We offer a broad range of diagnostic and management services. Our primary aim is to provide to patients and their referring doctors a high quality, comprehensive assessment, based on a detailed history and appropriate investigations.
What is allergy?
The term “allergy” refers to a hypersensitivity response to a normally innocuous environmental trigger, i.e. an inappropriately exuberant reaction to something that doesn’t cause symptoms in most people.
Allergies are very common in Australia, affecting around one in three people at some time in their lives. Most GP’s encounter such problems on a daily basis. The spectrum of these conditions includes allergic rhinitis, allergic conjunctivitis, sinusitis, asthma, eczema, angioedema, urticaria, drug and food allergy systemic or anaphylactic reactions to venoms, (primarily bee and wasp), as well as contact dermatitis to topically applied products.
Common allergens are dust mites, grass/tree/weedpollens, mould spores and some foods. In people disposed to allergy, an initial exposure to an allergen sensitizes them to that particular allergen and subsequent repeat exposure results in an allergic response. Some people don’t develop symptoms of allergy till their teens or later. People who emigrate from one country to another may have no symptoms for several years and then develop allergic disorders.
Allergic rhinitis or “hay fever” is relatively common in Australia and other industrialised nations with a prevalence of between 10-30% and is frequently associated with allergic conjunctivitis. It generally develops in childhood, although may not be recognized, as the symptoms may be attributed to “colds”.
There is increasing evidence that chronic inflammation is the primary factor in persistent bronchial hyper-reactivity and resultant chronic asthma. Dust mite has been shown to be a significant allergen in many allergic asthmatics, especially in warm humid regions. Reducing exposure to this can result in decreased asthma symptoms. Seasonal exacerbation of asthma is frequently associated with pollen allergy, particularly in the country areas of Australia.
Atopic Dermatitis (AD) or eczema starts in early childhood and affects approximately 5-20% children worldwide. It is often intensely itchy, resulting in chronic scratching and can be complicated by secondary infection. Allergens such as dust mites and certain foods (such as eggs, cow’s milk, wheat, soya bean, peanut and shellfish) have been shown to aggravate AD in some patients.
Important facts about Immunotherapy
Immunotherapy can reduce the production of allergy-associated antibodies, moderates the release of histamine and stimulates the production of blocking antibodies. Over time, these processes reduce allergic symptoms. Most patients enjoy better health and require less medication after completing their immunotherapy.
With careful monitoring and several provisos, immunotherapy can be safely given in pregnancy in most cases, though it is not commenced during pregnancy.
Often, patients with asthma, rhinitis and eczema will have other non-allergic irritants, which contribute to their symptoms. These will not be controlled by IT and some medications may still be required to ease these symptoms.
Immunotherapy is considered if you are suffering chronic allergy symptoms which are moderate to severe, do not respond adequately to medications, or those medications are complicated by side effects and/or those symptoms are triggered by allergens that are not easily avoided.
Immunotherapy is used to treat allergies caused by exposure to
› grass, weed and tree pollens
› animal dander (eg. cat, dog, horse)
› dust mites
› mould spores
› bee & wasp venom (resulting in anaphylaxis)
MAIN FEATURES OF THE IMMUNOTHERAPY PROGRAM
1. The injection is an extract of the substances (allergens) to which you are allergic. It is produced under sterile laboratory conditions.
2. Concentration and dosage of the allergenic extract is individually prescribed
3. Your own local doctor can administer the injections. It is given into the rear of the upper arm. A tiny needle is used, so discomfort is minimal.
4. There is a very small risk (1/10,000) of having a systemic reaction to the extract. As a precaution, you are required to wait for approximately 30 minutes at the doctor’s surgery after each injection.
5. Many people develop a minor local reaction to the injection. A small area of swelling and itchiness can be relieved with an icepack and antihistamine if necessary.
6. You should not receive an injection if you are suffering from an illness with a temperature or if your asthma is unstable. Check with your doctor.
7. Initially, injections are weekly extending to monthly after 6 months.
Sublingual immunotherapy is an option for patients who are needle-phobic or are unable to attend for the regular injections required for subcutaneous immunotherapy. It is a daily therapy administered by the patient themselves at home. Between 1 to 4 drops or 1-2 tablets are administered under the tongue and are not swallowed. We advise no eating or drinking for 15 minutes after each administration. It is also given for a total of 3-5 years. The most common side effect is oral discomfort, experienced in up to 40% patients, but only 4% patients have to stop the immunotherapy because of this discomfort. The risk of anaphyaxis is much lower than subcutaneous and is only seen in grass pollen allergic patients commenced on sublingual immunotherapy during the grass pollen season.
Reviews with the Allergy Specialist
It is important at the completion of each phase for you to be reassessed by the Allergy Specialist.
This involves a review of your progress on immunotherapy, discussion of symptoms, medication needs, review of lung functions etc.
70-80% patients on immunotherapy note improvement in their symptoms. How much improvement varies between individuals but is around 10-50% improvment, depending on what you are measuring.
Both subcutaneous and sublingual forms of immunotherapy are given for a total of 3-5 years. Immunotherapy given for shorter periods of time is more likely to result in a rapid recurrence of airway symptoms. At the end of 3-5 years of immunotherapy, the resulting reduction of sensitivity to allergens typically lasts for years.
The success of immunotherapy depends largely on patient compliance with the program and the responsiveness of the individual immune system.