> A lot of people take their allergies for granted, but real treatments for allergies are available and they work.
Source please. I talked to several doctors about treating hay fever (grass pollen allergy) and the consensus was that desensitization doesn't work that often. Success rate is 20-50% or something like that and there's the risk that the body develops other allergies for some reason.
Apparently, my hay fever symptoms are rather strong. Medication doesn't really work. Best is avoidance: staying inside, vacation in countries with less grass pollen, and wearing FFP2 masks outside (helps a lot!). Stuff you don't breathe in doesn't need to be fought by the immune system.
I’m highly allergic to a variety of pollen, grass in particular. Like you, medication is really only a “help me recover faster from exposure” sort of thing. I take it hoping there’s at least placebo effect.
I first discovered my allergies after walking through a pollenating corn field for my agronomist job, and coming out blind and swollen on the other end. I could from then on walk outside and tell specifically when corn was starting to pollenate miles away, because it has a distinct smell that burned itself into my danger detection.
I’ve been doing the allergy shots for ~6 years now. I no longer get seasonal eczema, and I can now even ride an ATV by a corn field without protection. Previously even being within a quarter mile would result in a reaction.
The extreme Fescue and ryegrass pollen here in Oregon’s willamette valley however still require me to use an N95 mask and dust goggles while outside for my job during june and july or I have a bad time.
However, it’s no longer to the point were I’d literally have to move elsewhere or die. My throat no longer gets tight, and it turns out my chronic and increasing eczema was due to pollen and is no longer an issue. I also recover from exposure much more quickly.
Basically the effectiveness of it all is personally mixed depending on the allergen, ranging from fuckall effect to nearly cured, but overall is absolutely worth it.
My recommendation is to have them load up the shot with as many allergens as you can get (20 or so last I checked) and continue with everything even after they say you can remove some of them.
Protip: if you have bad eye symptoms like me where it feels like literal sand in your eyes, applying a very strong menthol/cooling rub on your cheek (not to close to the eyes, should be below the cheekbone) will induce tears and save the day. I use a “kung fu balm”, but tiger balm or vicks vapor rub also work. Various goggles can also be used to occlude pollen as well as humidify your eyes.
Also don’t use nose sprays with oxymetazoline or eye drops with “redness eye reliever” as those are a trap. They constrict blood vessels, but your body quickly adapts and end up in a worse situation than before.
For me those help recovery, but don't help my direct exposure at all. Using a gel type eyedrop and letting that dry can kinda help because it will physically occlude the pollen to an extent.
That said, for people who aren't dumb enough to choose the worst possible matchup between their job and health conditions, those eyedrops should typically help. Alcaftadine (Lastacaft) is another one that recently became available without a prescription.
If you are willing to use it consistently, cromolyn is an old drug that may be effective pre-exposure. As I understand it, it’s essentially useless post-exposure. I’ve been told that it’s safe to stack it with antihistamines.
The ophthalmic form requires a prescription, for some reason.
Desensitization made a big difference for me. I had asthma linked to my allergic rhinitis and I was able to stop taking meds for asthma after (1) desensitization and (2) treating my heartburn which was complicating my asthma.
Turns out I can't take Omeprazole or any PPI for my heartburn because if I take that I don't get a wink of sleep all not. If I avoid NSAIDS completely I rarely need any other heartburn med. I was seeing a doc at the immediate care center the other day for pain in my foot and he asked me "What do you take for pain?" and I told him "Nothing" because NSAIDS cause dyspepsia and my primary care doc thinks Paracetamol (e.g. Acetaminophen, Tylenol) raises my liver enzymes and told me not to take it.
I once in a while take Fexofenadine for my allergies which is the only antihistamine I can tolerate these days. Years ago my allergist told me to use Cetirizine but I discovered that Cetirizine causes CNS effects on me because if I take it regularly and then miss a dose I get terrible "brain zaps" like people describe missing a dose of SSRIs.
My understanding is that immunotherapy is not that well standardized and if you go to different docs there may be differences in protocol that get different results.
There are a couple other second generation antihistamines for you to take a look at. If you're having CNS effects, focus on the receptor binding affinity for anything besides H1 (also look at metabolites).
Effectiveness of allergy shots is generally related to the maximum dose you work up to. Allergy shots are expensive, and I had to get them for years to make my dust allergy manageable. Question you should be asking is how much of the low efficacy rate is due to early termination of treatment.
"risk that the body develops other allergies for some reason."
More plausible mechanism is that people who get allergy shots also get more thorough allergy testing, and discover new allergies they already had. What mechanism would result in new allergy development from small, controlled subcutanous allergen exposure, that would not manifest from continual daily seasonable exposure?
> What mechanism would result in new allergy development from small, controlled subcutanous allergen exposure, that would not manifest from continual daily seasonable exposure?
Good question, I don't know. The doctor said this, I wondered as well, but I didn't ask.
I'm not aware of any increase in risk of developing other allergies from the treatment. It is true that success is not guaranteed, however I believe the success rate is higher than that. Here's a study finding 76% effectiveness in dust mite allergies in adults. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5705479/ And as I mentioned, I expect much higher effectiveness in children.
That said, the treatment does have risks and costs. It's certainly reasonable to decide against trying it. If your allergies cause asthma, Xolair and Dupixent are other options you can try. Combining Xolair or Dupixent with desensitization treatment is an exciting current area of research.
True, Dupixent seems less risky. It really seems like a wonder drug to me. I'm excited for the results of the trials of Dupixent with OIT, especially since it treats EoE.
I was told a similar thing by a primary care doctor in the late 90's. When I finally got fed up with my allergies again in 2014 or so and went to an allergist they were quite confident it was no problem at all to fix, and after several years of shots at various intervals I'm essentially cured of pretty severe grass/tree/pet allergies. At the end of it the allergist said there was a small chance that I might lose some of my immunity after about 5 years, and if that happened we'd simply plan to go back to once-a-month shots. It's been 7 years and I'm not showing any signs of increased symptoms, so according to him my immunity is most likely long-term.
When I first got tested they wiped off the grass scratch test after 2 minutes rather than waiting the normal 20, because I had already swelled up past the maximum amount. I was VERY allergic to grasses. Now I don't even think of them.
Easily the single most life-changing thing I've ever done. HIGHLY recommend visiting an allergist to see if you're a good candidate.
Most treatments, as far as I’m aware, take multiple years for maximum effect. The shots themselves as fairly painless if you have a good practitioner. My son’s shots take about 20 minutes from entering to clinic to exit; 5 minutes of waiting to receive the shot and 15 minutes to ensure there’s no adverse reaction.
It's not a 20-50% success rate, this isn't a 2 week antibiotic course.
Frew (2006) is one of the larger trials, two treatments, one group worked up to dosage of 10k, the other 100k. Higher dosage group had better measures of improvement across the board (excluding lung symptoms oddly), table III.
Source please. I talked to several doctors about treating hay fever (grass pollen allergy) and the consensus was that desensitization doesn't work that often. Success rate is 20-50% or something like that and there's the risk that the body develops other allergies for some reason.
Apparently, my hay fever symptoms are rather strong. Medication doesn't really work. Best is avoidance: staying inside, vacation in countries with less grass pollen, and wearing FFP2 masks outside (helps a lot!). Stuff you don't breathe in doesn't need to be fought by the immune system.