Imagine Life Without Allergies

What kinds of allergy tests are available?

There are several types of specific allergy tests. There are skin and blood tests for allergies. Immediate-type hypersensitivity (IgE) skin tests are typically used to test for airborne allergens, foods, insect stings, and penicillin. Immediate-type hypersensitivity also can be evaluated through serum IgE antibody testing called radioallergosorbent testing (RAST). Delayed-type hypersensitivity skin tests (patch-type skin tests) are commonly used in patients with suspected contact dermatitis. Some common allergens for patch testing are rubber, medications, fragrances, vehicles or preservatives, hair dyes, metals, and resins.

About 15 minutes after the application of to skin, the test site is examined for a wheal and flare reaction. A positive skin test reaction (typically, a wheal 3 mm greater in diameter than the negative control reaction, accompanied by surrounding erythema) reflects the presence of mast cell¬bound IgE specific to the tested allergen.

Skin tests are used most of the time. There are three main kinds of skin tests. The first kind is called a "scratch" or a "prick" test. Several types of skin testing instruments are available for percutaneous skin testing. Each brand of instrument has its own sensitivities and specificities. Positive-control skin tests (histamine) and negative-control skin tests (diluent) are essential for correct interpretation of skin test reactions.A tiny drop of testing allergen fluid is placed on your skin. Then, the skin is pricked through the drop. After 15 minutes, the test site is checked for redness and swelling. There's a "prick" sensation when the testing is applied, but it doesn't hurt a lot. Usually, about 240 prick tests are needed for a full exam.

In the second kind of skin test, the testing fluid is injected into your skin (like a shot). This test is used to check for allergy to medicines (most often penicillin) and bee-sting allergy.

The third kind of skin test is called a patch test. A small patch of material soaked in testing fluid is taped on your skin. After 2 or 3 days, your doctor will take off the patch and look for redness and swelling in your skin. Patch tests are used to evaluate rashes caused by allergy to things that might rub against your skin.

Why should I be tested for allergies?

It is not always necessary to have allergy tests. In some cases, it can be easier to skip the tests and go straight to taking allergy medicines. There are a number of safe and effective medicines that work well for most allergies. If these medicines do not work for you, or if you have severe allergy reactions, allergy testing may be helpful.

Allergy tests can help you find out what you are allergic to. Once you know what you are allergic to, you can try to stay away from it. The most common nose or lung allergies are to pollens, molds, dust mites, and cats. The most common food allergies are to peanuts, other nuts, wheat, milk, eggs, fish, and shellfish. Your doctor will also be able to tell what kind of allergy medicine is right for you. If your doctor finds out that your problems are not caused by an allergy, he or she can look for other causes.

Allergic diseases are among the most common medical problems encountered in ambulatory practice. However, some patients with suspected allergic disease turn out, on further evaluation, to have a medical problem that cannot be attributed to an allergy. Allergy testing can help the physician determine if a patient's problem is caused by an allergy and identify the specific problem allergens. Having established a correct allergy diagnosis, the physician is better equipped to select appropriate therapeutic interventions for that patient, such as allergen avoidance, medications, and, sometimes, immunotherapy. For example, a patient with a specific pollen allergy may be instructed to increase medication use during the pollen season. Patients with an animal allergy may be instructed to use allergy or asthma medication before exposure.

Immediate-Type Hypersensitivity Skin Testing

Immediate-type hypersensitivity skin testing is most commonly used in the diagnosis of allergic rhinitis, allergic asthma, food allergy, penicillin allergy, and stinging-insect hypersensitivity. Skin testing can be performed by the percutaneous route (diluted allergen is pricked or scratched into the skin surface) and by the intradermal route (injection of allergen within the dermal layer).

PERCUTANEOUS TESTING :

Antihistamines interfere with the development of the wheel and flare reaction and should be stopped before immediate-type skin testing. First-generation antihistamines may be stopped two to three days before testing, but the newer, second-generation antihistamines can affect skin testing results for three to 10 days or longer.1 Medications with antihistamine properties, such as anticholinergic agents, phenothiazine, and tricyclic antidepressants, also should be discontinued before skin testing. Histamine H2-receptor antagonists (e.g., cimetidine [Tagamet], ranitidine [Zantac]) have a limited inhibitory effect; these medications may be stopped on the day of skin testing.1 Inhaled and short-term systemic corticosteroids generally do not significantly suppress the wheal and flare reaction of immediate-type skin tests.

