Marek Jutel, EAACI President on Allergen Immunotherapy

By Adem Lewis / in , , /

It often happens that the patients are coming to us in the pollinating time. Around spring: in April, May, or June. They are asking for possibilities for desensitization In that case unfortunately, I have to tell them to wait until autumn. If we want to protect ourselves before the upcoming season, we should think about this a few months in advance. What is desensitization and how is it performed? It is important to stress out that desensitization is a natural method in contrast to pharmacotherapy, where we treat patients with a chemical compound. In AIT we use natural allergens which are not harmful for the patient. We initiate AIT with small doses of allergens, which are well-tolerated by all patients. Then according to well-defined protocols, we increase the amounts of allergen to the dosages that triggers – again natural – mechanisms of allergen tolerance in patients. How are these allergens administered? There are several routes of administration… basically two methods are the most frequently used Subcutaneous injection at well-defined time intervals; and sublingual tablets or drops used on a daily basis. How long does this therapy last? How many injections or tablets are necessary? The whole immunotherapy course takes a minimum of three years. So three autumn seasons? Today we use AIT which is administered during the whole year. When we decide to begin, we give injections at time intervals of 4 to 6 weeks for the whole year in case of injection theraphy. Sublingual immunotherapy patients take tablets or drops daily. Is AIT effective? Yes, AIT is very effective. It is one of the most effective medical therapies known today. The question is how do we evaluate this efficacy? On one hand AIT, or desensitization strongly reduces allergic symptoms, and for some patients it eliminates them entirely, so they are completely cured. These patients do not need to take any other drugs. They don’t have to take steroids which have side-effects Antihistamine medication? Yes, but also others such as GKS which can cause side effects. What is important is that we have other ways to evaluate efficacy. AIT may prevent progression of allergic disease. Allergies have a common characteristic. And many patients can confirm the fact that with time passing they become more severe with more symptoms present. For example, a patient with seasonal allergic rhinitis and mild symptoms for a few weeks during the year, which are basically well curable with drugs, has a tremendously increased risk of developing asthma or atopic dermatitis in the future – diseases that need a strong pharmacologic intervention with frequently observed side effects. We are not here to scare people but in some cases these diseases might evolve in the way which is life-threatening. So, allergy is not a disease but can convert into disease? Allergy is a disease, but it may affect various organs The most typical are allergic rhinitis and allergic conjunctivitis in patients allergic to pollens of grass, trees or house dust mites. But allergic diseases may start in this way and then progress, go deeper into our body, affecting the lungs and with time leading to the development of asthma – which is a serious illness. So AIT it is all about reinforcing our organism? Yes, of course, but one of the limitations I can imagine is the regularity of treatments that have to be performed, the other is about costs… is AIT reimbursed? We must explain the cost of the therapy in a different way. In Poland AIT for the most sensitizing allergens such as grass and tree pollen is reimbursed. We have serious problems with reimbursement for vaccines used in house dust mite allergic patients. So dust mite allergy is not a question of cleanliness and hygiene of our flats? Is it? This is a very good question, as we do not have any practical possibilities to eliminate exposure to house dust mite allergens. Really? But quite frequently we can observe advertisements of anti-allergic carpets, clothes and fabrics which should minimalize allergic symptoms. In controlled medical studies only physical elimination of house dust is the method that slightly reduces symptoms. It makes sense to get rid of the dust as much as possible. But even when our house is sterile and without any dust, we have to leave it eventually – to go to work, or to visit friends, so then we will be significantly exposed. I’m not allergic luckily, so I can go to work. To assess the risk we would have to measure how much dust there is in this room I’m pretty sure it will be enough for an allergic patient to present allergic symptoms. So in conclusion the only effective way to reduce symptoms for an allergic patient is to perform AIT. But what is worth to stress out is that no vaccine for AIT in house dust mite patients is reimbursed at the moment in Poland We are running out of time, just a short question – are adults and children desensitized in the same way? For children we use the same vaccines, the same doses and schemes as for the adults. AIT introduced early is the most successful, and far more efficient than in adults, so we all should try to make it available for children as early as possible.

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