Immunotherapy

Build Your Natural Allergy Resistance With Immunotherapy 

Many patients in the greater St. Louis area have moderate-to-severe allergies, with seasonal or year-round symptoms that cannot be fully controlled with environmental measures and medications. For these patients, immunotherapy (allergy shots and drops) can be life-changing treatments. As the name implies, immunotherapy works by re-educating the immune system to tolerate—rather than dramatically overreact to—each patient’s specific allergenic triggers. 

Immunotherapy is accomplished by carefully exposing allergic patients to measured, gradually increasing amounts of allergens. Over time, the immune systems of these patients become much less sensitive to these pollens, molds and other allergens—treating the cause of allergy rather than masking the symptoms. In fact, allergy medicines only treat symptoms, immunotherapy actually treats the cause.  

What Are the Benefits of Immunotherapy? 

As the allergens are better tolerated, symptoms and medication use decrease—and both have the potential to be eliminated. In fact, immunotherapy is the only allergy treatment with the potential to cure allergic disease. Immunotherapy benefits usually begin within the first few months of treatment and can include: 

• Significant improvement in allergic symptoms and ear, nose & throat related quality of life 
• Decreased allergy medication use 
• Improved asthma control in asthmatic patients 
• Prevention of progression to more advanced allergic disease (eczema, asthma & allergic rhinitis)—especially in children 

How Does It Work? 

With immunotherapy, allergens are introduced to the body either with a small shot under the skin or with drops of extract placed under the tongue. White blood cells then create circulating antibodies directed against these allergens, much like an immunization. For the patient on immunotherapy, allergens in the nose are immediately attacked and neutralized by these protective antibodies—and no longer produce a histamine response. Without histamine constantly being released into the nose, symptoms diminish dramatically. 

How Long Does Treatment Last? 

Though immunotherapy is usually remarkably effective shortly after beginning the treatment, the primary goal is excellent long-term symptom control. While your specific treatment goals and plan will be formulated by your Midwest ENT physician, ideal long-term improvement usually requires treatment with allergy shots or drops over time. Research indicates that with 3-5 years of treatment (most of which can be done at home), the immune systems of most patients can be permanently trained to tolerate allergens that once made these patients miserable. Immunotherapy, properly done, should give excellent symptom control with less reliance on medications now and indefinitely into the future. 

There is some inherent risk of causing an allergic reaction when an allergic patient is exposed to something to which they are sensitive. Rest assured that your safety is our primary concern. Through education, close monitoring and training, our staff will assure you receive the most up-to-date and effective allergic treatments in the safest possible setting. 

Choosing Your Immunotherapy Treatment: Subcutaneous (“Allergy Shots”) vs. Sublingual (“Allergy Drops”) Immunotherapy 

Your Midwest ENT physician will determine if you are likely to benefit from allergy immunotherapy based on your history, examination and allergy test. If you are a candidate, you may then choose which method of immunotherapy (allergy shots or drops) is best for you. Regardless of which option you choose, remember immunotherapy is a commitment—one that more than 90% of patients are very happy they’ve made. Consider allergy treatment a worthy (and cost-effective) investment into your long-term health. Most patients will be on home shots or drops for 3-5 years (and many will not need any other allergy medicines during this time).  Recent research indicates most patients will enjoy many years of symptom-free relief after completing the program. 

Allergy Shots (Subcutaneous Immunotherapy, or SCIT) 

Allergy shots (SCIT) have proven very effective for most patients with severe allergies or those who do not receive appropriate relief from allergy medicines. Shots are formulated based on the “recipe” generated from the patient’s allergy test—so each person’s shot vial is as unique to them. For safety reasons, weekly allergy injections start at low concentrations and “escalate” to more concentrated doses as tolerated. During this escalation process, patients must receive injections here at Midwest ENT Centre to be briefly monitored for swelling or other reactions to the shot. Once this escalation process is complete, patients then receive weekly “maintenance shots” consisting of the same amount of allergen each time. Most patients will be given the option of self-administering maintenance injections at home from allergy vials kept in their own refrigerators. The process of training the immune system to be “less allergic” takes time, but is well worth the effort. 