Immediate-type skin testing is a safe procedure with a very small risk of systemic reaction. A retrospective study2 involving 18,311 patients found six mild systemic reactions over a five-year period. A nationwide survey of allergy specialists reported six fatal reactions to skin tests from 1945 to 1986.3

Allergy to airborne substances (i.e., allergic rhinitis and asthma) is typically evaluated using a panel of percutaneous skin tests for about 40 allergens. A number of the most commonly used allergenic extracts for skin tests are now standardized (Table 3). Percutaneous skin testing has been used to test for food allergy; however, it is less reliable for evaluating food allergy than for evaluating reaction to airborne allergens.

Analysis of the clinical performance of percutaneous testing for establishing an allergy diagnosis is limited by the lack of a universal gold standard to confirm a specific allergy. Clinical studies suggest that the medical history is generally inadequate to serve as a gold standard.4,5 Experimental trials where allergy exposure is carefully controlled provide better data about percutaneous testing.

In a recently published trial,6 patients with suspected cat allergy were tested through enclosure in a small room containing two cats. During a one-hour exposure, the study subjects were monitored for upper respiratory symptoms, lower respiratory symptoms, and spirometry changes. Each patient also underwent percutaneous testing. The sensitivity and specificity of percutaneous testing were 94 and 80 percent for upper respiratory symptoms, respectively; 84 and 87 percent for lower respiratory symptoms; and 97 and 81 percent for decreased forced expiratory volume in one second (a 15 percent fall or greater). A negative result for percutaneous testing indicated that a true cat allergy was unlikely.

The performance of percutaneous tests in the diagnosis of food allergy also has been widely investigated. In a study7 where the gold standard for allergy was a double-blind food challenge to the suspected allergen (e.g., egg, milk, peanut, soy, wheat, or fish), the sensitivity of percutaneous tests was 76 to 98 percent, with specificity ranging from 29 to 57 percent, depending on the food extract used for testing.

The specificity for food allergen tests is generally low, partly because of cross reactions between some food groups (e.g., legumes). Negative reactions to suggested food allergens on percutaneous tests make a diagnosis of true food allergy unlikely in most cases; however, the poor specificity of these tests precludes a definitive diagnosis of food allergy based on positive test results alone. A double-blind food challenge should be considered when more clinical certainty is needed in diagnosing a serious food allergy.

INTRADERMAL TESTING :

Intradermal tests are much more sensitive than percutaneous methods (the tested allergen is 10- to 100-fold more diluted), but they have a lower specificity. Intradermal testing is usually reserved for venom and penicillin allergy testing when percutaneous tests are negative but there is high clinical suspicion of allergy. Stinging-Insect Hypersensitivity. Adults who present with a history of a systemic reaction to insects (e.g., bee, yellow jacket, hornet, wasp, fire ant) should be evaluated with allergy skin tests. Children who present with only dermatologic manifestations of a systemic reaction are not at substantially increased risk for future anaphylaxis and do not need allergy skin tests. Management of sensitive patients may include education, avoidance measures, self-administered epinephrine, and allergen immunotherapy.

Drug Allergy. Reliable allergy tests for drugs are available only for penicillin and local anesthetics. In many patients with a history of penicillin allergy, the simplest course is to prescribe an antimicrobial agent that does not contain a beta-lactam ring. In patients with a history of penicillin allergy who have a strong indication for use of a beta-lactam antibiotic, penicillin skin tests can be helpful.

A large study of patients with penicillin allergy showed that 1,220 of 1,227 patients (99 percent) with intradermal skin tests negative to penicillin did not experience a drug reaction when given penicillin.8 [Evidence level B, nonrandomized clinical trial] Of the nine patients with positive penicillin skin tests who received penicillin, two (22 percent) developed a drug reaction. In a similar but smaller study,9 96 percent of patients with negative penicillin skin tests had no reaction when given penicillin, and 50 percent of patients with positive penicillin skin tests developed a drug reaction when given penicillin. [Evidence level B, nonrandomized clinical trial].

