Allergy questions a go-go

April 4, 2007 2:46 PM

A couple questions about allergies and immunotherapy

I am considering starting immunotherapy for environmental allergies and an avoidance diet for food allergies. There seem to be conflicting views on 'allergy theory'. What I am not clear on is whether with repeated exposure allergies get worse over time, get better, or the symptoms simply change and it has nothing to do with exposure. The conventional wisdom seems to be that you grow out of your allergies, which means that repeated exposure innoculates you. But I remember reading that with peanut allergy you may have an unpleasant reaction at first but with repeated exposure this quickly turns into anaphylactic reaction. I need to know this to decide whether to go on the food avoidance diet. If I avoid exposure to the foods I may never become accustomed to them. None of my food allergies are life-threatening.

The shots I will be getting are from Quorum Pharmaceuticals in Canada. It is 2 shots because apparently you can't mix some of the stuff together in the same shot. $300 CDN for enough serum for about a year, and then when I am on a maintenance dose it will be 1 shot at presumably lower cost. Does this sound reasonable?

posted by who else to health & fitness (14 comments total)

I always assumed that the exposure to allergen theory was for seasonal allergy type stuff (hay fever, dogs, cats) and that it can get better over time through exposure.

As for food allergies, I don't think that's the case and that at any point a mild food allergy can explode into an anaphylactic reaction.

I don't know about the costs - but have you considered allergy drops as opposed to allergy shots?
posted by Sassyfras at 3:04 PM on April 4, 2007

Allergies are pretty unpredictable so any advice you get here won't do you a heck of a lot of good. Even your doctor's advice will be general. All allergists I've gotten shots from required you to stay in the office anywhere from 10 to 30 minutes after the shot to see if you have a reaction. That's for every shot, every time. It's just not a predictable thing yet.

For my seasonal and environmental allergies, shots have been terrific. Getting to maintenance dosage required a lot of time but I'm pretty happy now. If you think you're life will be stable for the next year (switching doctors is a pain), I'd say go for it.
posted by chairface at 3:11 PM on April 4, 2007

Although you can grow out of your allergies, it doesn't always happen. I have allergies to several animals, as well as mold, some kinds of pollen, and tree nuts, and I haven't grown out of any of them or my asthma, either.

And Sassyfras is right. I did allergy shots for a few years myself, and they helped quite a bit. Unfortunately I didn't keep up with them when I went on vacation once, and ended up stopping because once you've gone too long in between shots, you have to go back to square one again -- so it is a bit of a commitment.

As for food allergies, the best option is the avoidance diet because they can become serious at any time. As far as I know, it's not very likely to become accustomed to them like you can with environmental allergens. It is a pain in the butt and hard to adjust to at first, but be prepared to check the labeling on pretty much everything you eat and to avoid foods you aren't sure about -- things like peanuts and tree nuts can show up in anything. I have to avoid all snacks at parties/potlucks/etc., but it's well worth it to know I'm avoiding a potentially serious reaction.
posted by flod logic at 3:23 PM on April 4, 2007

Allergy shots combined with food avoidance can be a great solution.

With shots, you can often move to less frequent visits and adjust your serum for the best possible results. With the exception of the first dosage of a new serum, I have never experienced the waiting that chairface describes. In fact, many allergists (at least in the US) will provide you with serum and prescription syringes (similar to those used for insulin) to administer shots at home.

Instead of complete avoidance, I rotated through the foods that caused reactions (congestion and skin rashes). Monday I could have a moderate amount of milk, Tuesday was corn, Wednesday was peanuts, etc. I was able to limit my reactions without severely limiting my diet. You, your doctor and possibily a nutritionist can best judge what will work for you.
posted by annaramma at 3:39 PM on April 4, 2007

Hmm, the foods I am supposedly allergic to are many. I have never tried avoidance before because, well, there are no symptoms I am aware of having, although I wouldn't be surprised at all if I felt better on an avoidance diet. I am apparently mildly allergic to peanuts and shellfish, which I know can be killers, but I don't have any issues eating this stuff. Now I wonder if I should go on avoidance just so I don't randomly develop bad reactions to this stuff. I have definitely seen nasty new symptoms to environmental allergies of mine which is why I am asking here because I really don't want new symptoms to my allergies...
posted by who else at 3:43 PM on April 4, 2007

Yeah, you don't have to wait except when getting a new, higher concentration vial. Every 4 months or so. I did the shots for 5 years and they really helped. Easy to give. But they were expensive.

I don't have food allergies so can't help you there.
posted by vronsky at 3:47 PM on April 4, 2007

I received allergy shots (in Canada, but I don't remember the name of the company that made them) several years ago. That price sounds about right. Blue Cross paid several hundred (I forget, maybe 2 or 300) for the serum itself, and I paid $5 to the university clinic nurse for her time, each week (which I was really pissed about, as I recall).

They were for tree and grass pollins, and cats and dogs, all in one shot. They worked great, although they weren't permanent - the course of shots took 2 1/2 years iirc, and I went from needing nasal steroid antihistimines to not needing any. I didn't have a maintenance dose (and none was ever mentioned to me). Gradually the effect wore off, although it's been more than a decade and I still don't require quite the same level of antihistimines (I currently take two 10mg reactine/zyrtec a day).