Allergy Drops (Sublingual Immunotherapy, or SLIT) 

In past decades, allergy shots were the only option for patients requiring immunotherapy. At Midwest ENT Centre, we understand that some of our allergic patients (especially children) may be “needle-phobic,” and some may have schedules that prevent them from coming into the office for 10-30 consecutive weeks for allergy shot escalation, or “build-up.” To give these patients an option for effective treatment, Midwest ENT Centre offers sublingual immunotherapy (SLIT). SLIT has been proven to deliver the benefits of allergy shots in a pain-free, convenient manner. With SLIT, drops containing allergens are placed under the tongue, held in place for 2 minutes and swallowed. Similar to allergy shots, SLIT gradually desensitizes the immune system to the allergens that had been provoking it, significantly improving symptoms and decreasing the need for allergy medicines over time. 

Who Can Benefit From SLIT? 

Some patients well-suited for SLIT include the following: 

• Those with work/school conflicts that prevent them from in-office escalation of shot therapy in the office 
• Patients at higher risk for adverse events during the course of SCIT escalation/therapy: 
• Moderate-severe asthmatics 
• Patients with unacceptably large local shot reactions 
• Out-of-town college students 
• Needle-phobic patients 
• Pediatric patients 

SLIT is very safe. In fact, documented cases of anaphylaxis with sublingual treatment are exceedingly rare. Since it is so safe, the entire treatment—both escalation and maintenance—can be done fully at home. Patients need only come to the office for periodic allergy reviews. For select patients, SLIT offers symptom improvement with minimal inconvenience—and without needles. 

Please consult the following table to learn more: 

For more information about the SLIT program, please see our SLIT frequently asked questions. 

SLIT program Frequently asked questions 

How to Get Started on Immunotherapy at Midwest ENT Centre 

If you and your Midwest ENT Centre physician decide that allergy shots are right for you, here are a few tips to help you get started: 

• If you agreed to start allergy shots during your post-test appointment with your doctor, stop by the Allergy department window to complete Immunotherapy program enrollment. If you decide at a later time to start shots recommended to you at your appointment, simply stop by the Allergy department window during normal business hours to enroll in the Immunotherapy program. 
• Once enrolled a specific start date will be provided to you. 
• You may come in anytime during our allergy shot hours for your first (or any subsequent) shot. Shots are given on a walk-in basis and usually there is little to no wait. No appointments for shots are necessary. Allergy shot hours are as follows: 

• Monday: 12:30 PM – 5:30 PM 
• Tuesday: 12:00PM  – 4:30 PM 
• Wednesday: 8:30 AM – 1:00 PM 
• Thursday: 12:30 PM – 5:30 PM 
• Friday: 9:00 AM – 1:00 PM 

• Most shots will be given in the upper arms, so remember to wear clothes that will allow the nurses easy access to your arms. 
• It is normal for the injection site to swell some after each shot. Taking an antihistamine 30 minutes prior to the injection or icing the site after the shot can help. 
• For quickest improvement and maximum benefit and safety, you need to get your shots every 5-11 days. You may choose which day of the week to come in, and it need not be the same day each week. 
• Shots given sooner than 5 days from the date of the last shot can lead to higher risk of adverse reactions to your shots. 
• If too much time (≥12 days) elapses since your last shot, you may need to repeat the same dose as the previous shot—prolonging the shot dose escalation process. 
• Home injections may be available for some patients once the dose has been safely escalated to the appropriate level in the office. See the nursing staff for details. 
• Remember that you will need to see your doctor three months after starting the Immunotherapy program and then at least once yearly. 

If you have settled on treatment with allergy sublingual drops, contact the allergy department via your Follow My Health patient portal account to arrange for payment, mixing and delivery. Drop vials can be mailed directly to your door and can be done entirely at home. 

Call Midwest ENT Centre at (636) 441-3100 for more information or to schedule an appointment.