These results suggest that penicillin can be given safely to patients with negative intradermal skin tests to penicillin. Patients with positive penicillin skin tests may be at increased risk for drug reaction, but the specificity of intradermal testing is low.

ASSAYS FOR SPECIFIC Ige ANTIBODIES :

Although widely used in the past, serum measurement of the total IgE level is unhelpful in the diagnosis of allergy. Of more clinical use are assays for specific IgE antibodies to suspected allergens.

Assays for IgE antibodies specific to common airborne and food allergens are readily available. IgE antibody tests for venom and drugs have less clinical utility and are not routinely used. RAST was the first widely employed method of detecting IgE antibodies in blood that are specific for a given allergen. Quantitative assays that include a reference curve calibrated against standardized IgE are preferred. It is important to select a reliable laboratory to perform RAST testing.

In general, RAST and other laboratory methods for IgE testing are highly specific but somewhat less sensitive than percutaneous tests. Results of laboratory testing for food-specific IgE are generally poor, even less helpful than those for percutaneous skin testing.

RAST or other laboratory testing is typically considered when skin testing is inconvenient or difficult to perform. Most primary care physicians do not have immediate access to a clinical skin testing laboratory, so RAST may be easier to obtain. Some patients cannot undergo skin testing because of skin disease that would obscure wheal and flare results (e.g., extensive atopic dermatitis) or because they cannot stop taking medications that suppress the skin test response. In cases of life-threatening allergy (e.g., anaphylaxis), laboratory testing is sometimes used as a proxy result, keeping in mind its limited sensitivity.

ALLERGIC RHINITIS :

The most common allergy-mediated clinical problem where specific testing may be needed is chronic rhinitis. The differential diagnosis of chronic rhinitis (nasal congestion, rhinorrhea, sneezing) includes allergic rhinitis, nonallergic inflammatory rhinitis, and rhinitis from a non-inflammatory process, such as vasomotor rhinitis.

Many physicians make a presumptive diagnosis of allergic rhinitis based on the medical history. Management of these patients may include use of antihistamines, decongestants, or intranasal steroids. This is a reasonable and effective approach in many patients. In patients with significantly discomforting or disabling symptoms that are not controlled with standard measures, specific allergy testing may be warranted.

Percutaneous testing can help establish the correct diagnosis and identify the offending allergens (pollen, mold spores, dust mites, cockroaches, or household pets). Allergen avoidance measures often are difficult to implement and costly. After specific testing, avoidance measures can be targeted to allergens to which the patient is known to be allergic.

Allergen immunotherapy is another option in refractory cases of allergic rhinitis not amenable to the usual control measures. Like allergen avoidance, it can involve a lot of labor and expense. Specific allergy testing can identify patients likely to benefit from immunotherapy and provide guidance about which allergens to include in the therapy regimen. Allergen immunotherapy may be especially beneficial when avoidance and medications no longer control the patient's symptoms.

ASTHMA :

Allergic asthma often shares the same allergic triggers as allergic rhinitis. It is important to consider allergy and asthma as the manifestations of a hypersensitive “UNITED AIRWAYS.” Allergen exposure in sensitive persons is an important cause of asthma symptoms and exacerbations. When standard control and avoidance measures are not effective, specific allergy testing may be helpful.

The second National Heart, Lung, and Blood Institute (NHLBI) guideline on allergic rhinitis & asthma management recommends that all allergic rhinitis & asthma patients who require daily or weekly therapy be evaluated for allergens as possible contributing factors.10 They also note that, in selected patients with asthma at any level of severity, specific allergy testing may be indicated as a basis for allergen avoidance or immunotherapy. These recommendations would lead to a limited number of allergy tests in about one half of asthma patients, according to guideline predictions. As mentioned previously, the NHLBI notes that specific allergy testing may be particularly helpful in justifying the expense and effort involved in avoidance measures. In addition, it could help promote patient compliance in maintaining environmental controls (e.g., with regard to pets).

This is because we may be overusing antibiotics – creating the problem of antibiotic resistance.

Sometimes, middle ear effusion is overlooked in patients with hearing loss, causing lack of attention in classrooms and poor grades in school.