Of course, ymmv, but my experience with them was great.

HOWEVER, you need to stay in the clinic or hospital that administers them for at least half an hour (or it might have been 45 min) every single time. That's so they can respond if you go into anaphylactic shock. A small percentage of people who get the shots do go into shock. You should discuss the risk with your allergist. For me, it was worth it (I had trouble breathing if I was late taking the steroids).
posted by joannemerriam at 3:48 PM on April 4, 2007

Shellfish and peanut allergies are famous for escalating quickly. See an allergist before doing anything other than avoidance for shellfish and peanuts.
posted by joannemerriam at 3:50 PM on April 4, 2007

First off, I don't have allergies so I can't help you first hand. I do however, have an immunology exam I'm studying for, so I can help a bit with (my professor's view of) allergy theory. Basically, very low levels of allergen not only do not induce a reaction, they induce tolerance. This is through a mechanism similar to the one that prevents you from having autoimmune reactions to all the stuff that should be in your body, like your own cells. A very high dose of allergen also induces tolerance, but I haven't heard of that being used, probably for obvious reasons. Also, here's an article I read a while ago on allergy therapy:
posted by fermezporte at 6:35 PM on April 4, 2007

I'm in my late thirties, and was diagnosed with allergies as a small child; took regular allergy shots (bi-weekly at first, later weekly) from about age 7 or so until I was 18.

I haven't "grown out" of my allergies, nor did the shots have any appreciable long-term effect on my symptoms. The symptoms and sensitivity levels have changed somewhat with time and exposure and moving into new environments, though; some triggers have gotten a bit better over the years, others have gotten worse. And my mother, who never had any allergy symptoms in her younger years, started having problems in her late fifties...so yeah, this stuff is definitely very unpredictable.

It's worth giving the shots a try, especially if your symptoms are really miserable and you're not horribly needle-phobic, as many people do report really good results with them; but they're not always a permanent magic cure. Also do note that the shots will have some side effects; just as anaphylaxis is a small risk, the lower-grade symptoms of a reaction to the allergen may crop up too -- soreness and swelling at the injection site, itchiness, hives: my arms always got VERY lumpy and tender, and I would feel low-level fatigue afterwards, just like I did when exposed to allergens outside of the doctor's office. So you might want to bear that element in mind when working out a schedule for your treatments.

(Sorry, I can't really speak to the food allergy issue as I was never tested for that. I do suspect, based on experience and observation, that I have at least mild sensitivities to shellfish, and there was a mystery episode of anaphylaxis a few years ago that seems like it might have been linked to nuts. I carry an Epipen (prescribed after the ER visit) and mostly just avoid the suspect triggers, but since they're not particular favorites and not as omnipresent as dairy or peanuts, it's really no great hardship for me.)
posted by Smilla's Sense of Snark at 7:04 PM on April 4, 2007

Food allergies can escalate quickly. My penicillin allergy showed up that way, too - actually a reaction to amoxicillin (which is closely related). I'd used amoxicillin at least once or twice a year for *years*, and all of a sudden, I took one pill and ended up in the emergency room. I recovered on my own, and it was never life-threatening (as my throat didn't swell up), but it was anaphylaxis - so since the next time could be much worse, I just don't take penicillins anymore.
posted by spaceman_spiff at 7:24 PM on April 4, 2007

Not much new to add to what has already been said, but I want to emphasize the importance of avoiding food allergens. There is no getting around that It is a major adjustment, especially if you are allergic to more than one food. As has already been said, food allergies tend to get bad really fast. Label reading is no longer optional for you.

I never knew I had environmental or food allergies until my first allergic reaction put me in the emergency room at the age of 37...as my allergist said, it's unlikely that I'll outgrow any of them. It's certainly not a given, but it is also possible you'll develop allergies to other foods as well, so you need to pay attention to your body anytime you feel odd after eating something.

My main three food allergens are wheat, corn (both anaphylaxis inducing), and soy, which practically guarantees that if a food product comes in a box or a plastic wrapper, I can't eat it. It's taken a lot of experimenting, and meals will always take a good bit of work (no such thing as "fast food" for me), but I manage to eat pretty well, and you will too once you find what works and what doesn't. Good luck to you.
posted by faineant at 12:16 AM on April 5, 2007

I've been doing injection immunotherapy for one year, starting last spring after a particularly bad pollen season. I haven't noticed any real benefit yet (although this year's pollen counts were even more astronomical). Just bear in mind that you can administer the shots yourself and that they are somewhat expensive if your insurance doesn't cover them. Something like $100 per month for me.
posted by aliasless at 12:48 AM on April 5, 2007

Well I'm going to have to inquire with my doctor about the food allergies and look at being re-tested since my food allergy test over a decade ago. Weird that they never conveyed any seriousness about the allergies or gave me an epipen or anything... Thanks for the responses!
posted by who else at 8:50 AM on April 5, 2007