Question
I forgot my allergy serum/extract at home and I need it for the summer (being spent away from home). My brother now has it and can get it to me in a few ways:
Answer
The best method is to carry it by hand in a small cooler with some ice. However, we do ship extracts by mail without ice. If you put it in checked luggage it will freeze and will be ruined. The amounts are small enough for it to pass through airport security.
Question
My new Allergist retested me for allergies for mold and trees. I tested positive for 28. I have been taking allergy shots for 43 years monthly. Yes, 43 years. I am 56 years old. My new doctor suggested that I stop taking allergy shots because she said they are no longer benefiting me. I am so confused. I have not had a cold and allergy problems for the past 20 years. I am so afraid that if I stop taking the shots, I will get sick again. I am so lucky to be very healthy and I attribute that to my allergy shots. What do you think? I just spent 1 hour on the web reading aaai and acaai and can't find a page where this addressed. The only I found was that I may feel good for 3 yrs. Isn't my body relying on these shots after 43 years. Please respond as soon as possible. My doctor wants me to make up my mind. She will keep me as a patient and continue to give me my regular shots for only 1 more year.
Answer
The most prudent path is to stop the shots for a while and see how the patient does. The three year concept comes from a study that only lasted 3 years and so the study didn’t answer what truly happens- and that is some people are “cured forever”, in others symptoms come back. My own policy is to recommend after 5 years that patients quit and see how they do. Many patients over the years stay well, others need to resume allergy shots. In that case after another 5 years they don’t want to quit again and I understand that. I think the allergist’s recommendation is sound since skin tests can be positive and patients are not symptomatic from the allergies. I hope this discussion is helpful.
Question
Does taking an antihistamine before getting allergy shots impact the effectiveness of the immunotherapy? I have seen occasional recommendations to take one in order to avoid a bad reaction, but I have not been able to find an answer to this concern. In addition, is it a problem if a patient has been doing this consistently, and then stops taking the antihistamine? Would it increase the chance of a negative reaction?
Answer
Data from immunotherapy for venoms suggests that antihistamine pre-treatment during the rapid build-up phase of immunotherapy reduces local adverse symptoms related to venom injections such as redness, swelling, and itching. A 2001 study looked at the question of whether antihistamine therapy influenced the effectiveness of honeybee immunotherapy. Results of the 2001 study, conducted after patients were on venom immunotherapy for an average of 3 years, suggested that pre-treatment with antihistamines during the initial phase of immunotherapy improved the effectiveness of the immunotherapy.
Some allergists recommend pre-treatment with oral antihistamines with the goal of prevention of local adverse symptom at the site of allergen immunotherapy injections. If a patient had been consistently taking antihistamines prior to immunotherapy, and stopped taking the antihistamines prior to immunotherapy, it is possible that they might have increased local irritation related to immunotherapy injections. However, it is also possible that the patient might not experience increased local irritation related to immunotherapy injections.
I recommend that you discuss your specific history and your concerns with your allergist, in order to develop a plan that is personalized for you.
Question
My 15-year-old son has peanut allergy. Is SLIT available at this time as a treatment for this?
Answer
Unfortunately, there is no definitive treatment for peanut allergy at this time. Researchers continue to study desensitization methods to include oral dosing and epicutaneous (delivered to the skin through a patch) delivery.
The National Institutes of Health (NIH) did sponsor a study on sublingual immunotherapy (SLIT) for peanut allergy, which was published in 2013. This study did show promise, and many patients were able to consume more peanut powder at the end of the study than at the beginning of the study.
Although these results were very encouraging, none of the patients who were treated with SLIT for 44 weeks were able to undergo a desensitization challenge without symptoms.
Your son’s allergist can help keep you updated on emerging research and methods, and help your family consider further strategies that may be helpful for your son’s care.
Question
I had an egg allergy when I was a kid, around 5-6 years old. Now I’m 33 and no longer seem to have any reaction to eggs. I would like to get a flu shot, but I’ve been told I need to be sure I don’t have an egg allergy. I eat eggs every morning and don’t notice any reaction, so I don’t think I’m allergic anymore. Can I just get the flu shot? What do you suggest?
Answer
If you are tolerating eggs daily without symptoms, you are no longer allergic to eggs. If you do not have any skin, stomach, swallowing, throat, or breathing symptoms related to eating eggs; then you do not have to worry about egg allergy. You should get the influenza vaccine annually, and you do not need any special precautions or monitoring.