You know your child has adenoids if he has the following symptoms :

The adenoids cannot be seen by looking in the mouth directly, but can be seen with a special mirror or using a flexible endoscope through the nose. Tests may include:

If the child is symptomatic after 6 weeks of conservative management or has recurring episodes (>4) in a year, it may be appropriate to discuss the matter with the paediatric ORL specialist.

Treating throat infections early may prevent the adenoids from becoming enlarged from long-term infection and inflammation. Adenoidectomy prevents the complications of long-term airway obstruction.

Conventional Adenoidectomy is generally performed, but it is a blind procedure and it has its inherent deficiencies.

In our Clinic, we perform adenoidectomy by the latest advancement, ENDOSCOPIC MICRO-DEBRIDER-AND COBLATOR ASSISTED ADENOIDECTOMY. This is the latest and most technological advance for the treatment of adenoids and tonsils.

Conventional Adenoidectomy	COBLATOR-assisted Adenoidectomy
1. Blind procedure	Done under endoscopic visual control
2. Occasionally incomplete removal	Precise and total removal
3. Choanal part of the adenoids	Choanal part is removed under endoscopic vision
4. Erratic mucosa preservation slow healing	Good mucosal preservation-rapid healing
5. Post-operative haemorrhage reported	No post-operative bleeding in 8years

ALLERGY IMMUNOTHERAPY IS THE MAINSTAY OF TREATMENT OF ALLERGIC RHINITIS AND ASTHMA WORLDWIDE.

SLIT (sub-lingual Immunotherapy) is a method by which oral allergy drops are provided, which is customized to the individual’s allergies. These drops are taken for 6-18 months in order to reduce the allergic response of the patient.

Allergy shots (Sub-cutaneous Injections) are also used, but many patients do not accept them due to the need for multiple visits to the doctor’s office for allergy injections.

SLIT is recommended by global authorities as an effective measure for allergy control.

Allergen immunotherapy recommended for secondary development of asthma, recommendation that SLIT is safer than SCIT....slit can be used in children and adults with pollen rhinitis.
ARIA GUIDELINES UPDATED IN 2010

SLIT IS THE ONLY TREATMENT THAT MODIFIES THE ALLERGY DISEASE PROCESS.

Allergen immunotherapy has a disease modifying effect, and not only reduces the symptoms but helps stop progress of the disease.it has long lasting benefits, even after cessation of the therapy.
European Academy of Allergy and Clinical Immunology, EAACI. european declaration on immunotherapy 2011

Treatment of nasal inflammation may be required in order to obtain full control of bronchial inflammation and asthma symptoms. Therefore it is important to perform screening of all patients who present with asthma symptoms to rule out rhinitis & vice versa. A combined strategy should ideally be used to treat the upper and the lower airway diseases in terms of efficacy and safety.

1. DIAGNOSE THE OFFENDING ALLERGEN!

The most common allergy-mediated clinical problem where specific testing may be needed is chronic rhinitis. Many physicians make a presumptive diagnosis of allergic rhinitis based on the medical history. Management of these patients may include use of antihistamines, decongestants, or intranasal steroids. This is a reasonable and effective approach in many patients. In some patients, specific allergy testing may be warranted.

2. BEHAVIOURAL MODIFICATIONS - REDUCE OR ELIMINATE THE INCITING ALLERGEN

Behavioural Modifications and Environmental Controls

In the case of managing allergies and allergy symptoms, patients should try and remove triggers from the environment. This may include cleaning for dust more frequently for those who are dust mite allergic and avoiding places where triggers are present in high volume. After allergy testing is complete and the doctor has identified the triggering allergens, your doctor can discuss other behavioural modifications that can be helpful in controlling allergy symptoms.

3. LESSEN THE ALLERGIC RESPONSE

Anti-allergic Medications are as follows :

The regimen in uncomplicated Seasonal Allergic Rhinitis :
We teach the patient to anticipate the symptoms Seasonal prophylaxis is recommended. Antibiotics may be prescribed as required – usually after lab-proven evidence of infection

Oral 2nd gen oral anti-histaminic + decongestant + mucolytic + steroid as a short course
Then 2nd gen oral anti-histaminic x 10 days + Topical steroid spray + anti-hist. Drops x 10 days
Then steroid spray x 60 days + saline nasal spray for extended use

This regimen has been effective in many cases in our clinic.

