Allergy Immunotherapy

VIDEO: Allergy and Asthma Treatment during COVID-19

During the COVID-19 pandemic, we have had to think creatively on how we can safely continue needed services such as allergy desensitization.

I encourage our patients to watch this video to learn about your options: Home injections; Drive-through injections; Drops or tablets to dissolve under the tongue; or simply put your allergy desensitization on hold for the summer.

– Dr. Armstrong

What is Immunotherapy?

Immunotherapy has been used for almost 100 years to treat allergic diseases and is the only treatment shown to truly cure or prevent asthma and allergic disease. The standard of care in the United States for the past 50 years has been subcutaneous injection immunotherapy, commonly known as “allergy shots.” In the past 20 years, safety concerns over allergy shots have led to the development in Europe of sublingual immunotherapy, sometimes referred to as “allergy drops” or sublingual immunotherapy (SLIT). In a January 2014 review article on the status of sublingual immunotherapy (SLIT) in the US, Linda Cox observed that SLIT has been used for over 30 years with excellent safety.¹ In 2013, the Federal Drug Administration (FDA) Allergenic Products Advisory Committee recommended approval of two products for treatment of grass pollen allergy. We are pleased to offer both sublingual immunotherapy and traditional subcutaneous immunotherapy at Richmond Sinus & Allergy.

The goal of immunotherapy is to desensitize the patient by administering small doses of the offending antigen on a regular schedule. The dose is gradually increased until the original allergy symptoms resolve or side effects limit further escalation of treatment. The testing methods we employ allow us to custom blend your allergy shots to the strongest safe starting dose. Each antigen is mixed at a concentration determined by the reactivity in your skin. This allows us to smoothly increase the doses of highly reactive and less reactive antigens with minimal side effects. Many patients experience improvement within 3 to 6 months.

As you continue treatment, your body will increase antigen-specific concentrations of the protective antibody IgG and decrease amounts of the allergic antibody IgE. This will be associated with a shift of T-helper white blood cells from an allergic response to a normal defense response. These helper cells down-regulate the response in target organs: your nose, your lungs, your eyes and your skin. This cascade of biochemical and cellular changes has been demonstrated with both allergy shots and allergy drops.

If you choose to begin allergy shots, you will be expected to come to the office weekly for injections. You may not administer the shots at home, but you may arrange for another physician to supervise the shots. We will observe you a minimum of 20 minutes after each injection for possible side effects, which are the same as the risks and side effects described above for testing. Common reactions include itching, swelling and soreness in the arm. Serious anaphylactic reactions that require emergency treatment are rare. After one year, many patients are experiencing a significant reduction in symptoms. Most are reducing their medication usage and some will decrease the frequency of visits to once every two to three weeks. After 3-5 years, many patients can discontinue treatment altogether and experience years of improvement.

Sublingual immunotherapy is available as a prescription tablet or as customized drops that we prepare in our office.  Pleasant tasting drops or tablets are placed under the tongue once daily for two minutes, and can safely and easily be administered to children. This convenient alternative requires only quarterly check-ups at the office, and is popular among working people and busy students. Allergy drops require at least one year of treatment to become effective and are not covered by insurance plans.

Allergy Immunotherapy Financial Information

We are dedicated to providing the best possible care and service to you. We also believe that your understanding of your financial responsibilities is an important element of your relationship with our practice. Allergy testing and treatment is generally covered by most insurance plans. Although immunotherapy is an expensive treatment option, it is usually less expensive than a lifetime of continued allergy symptoms requiring two or more brand name prescription drugs. A recent study showed that immunotherapy reduces the overall cost of allergy and asthma treatment by over $400 per year. Typically immunotherapy is continued for 3-5 years, after which it is usually discontinued, with substantial health care savings.

Should you decide to proceed with allergy shots, you should budget sufficient time and money for weekly office injections for one year, and at least twice a month for another 3-4 years. Administration fees range from $20-35 for shots, which may require an office co-payment before insurance pays the balance. For example, if you have a $20 co-payment and visit 50 times a year, you should budget at least $1,000 for the first year for co-payments, plus any current expenses on medication. Our goal is to decrease your medication need with successful allergy treatment. In addition to the charge for shot administration, there is a fee for the supply cost and preparation of each ten–dose vial of immunotherapy serum. Many patients require two vials simultaneously and a few require three. After the first year, we hope that you have greatly reduced your need for medication, and we hope to reduce the frequency of shots to twice a month.

Currently, no insurance plan in our market covers sublingual allergy drops. However, this needle-free solution has become quite popular due to its proven safety and convenience. We currently charge $200 per ten cc vial, which lasts 5-10 weeks, depending on your dose. You will need to budget at least $1,000-$2,000 per year to pay for these drops out of pocket. This may qualify as a tax-deductible healthcare expense, but will likely not apply to your deductible or out-of–pocket maximum.

RISKS of treatment include localized pain, swelling, itching, or redness at or near the injection site. Worsening of symptoms may occur, and we may decrease your dose or postpone your injection if you are ill. Anaphylaxis is a severe, life-threatening allergic reaction, which can occur naturally or in response to immunotherapy. We will prescribe an epinephrine auto-injector to all patients on immunotherapy, and to those who have had severe reactions to foods or bee stings. Keep the injector with you, and protect it from heat and sunlight. Replace it immediately after the expiration date. Should you develop a severe allergic reaction associated with swelling or shortness of breath, administer epinephrine and call 911 immediately.

¹Cox L. Sublingual immunotherapy for aeroallergens: Status in the United States. Allergy and Asthma Proceedings, Volume 35, Number 1, January/February 2014 , pp. 34-42(9)