George A. Sprecace M.D., J.D., F.A.C.P. and Allergy Associates of New London, P.C.
www.asthma-drsprecace.com


ALLERGY IMMUNOTHERAPY

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A highly effective form of clinical immunologic treatment for respiratory allergies since the 1930's, this approach has remained a relative "niche" of certified Allergists...ignored by many physicians and evidently suppressed by many Pulmonologists and ENT specialists. These are the other two medical specialties whose patients could most benefit from its application.

Why? Both groups have been evidently concerned that such therapy, either by Allergists or through Allergists by themselves would cause them to lose patients and opportunities for patient care. They are right. In a relatively short time there would be fewer stubborn asthmatics, "COPD" patients and nasal - sinus patients...or at least much better controlled.

Patients of Pulmonologists should insure that they get an allergy evaluation for all Asthma and/or "COPD" patients...the latter often a poorly defined category of obstructive airway disease for which any accompanying bronchial asthma is the potentially curable component.

ENT patients should insure that any underlying respiratory allergic component is evaluated and adequately treated before considering related surgery.

Allergy Immunotherapy is based upon the biologic fact that the body's immune system reacts to exposure to an allergen in two different ways, depending upon how it experiences it. If through the mucus membranes, it sensitizes. If by subcutaneous injection, it gradually desensitizes. These facts were worked out clinically in the early 20th century by pioneers including Drs. Robert Cooke and William Sherman; and they were further documented in the Immunology laboratories of Drs. Larry Lichtenstein and Ishizaka in the 1960's. This is the foundation for "allergy immunotherapy", "Shots", administered by and through trained, competent and experienced hands.

GS

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Allergy Immunotherapy, “allergy injections”, “shots”, or “desensitization”, is the treatment whereby one’s own immune system is stimulated to block, and gradually to prevent, immune actions which are causing a disease process.  This form of treatment deals with basic causes rather than with effects, and aims at “cure” and not just management.

Allergy Immunotherapy works.  This statement is based upon 50 years of clinical  research between 1910 and  the 1960’s.  It is  confirmed by 15 years of sophisticated laboratory investigation, accompanied by 25 years during which time many placebo-controlled, double-blind, crossover studies ( the gold standard of medical research)  have established its safety and efficacy.  This is true both with regard to symptom relief and  also in effecting beneficial immunologic change. Persons, professionals or lay persons, who maintain otherwise are either ignorant of the facts or have a self-serving agenda.

In order to understand how this important form of treatment works for many allergic diseases including bronchial asthma, one must have some knowledge of what allergies are and of how they cause disease.

In contrast to poisons, infectious agents, direct trauma, destruction of our filtration or blood supply systems, etc., allergies are caused  by the workings of the Immune System. That is the system set up for our protection against invaders through the action of antibodies and implementing chemicals.  Antibodies are substances, usually proteins, that our body produces in direct response to invaders, defined as “non-self”.  Indeed, if the body’s immune system had not been trained during the earliest months of existence to distinguish “self” from “non-self”,  the immune system would attack “self”,  and we would all be dead in short order. In fact, when this critical identification and distinction process malfunctions, a person comes down with  “auto-immune diseases”,  the result of the immune system attacking one or more structures and functions of our own body.

In normal operation, the immune system (thymus, white blood cells, CD4 helper cells, CD8 supressor cells, spleen, lymph nodes, etc.) produces antibodies against non-self.  Antibodies attack and combine with this  non-self  “antigen”, and the new “antigen-antibody complex” stimulates the release of implementing chemicals (histamine, leucotrienes, and many others), that have specific reactions in the body.  Histamine-like chemicals are released in many allergic (antigen-antibody) reactions and widen  blood vessels,  either locally in specific tissues (target organs)  or throughout the body, resulting in either a localized or generalized loss of blood fluids into  the surrounding tissues. This action can lead  to local flushing or hives, to swelling of nasal membranes or bronchial tube linings, etc.;  or it can lead to great  loss of fluid from the entire blood-vascular system, leading to shock and death (“anaphylaxis”).  Other allergic reactions cause white blood cells to release “cytokines” like “leucotrienes” that produce  an inflammatory reaction in the tissues  affected, similar to the reaction to infection.  The inflammatation can produce tissue damage, either temporary or permanent.

For reasons that are unclear, but that are probably related to a re-adaptation  of a part of the immune system, the IgE system, needed in the past to deal with parasites,  about 20% of the general population  experience this system  attacking even harmless “non-self” agents such as pollens, molds, and dust mites as invaders.  In fact, in areas of the world where parasite infestation remains a serious health problem, this IgE system continues to be devoted to that problem, with much less in the way of  “allergic diseases” that so affect the Western world.

There are many chemicals and medicines  which specifically reverse one or another of the results of these allergic reactions.  Antihistamines, bronchodilators, leucotriene inhibitors and steroids (cortisone) are some of these.

Then there is  a form of treatment designed to prevent the allergic reaction from ever occurring, thus treating the basic cause of the disease process.  This is Allergy Immunotherapy.  Its mechanism of action is based upon the fact that the body produces different antibodies to the same antigen depending on how the antigen is introduced  into the body.  For example, ragweed antigen produces troublesome  IgE when introduced through the mucous membranes ( nose, bronchi, gastrointestinal tract).  This same antigen produces an IgG antibody, acting as a blocking antibody,  when introduced by injection. The IgG  antibodies  thus produced  by allergy immunotherapy  act  to block the reaction  of  IgE which triggers the release of histamine, etc.  Furthermore, prolonged allergy immunotherapy gradually reduces the level of IgE antibody over three to five years in most patients so treated, so that most patients can then discontinue injection treatment and can essentially be “cured” of that allergic problem.

Allergy immunotherapy should be used in patients with long-lasting and/or troublesome upper respiratory diseases, including established sinus diseases.  It should also be used in all patients with established bronchial asthma;  that is, in  patients who have persistent wheezing and/or hacky cough (“cough-variant asthma”) which requires the use  a bronchodilator   more than  two or three times weekly.  In such patients, simply using  drugs like bronchodilators,  intal, steroids, etc. is inadequate treatment and leads to progression of the disease process.

Thus,  Allergy Immunotherapy is safe and effective, is useful in many allergic diseases, and is a necessary part of the comprehensive treatment of bronchial asthma.

GS


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