Uncontrolled allergen exposure can lead to chronic irreversible changes in the upper and lower airway.

Chronic allergen exposure can lead to enlarged turbinates, polyps, etc. which are best addressed by surgery. Uncontrolled allergen exposure can lead to chronic irreversible changes in the upper and lower airway.

In patients with significantly discomforting or disabling symptoms that are NOT CONTROLLED with standard measures, surgery may also rarely be prescribed as an option WHERE NASAL OBSTRUCTION IS A PREDOMINANT SYMPTOM, SURGERY REMAINS THE METHOD OF CHOICE FOR AIRWAY CORRECTION.

Surgery may involve any or all of the following :

Septoplasty

A deviated septum may aggravate nasal obstruction in allergy sufferers. Re-alignment of the septum will reduce the nasal obstruction.

Reduction of the turbinate size to reduce the sensitivity - Turbinates are the 3 bones on either side of the nose. Swelling of these bones due to allergy is common and the patient suffers a “stuffy nose”. We offer COBLATION TURBINOPLASTY, the world standard in turbinate reduction.

Ablation of the vidian nerve (the nerve responsible for a hyper-reactive nose) is an excellent solution for patient who have excessive sneezing and watering despite prolonged medical therapy

Functional sinus endoscopy - Re-establishment of blocked pathways for the sinuses to aerate (allow for sufficient oxygen to enter the sinuses).

Constant exposure to allergens means constant allergy symptoms. That's why controlling or avoiding the allergens that cause your symptoms is an important part of your treatment. The more you do to keep all allergens away from your nose, the better you'll feel.

Pollen :

Pollen is in the air whenever trees, grasses, or weeds are blooming, so it's hard to avoid. But there are some things you can do to limit your exposure to pollen: After spending time outdoors, change your clothes, and wash your hair before bed. Stay indoors on windy days.

Mold :

If you're allergic to mold, pay special attention to areas where water tends to collect. Here are some tips for avoiding mold: Clean the bathroom shower or tub regularly with bleach, and check the shower curtain for mold growth.

Get leaky faucets or leaks in the roof fixed right away.

While bathing or showering, leave a window open or run a fan so moisture can escape.

If your house is damp, use a dehumidifier.

House-Dust Mites :

House-dust mites are almost impossible to get rid of. But you can keep them under control. Try some of these tips:

Enclose your mattress, box spring, and pillows in allergy-proof casings.

Wash sheets, blankets, and mattress pads every 1 to 2 weeks in hot water Wash bedding in hot water (at least 130°F) to kill house-dust mites. Warm or cold water won't kill them.

Remove stuffed animals and things that collect dust, such as wall hangings, knickknacks, and books–especially in the bedroom.

Have as little carpeting as possible.

Each week, have your home dusted with a damp cloth and vacuumed.

If someone else can't dust and vacuum for you, take your medication before doing these tasks. Wearing a filter mask may help.

Animals :

The dander, saliva, and urine of animals are all allergens. Cats produce more of these allergens than most other pets. Animal fur may also contain dust, mold, and pollen. The best way to avoid animal allergens is not to have a pet. If you already have a pet and can't bear to part with it, try to reduce your exposure as much as possible.

Use shades or vertical blinds instead of horizontal blinds, which collect dust. Replace drapes with curtains that can be washed regularly.

Enclose mattresses, box springs, and pillows in allergy-proof casings. Use washable blankets and quilts. Avoid feather pillows, down comforters, and wool blankets.

Install a fan to keep the bathroom well ventilated.

Don't let wet clothing sit and grow mold. And don't hang clothes outside to dry where they can collect airborne pollen. Dry clothing immediately in a clothes dryer that's vented to the outside.

Check stored food for spoilage and mold growth. Clean up spills right away.

Avoid dust-catching clutter. Have enclosed places to keep books, toys, and clothes. Keep closet doors closed.

Use washable throw rugs wherever possible, or have bare floors.

Put filters over forced-air heating vents. Change the filters regularly.

Keep your car clean. Vacuum the seats and carpets regularly. If you have air conditioning, use it instead of opening the windows.

Keep rain gutters clean. Remove leaves and debris that can grow mold.

Seal all the spaces between your cupboards and beds and the wall.