Question
Can long term allergy treatments provoke the body to become allergic to other things? My husband is following a 3 year anti-allergy program and he seems to have worse symptoms than before. In other words, he is now allergic to things he cannot identify.
Answer
Allergic sensitization generally increases over time, from childhood to adulthood.
Allergen immunotherapy (also called “allergy shots” or “AIT”) involves the administration of gradually increasing quantities of specific allergens until a dose is reached that is effective in reducing symptom severity from natural exposure (similar to a vaccine). The major objectives of allergen immunotherapy are to reduce responses to allergic triggers that precipitate symptoms in the short term and to decrease inflammatory response and prevent development of persistent disease in the long term. Data on allergen immunotherapy in children are interesting, as immunotherapy may prevent development of new sensitizations in children.
It is certainly possible that your husband has developed new sensitizations over time. Alternatively, perhaps with treatment of symptoms triggered by allergens, symptoms related to non-allergic triggers such as respiratory irritants or infections may be relatively more prominent. Allergen immunotherapy is not thought to provoke new sensitizations.
Your husband should discuss his symptoms, and potential strategies for managing symptoms, with his allergist.
Question
How can I decrease the chance that I have a bad reaction to allergy shots?
Answer
There are many things that you can do to decrease and manage your risk of a bad reaction. First and foremost is to wait the recommended 30 minutes in your allergist’s waiting room. Studies have found this is the time period when most bad reactions occur, and it is important that your doctor be able to treat you quickly if you do start to have a reaction. If you leave before the recommended wait time and have a reaction outside of the allergist’s office, the delay in treatment can result in a more life-threatening outcome.
Second, you should always let the nurse/doctor know immediately if you are experiencing any symptoms of a reaction, or notify your doctor if you ever experience these symptoms later in the day after your shot. Symptoms of a reaction can include itching, runny nose, itchy watery eyes, coughing, shortness of breath, hives, swelling, or just feeling like something is different from when you came in.
Other things that can decrease your chance of having a bad reaction is to not come in for your shots if you are having severe allergy symptoms, symptoms of asthma such as wheezing or shortness of breath or use of albuterol, or an upper respiratory infection.
You should also let your doctor know if you begin taking any high blood pressure medications, particularly beta blockers, since these can make it harder for your doctor to treat you if you do have a reaction.
You may want to discuss with your allergist a prescription for injectable epinephrine that you can carry with you on the day of your shots.
Question
I have a lot of allergy problems and I'm tired of taking medicine that doesn't work very well. Several of my family members take allergy shots at home and tell me I should do them, too. I called my local allergist and asked if they did allergy shots at home. I was told that they did allergy shots for their patients, but the shots had to given in a doctor's office. I'm confused. I am interested in allergy shots if they help, but why do some people do them at home and others in a doctor's office?
Answer
First, we should address allergy shots (also known as subcutaneous immunotherapy) in general. For people who have allergic nasal symptoms, asthma or atopic dermatitis, and are able to receive allergy shots, those shots have been shown to be very effective. As a board-certified allergist, I believe the best physicians to prescribe allergy shots are those trained as allergists (certified by the American Board of Allergy/Immunology).
While allergy shots are relatively safe, there is a low but real risk of a systemic allergic reaction to the shot each time you receive one. This is the reason allergists have their patients receive shots in a doctor’s office and then wait for thirty minutes afterwards – to decrease the risk that a serious life threatening reaction occurs back at home, when you’re no longer in reach of immediate medical help. Allergic reactions, whether they are to allergy shots, medications or foods, can progress rapidly and should not be taken lightly.
Question
I have seen some information on the internet that suggests that allergy shots can be more effective if given directly into a lymph node. Is this correct? If so, is this something that is available now?
Answer
The idea of injecting immunologic material into a lymph node (called intralymphatic immunotherapy) isn’t new — it has existed for a number of years, mainly in the setting of experimental anti-cancer therapy. Targeted cancer immunotherapy, placed directly into a lymph node, may more effectively target the source of problems at a lower dose than would otherwise be needed.
Since we are always looking for ways to improve treatment of allergies, allergists are studying this idea — along with many others — to determine its potential. An article published in 2008 by researchers in Switzerland indicates this new approach might work well in allergy treatment. In this study of 165 people, a series of 4 doses of grass immunotherapy were injected into an inguinal (groin) lymph node. The intralymphatic therapy was found to be as effective in this group as 3 years of traditional allergy immunotherapy (subcutaneous immunotherapy). Subsequently, the same researchers in Switzerland have also shown this treatment’s effectiveness in treating allergies to cat dander and bee venom — but these later studies were done in mice, not humans.
