08/14/2020
Article from the Medical Professionals Charlotte Magazine - August 2020.
The people of Charlotte are no strangers to allergies. With allergies of all forms on the rise, nearly every physician has to address allergies in some form regardless of their scope of practice. It is my honor to have the opportunity to highlight several clinically available allergy treatment options in our community along with when and how they may be useful.
AVOIDANCE
🖐 Traditional allergy treatment strategies have focused on identifying a patient’s allergens and subsequently avoiding them. Avoidance of allergens can provide useful symptom relief, but we have learned this should not be as quick trigger of an initial strategy as it has been in the past, especially in regard to foods.
MEDICATIONS
💊 Antihistamines, inhalers, and steroids provide symptom relief, and epinephrine can be lifesaving to those with anaphylaxis. Newer injected biologic medications, such as omalizumab and dupilumab, offer the ability to interfere with reactivity pathways to provide additional healing to those struggling with poorly controlled chronic allergic conditions. There are many types of medications that can offer useful allergy symptom relief, but each may also cause adverse effects and many cannot be used long-term.
ALLERGY SHOTS (SCIT)
💉 Allergy shots have been the mainstay of environmental allergen immunotherapy in the U.S. for decades. The treatment can begin to provide long-term symptom relief typically within a few months, with less need for medication over time as chronic disease improves. This treatment is usually considered for patients 5 years old and up, is delivered by injection, and requires frequent appointments for at least three to five years.
ORAL IMMUNOTHERAPY (OIT)
🥜🥚🥛 Oral Immunotherapy is a newer form of food allergen immunotherapy gaining popularity in the U.S. because it has demonstrated the potential to drastically increase a patient’s tolerance threshold to their food allergen over the course of months to a year. OIT dosing involves the patient eating their food allergen, a benefit for some, and a limiting factor for others. It is often used in ages 4 and up, though it is starting to become available for younger children due to studies supporting a benefit to treating earlier.
SUBLINGUAL IMMUNOTHERAPY (SLIT)
💧 Sublingual Immunotherapy (Allergy Drops or Tablets) is a non-invasive allergen immunotherapy option already prevalent in Europe and gaining traction recently in the U.S. due to its safety and growing evidence of its efficacy. Uniquely, it can be used for the treatment of both environmental and food allergies to raise a patient’s tolerance threshold leading to symptom relief, reduction in disease, protection, and quality of life improvement. SLIT drops can be tailored for use at any age, including infancy if appropriate which can utilize the early window of immunologic development. There are also four FDA-approved standardized high-dose single-allergen (environmental) SLIT tablets that can be prescribed, which are designed for older children or adult age ranges.
IN CONCLUSION
👩⚕️🧑⚕️ Allergy care is challenging because of the complexities of each patient’s immune system, psyche, and the treatment methods themselves. It becomes vital to understand each patient’s health and quality of life goals and how they feel about the risks, utility, and lifestyle requirements comprising each of the above available treatments. Knowing these details can help us effectively connect patients to their most successful treatment path, and we have many useful treatment options available right here in Charlotte.