Do not use carpets.

Look for fungus on the walls and have the walls painted regularly.

Initial Management of these patients is MEDICAL, & may include use of antihistamines, decongestants, or intranasal steroids. This is a reasonable and effective approach in many patients.

Allergen Immunotherapy may be especially beneficial when avoidance and medications no longer control the patient's symptoms.

Allergy management is customized to each individual patient. Hence PRECISE DIAGNOSIS is essential. we provide high quality custom kits in multiple formats

Till recently, injection immunotherapy was the only treatment available, and multiple injections with the risk of severe allergic reactions was not accepted. We now offer oral drops & tablets.

It is now accepted by the World Allergy Organisation that Sub-lingual Immunotherapy is as effective as Sub-Cutaneous immunotherapy, with less risk and more compliance.

When used correctly, studies have shown STALLERGO SLIT reduces the requirement of anti-histaminics, steroids and antibiotics by 60-74% of chronic nasal allergy and bronchitis sufferers.This increases the patients’ QOL & reduces his/her dependence on medication.

(Immunotherapy is currently the ONLY intervention that could potentially alter the natural course of allergic diseases World allergy Organ J. 2014; 7 (1): 6)

Chronic allergen exposure can lead to enlarged turbinates, polyps, etc. which are best addressed by surgery. Uncontrolled allergen exposure can lead to chronic irreversible changes in the upper and lower airway.

In patients with significantly discomforting or disabling symptoms that are NOT CONTROLLED with standard measures, surgery may also rarely be prescribed as an option WHERE NASAL OBSTRUCTION IS A PREDOMINANT SYMPTOM, SURGERY REMAINS THE METHOD OF CHOICE FOR AIRWAY CORRECTION.

Surgery may involve any or all of the following :

What kinds of allergy tests are available?

If you have allergic asthma, your airways are extra sensitive to certain allergens. Once they get into your body, your immune system overreacts. The muscles around your airways tighten. The airways become inflamed and over time are flooded with thick mucus.
Whether you have allergic asthma or non-allergic asthma, the symptoms are generally the same. You're likely to:

Allergens, small enough to be breathed deep into the lungs, include :

Allergens aren't the only thing that can make your allergic asthma worse. Irritants may still trigger an asthma attack, even though they don't cause an allergic reaction.
These Includes :

Your doctor can test you to see what causes your allergic asthma. The two most common (and recommended) methods are :

The second National Heart, Lung, and Blood Institute (NHLBI) guideline on allergic rhinitis & asthma management recommends that all allergic rhinitis & asthma patients who require daily or weekly therapy be evaluated for allergens as possible contributing factors. They also note that, in selected patients with asthma at any level of severity, specific allergy testing may be indicated as a basis for allergen avoidance or immunotherapy.

Medications:

Nasal allergy medications that don't make you sleepy (like over-the-counter generic Claritin), saline rinses, and decongestant nasal sprays (but only for a few days). If these don't work, use nasal steroid sprays and stronger antihistamines. If none of this helps, it may be time to talk to a doctor about allergy shots.

There are many good asthma treatments, but most require a prescription. These medications include inhaled steroids, which fight inflammation, and bronchodilators, which open up your airways. If traditional treatments don't help your allergic asthma, Xolair, an injectable medication that reduces IgE levels, may help.You may be given an asthma inhaler with albuterol, ipratropium, and/or inhaled steroids (anti-inflammatory agents). You should see a gradual improvement in asthma symptoms over six to eight weeks.

Immunotherapy treats the cause of allergies by giving small doses of what a person is allergic to, which increases "immunity” or tolerance to the allergen and reduces the allergic symptoms. Thus, Immunotherapy is designed to build the body’s defences toward the range of allergens the patient has sensitivity to. The allergen is introduced into the body in small quantities, which are slowly increased to slightly larger quantities, and the body produces a better defence. In this way, Immunotherapy modulates the body into building a better defence against a trigger, such as wheat or dust or fungus.

Unlike injection Immunotherapy, which is given as shots, Sublingual Immunotherapy is given as drops under the tongue.

The first step is to confirm a patient’s allergies through allergy testing. Then, a custom-mixed vial of drops is prepared for the patient. The patient takes drops under the tongue daily. During the first four months, called the “escalation phase,” the dosage is gradually increased. After that, in the “maintenance phase,” the patient takes the same dose of drops each day.