Intralymphatic allergen immunotherapy treatment remains experimental at this time and is not available as a treatment in the United States.
See your allergist to discuss immunotherapy options that are right for you.
Question
I thought the flu vaccine changed every year, but my nurse looked at this year’s flu vaccine and found it has H1N1 in it. Isn’t that the same as swine flu?
Answer
Your nurse is right! The terminology is a little confusing, so here’s a refresher: H1N1 is a subtype of Influenza A that has caused roughly half of all human flu infections we’ve seen in the past several years.
H1N1 viruses are identified by two surface proteins: Hemagglutinin (H) and Neuramidase (N). The strains H1, 2 and 3, and N1 and 2 are found in people – a lot more strains are found in birds and pigs, and can be spread to humans. If a sufficient genetic shift occurs in an animal virus strain, it can then be transmitted person to person.
Scientists closely monitor the strains infecting humans as well as animals, since crossover to humans may signal the next pandemic influenza.
Yes, the human influenza strains do shift from year to year, but it is very rare that all three strains in an influenza vaccine change in a single year. Therefore, you will see repeating strains if you watch the vaccines’ contents.
People need a yearly influenza vaccine for two reasons: the vaccines usually contain new strains each year, and immunity to influenza decreases over time. The yearly vaccine helps keep your immunity strong and ensures that you have resistance to the strains scientists have identified as important for the year.
Question
My 4 year-old son recently had anaphylaxis after the following vaccinations were given at the same time: chickenpox, DTP, polio, and MMR. Immediately after these immunizations in our pediatrician's office, he complained of his throat hurting, was sneezing, drooling, threw up and had red, itchy skin and trouble breathing. He was taken by ambulance to the ER, and treated with shots including epinephrine. In the past, he has had drooling and vomiting after eating a piece of protein chocolate bar and when taking his gummy vitamins, and complained of his throat hurting after eating marshmallows. My son doesn't have any hay fever, and we don't have a family history of allergies. Do you have any idea what could be causing these reactions?
Answer
Based on the information you’ve provided, your child’s reactions may be related to gelatin, which is added as a stabilizer to some vaccines and is found in both the MMR (measles-mumps-rubella) and chickenpox (varicella) vaccines. Yellow fever vaccine and rabies vaccine also contain gelatin, but are not part of the routine childhood vaccination schedule.
The foods you list also frequently contain gelatin.
Neomycin, an antibiotic, is another ingredient in some vaccines which can be related to allergic reactions; it can also result in a reaction if used with topical application (as in “triple antibiotic” antibacterial skin creams, sold over-the-counter).
Your allergist can evaluate the possibility of a gelatin (or other) allergy and perform testing on your child to confirm. Given the circumstances, any further vaccinations should be held – and foods containing gelatin avoided – until the exact cause of reactions has been determined.
Question
I am a 66 year-old man who was recently discharged from the hospital after a prolonged and resistant bout of pneumonia. After seeing an allergy/immunology doctor for an evaluation of a possible immune deficiency problem, I had some lab studies done. A certain test called gamma globulin came back in the low normal range, but some of the other tests were not quite normal. The allergist recommended that I have a Pneumovax (pneumococcal vaccine) and a tetanus/diptheria/pertussis vaccination and then have some repeat blood tests. Is it really necessary to have both of these vaccines? How do they help to identify if I have an immune problem?
Answer
Someone with an immune deficiency is very likely to have low normal or even normal gamma globulin levels but still have an inability to make antibodies to specific organisms such as pneumococcus (a bacteria which can cause pneumonia).
The blood work you had taken likely showed your allergist that you lacked proper antibodies to specifically fight pneumococcal diseases and that you lacked protection against tetanus and/or diphtheria. The absence of these antibodies does not in itself mean that you have an immune problem. You may have lost the immunity from the diphtheria/tetanus/pertussis that you had as a child, and may simply not have been exposed to many of the pneumococcal organisms that were tested in the blood.
However, you do need protection against all these organisms – that’s a standard recommendation for all adults over 65! Receiving the vaccines your physician has recommended will likely give you that protection. Repeating the blood tests 4 weeks afer the vaccinations will help your allergist know if your immune system is functioning properly. You really need both vaccinations for protection and to gain necessary information about your immune system. If your body shows an inadequate response to these vaccines, further immune studies and treatment, possibly long-term, may be required.
These vaccines can be administered at the same time. I would suggest that you follow your allergist’s advice and obtain the vaccines and then the blood tests 4 weeks later.
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