Seasonal Advice, Treatment and Prevention
Allergy Advisor - Seasonal Update  WINTER/ SPRING/ SUMMER/ FALL
Limiting Exposure to Allergens in the Home 
Prevention of Allergy and Asthma in Children
Treatment of Allergy and Asthma
Skin Testing and Allergy Injection Treatment
Inhalers for Asthma
Spacers for Asthma Inhalers
Inhalers for Rhinitis
Tricks for - children to swallow pills
                 - eye drops
Mexican Medications

Skin Testing and Allergy Injection Treatment for Allergies and Asthma

Allergy skin testing and allergy injection treatment (allergen immunotherapy) are not needed for every patient with allergic rhinitis and/or asthma.  Effective medications are available for both conditions and may be sufficient for adequate treatment of many patients without starting allergen immunotherapy.

Allergy Skin Testing

• Testing for skin sensitivity to a number of different allergens confirms and amplifies information from the history of symptoms and a physical examination done by the allergist.  It does not replace the initial clinical evaluation by the allergist.  Indiscriminant testing with a large panel of allergens including foods is not routinely appropriate in the investigation of patients with repiratory allergy.
• The testing can help to identify allergy to avoidable allergens, to determine if the allergy is mainly to unavoidable allergens (such as pollen), and to help in distinguishing respiratory disease that is triggered by allergens from non-allergic respiratory disease.
• Blood testing by RAST and similar tests in a reliable laboratory can provide information comparable to that from skin tests.  Currently these tests are more expensive and, depending on the methods used, are often less sensitive than skin testing.  Regardless of the choice between skin testing and blood testing, the panel of allergens tested must be chosen by an allergist who is familiar with locally important allergens.  IgG (immunoglobulin G) testing for allergy is not of proven diagnostic value.
• If the patient to be tested has moved from a botanically different area (such as from Seattle to Tucson) within only a few months,  testing is best delayed until all of the seasons' pollens have been encountered.

Allergen Immunotherapy ("Allergy Shots")

• What is it?  When appropriate medications and avoidance of allergens are inadequate for control of respiratory allergy (allergic rhinitis or asthma), allergen immunotherapy (allergy injection treatment) may be indicated.  The treatment consists of repeated injections of one or more mixtures of extracts of allergens over a period of several years.   Studies of oral immunotherapy with allergens (drops under the tongue) suggest that this might be effective under certain circumstances, but has not been proven to be effective for treatment of sensitivities to multiple allergens seen in most allergic patients.
• How does it work?  In the first year of treatment, the injections redirect the immune system toward more normal functioning.  This has the effect of suppressing the levels of IgE antibodies and reducing allergic inflammation, so that tolerance of exposure to allergen steadily improves.
• How is it done?  The allergens selected for treatment  are determined by the allergist to be important in provoking disease in the patient.  Initially the injections are very small doses of weak allergen extracts given once or twice a week, and the doses are progressively increased as the reactivity of the patient's immune system to the allergens decreases. 
• Is it effective and safe?   Allergen immunotherapy has been proven by scientifically controlled studies to be effective in reducing symptoms.  Although immunotherapy never provides a permanent cure for asthma or allergic rhinitis, it reduces the need for medications in many patients with allergic rhinitis and asthma.  Because there is a risk of allergic reactions to the injections that varies from one patient to another, the allergist gives advice on the balance between benefits and risk before starting treatment.
• Does it work for all allergies?   Allergy injection treatment is more effective for allergy to pollen, cats and house dust mites than it is for mold allergy.  This is fortunate for us in the desert, where mold allergy is less of a problem than in more humid climates and where both allergic rhinitis and allergic asthma are commonly triggered by pollen.  Immunotherapy appears to be less effective in the treatment of allergic asthma than in the treatment of allergic rhinitis, but patients who have both conditions usually benefit from immunotherapy.  It is not indicated for treating food allergy.
• Does it replace the need for medications?   Since improvement in symptoms is normally delayed for 9-12 months, medications taken before starting the injections must NOT be stopped during this period.  Medication requirements usually decrease after one year of treatment, but some patients never become independent of medications.

Further reading
Calderon MA. Alves B. Jacobson M. Hurwitz B. Sheikh A. Durham S. Allergen injection immunotherapy for seasonal allergic rhinitis.[Review] [316 refs] Cochrane Database of Systematic Reviews. (1):CD001936, 2007.
Creticos PS:   The consideration of immunotherapy in the treatment of allergic asthma.  Journal of Allergy and Clinical Immunology  Vol 105: pp s473-s476, 2000.
Norman, PS:  Immunotherapy, past and present.  Journal of Allergy and Clinical Immunology Vol 102, pp 1-10, 1998.
Durham SR, Till SJ:  Immunologic changes associated with allergen immunotherapy.  Journal of Allergy and Clinical Immunology  Vol 102, pp 157-164, 1998.
Platts-Mills TAE, Mueller GA, Wheatley LM:   Future directions for allergen immunotherapy.  Journal of Allergy and Clinical Immunology Vol 102,  pp 235-243, 1998.
AAAAI: What is allergy testing?
AAAAI: What are allergy shots?

Disclaimer:   This site is for educational purposes only.  Any information that you have found in this web site is not intended to replace medical care or advice given to you by your own physicians. You should consider consulting your local medical library and other web sites for additional information. 

Comments and suggestions welcome!   Email: schumach@u.arizona.edu
Content Owner:  Michael J. Schumacher, MB, FRACP, The University of Arizona
Updated  5/2012