It is very safe, for both adults and children. Patients take the drops in the convenience of their own homes instead of going to the doctor’s office every week for anti-allergy injections.

The World Health Organization (WHO) has endorsed Sublingual Immunotherapy as a viable alternative to injection Immunotherapy.

Many published scientific studies have shown that it significantly reduces allergy symptoms.

We recommend that patients keep using the drops for 36 months or longer so that the body will build up a lasting "Immunity."

If you are, you will be prescribed the Sublingual Immunotherapy. The vials take a weeks to prepare because these are customised to each patient. During therapy, when your last vial is half empty, please call our office to order your new vial.

A benefit of Immunotherapy whether allergy shots or allergy drops — is that it can alter the course of allergic disease by treating the root cause, not just the symptoms. Once tolerance is built, it can be permanent for many patients. Key studies have already been conducted to explore the long-lasting effect of allergy drops, including a 10-year study on children with asthma that demonstrated drops maintained effectiveness long after treatment stopped.
But even the best treatments won’t work if you don’t stay with them. Like allergy shot treatment, it’s important to stay with allergy drop treatment until your doctor has determined treatment can be discontinued to give you the best chance of long-term effectiveness.

Benefits of three times daily dosing

We have observed a combination of clinical symptom improvements, reduced skin test reactivity, and decreases in specific IgE levels at low doses of sublingual immunotherapy given three times a day. In 1986, Drs. Scadding and Brostoff published a dust mite study using threshold dosing four times daily. This double-blind, cross-over design study showed improvement in 72% of patients after only two weeks of treatment.
The past 15 years have produced studies with a wide variety of dosing regimens showing efficacy. In some studies, when higher concentrations of antigen were used, side effects increased without much additional benefit. Frequency of dosing has also ranged from once a week to multiple times per day. Several studies now suggest there is more than one mechanism that helps an individual develop tolerance to their allergens. High-dose intermittent administration of antigen, similar to the La Crosse Method Preseasonal Protocol, produces clonal deletion and/or anergy. The low-dose frequent administration (three times daily dosing) of antigen sublingually leads to active suppression. This approach is used with the La Crosse Method Inhalant and Food Allergen Protocols. Combining multi-antigen threshold dosing with pre-seasonal rush protocols has clinically given providers the ability to take advantage of both mechanisms to develop allergen tolerance in a wide variety of allergic patients.

Multi-allergen inhalant threshold dosing can be provided for patients with multiple moderate to severe allergies to pollens, mites, animals and molds or with a history of anaphylaxis. The treatment level is tailored to the patient's skin or blood test results. Patients take a dose three times daily using a metered dispenser that delivers a precise amount of antigen. One bottle lasts 90 days.

Patients who test positively to seasonal allergies and fit the safety profile may be recommended for this high dose seasonal allergen therapy eight weeks before the allergy season begins, and continue treatment into the season. This treatment is considered an add-on to year-round inhalant Sublingual Immunotherapy. Some patients find that adding pre-seasonal treatment to their year-round therapy can reduce the time it takes to complete their therapy.

The safety and efficacy of allergy drops has been proven in Europe for over 30 years. In fact, the World Health Organization has endorsed allergy drops as “a viable alternative to injection therapy.” The safety of Sublingual Immunotherapy has also been studied. Research has shown that severe reactions with Sublingual Immunotherapy are three times less common than with conventional allergy injections. Furthermore, there has never been a life-threatening anaphylaxis reaction with allergy drops in over 30 years, and over 200 million doses.

Immunotherapy treats the cause of allergies by giving small doses of what a person is allergic to, which increases "immunity” or tolerance to the allergen and reduces the allergic symptoms. Thus, Immunotherapy is designed to build the body’s defences toward the range of allergens the patient has sensitivity to. The allergen is introduced into the body in small quantities, which are slowly increased to slightly larger quantities, and the body produces a better defence. In this way, Immunotherapy modulates the body into building a better defence against a trigger, such as wheat or dust or fungus.

Unlike injection Immunotherapy, which is given as shots, Sublingual Immunotherapy is given as drops under the tongue.