexible in their decision making. The patient or family preference could have an influencing role. Note that a recommendation or option may be for or against a specific action. Patients and their families and caregivers are encouraged to use the statements for discussion with their health care providers.

Who Should Get AIT?

Patients aged 5 years and older with allergic rhinitis (hay fever) who have positive allergy test results may be candidates for AIT. Allergic rhinitis is a condition in which the inside of the nose becomes inflamed and irritated. This occurs when the body’s immune system reacts to an inhaled allergen. Symptoms of allergic rhinitis include sneezing, itchy or runny nose, and nasal congestion (blockage). AIT may be the right treatment option for patients who are unable to manage their symptoms with regular medications and prefer a treatment with lasting benefits.

Who Should NOT Get AIT?

There are circumstances where AIT may not be suitable due to increased risks of adverse events. Patients should discuss the potential risks and benefits with their health care provider if they:

  • Are pregnant.
  • Have uncontrolled asthma.
  • Are unable to tolerate injectable epinephrine.
  • Use beta-blockers.
  • Have a history of anaphylaxis.
  • Have a weakened immune system.
  • Have eosinophilic esophagitis (EoE). Worsening of EoE is a concern only for SLIT (tablets or drops).

How Do You Determine Which Allergens to Treat?

Health care providers identify allergens based on an assessment of several factors. This includes symptoms, medical history, the season of symptoms, and allergy test results. Based on these factors, a qualified health care provider can determine which allergens to include in the treatment regimen that deliver the best possible results.

AIT can also be used treat multiple allergies at the same time. Health care providers may choose to treat one or a few allergens or multiple allergens. Studies show that both methods are safe and effective. Treating with even a few allergens can change your body’s response to other allergens. There is currently no evidence that show if one method is better than the other.

What Are the Different Treatment Options for AIT?

For inhalant allergens, AIT is usually administered using 1 of 2 methods. Subcutaneous immunotherapy (SCIT) places allergens under the skin with a needle. Sublingual immunotherapy (SLIT) involves using drops or tablets placed under the tongue. Both SCIT and SLIT are considered cost-effective and safe ways to treat allergies. AIT candidates should discuss their options with their health care providers. This includes their differences in associated risks, benefits, efficacy, convenience, and cost.

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How Long Does It Take to See the Benefits of AIT?

The duration of AIT is tailored to each patient’s specific needs. Patients can expect to see a decrease in symptoms in the first year of treatment. It is generally recommended to continue taking doses for at least 3 years for maximal benefit. This amount of time is believed to induce tolerance to the allergens that continues for at least 1 year after stopping treatment. Currently, there are a limited number of studies that show how long you should stay on AIT and if you will stay symptom-free after stopping. The decision to continue or stop should depend on factors such as your response to the treatment and the overall benefits achieved.

What Are the Risks of AIT?

Both SCIT (shots) and SLIT (tablets or drops) are considered safe and effective treatment options. AIT, particularly SCIT, can, however, induce a severe and potentially life-threatening reaction—called anaphylaxis—on rare occasions. Anaphylaxis can affect different parts of the body. It can include mild symptoms like hives and itching. It can also include severe symptoms such as difficulty breathing, chest pain, abdominal pain, and low blood pressure. In the worst cases, it can lead to a person’s heart and blood pressure failing. Health care providers should know how to recognize and treat this rare side effect if it happens. Patients receiving AIT should discuss all potential risks including the symptoms of anaphylaxis and how to use epinephrine, which is the main treatment for anaphylaxis. Additionally, having asthma increases the risk of a severe allergic reaction. All patients should have their asthma status assessed by a health care provider before taking AIT.

Where Can I Get More Information?

You can access this plain language summary, the AIT CPG, and related handouts and information online at www.entnet.org/aitcpg. In addition, visit www.enthealth.org/ for any information about the ear, nose, throat, and head and neck. The information can assist you with talking to your health care provider and help you make the right decisions.

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American Academy of Otolaryngology–Head and Neck Surgery Foundation

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