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Tag: allergy shots

  • Should I Get Allergy Shots?

    Should I Get Allergy Shots?

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    What Are Allergy Shots?

    You probably take something to ease your seasonal allergy symptoms. Maybe you’re using more and more medicine over time, or it’s not working that well. You may be thinking about switching to immunotherapy to see if that helps more.

    Immunotherapy for allergies exposes you to a tiny amount of your allergy trigger so that over time, your body learns to handle it better. This can make a big difference in your allergy symptoms. 

    “A lot of patients now are looking for more natural treatment options and minimizing the amount of medications they’re needing,” says Kara Wada, MD, an assistant professor of allergy and immunology at the Ohio State University Wexner Medical Center.

    If you’ve got asthma, it must be under good control before you start this type of treatment because exposure to your allergy trigger has the potential to cause a flare-up.

    Allergy shots are one form of immunotherapy for allergies. You get the shots in a doctor’s office. They can make a big difference and may even get rid of your symptoms. But it may take years for them to take full effect.

    Sublingual immunotherapy is another form. It uses tablets. (“Sublingual” means that the medicine goes under your tongue.) Sublingual treatments haven’t been studied as much as allergy shots. They haven’t been shown to work as well as allergy shots. But if you’re up for the commitment of taking the medicine day in, day out, as prescribed, it might be an option to explore for the specific allergies it targets.

    If you’re interested in allergy shots or sublingual immunotherapy, you first need to visit your allergist and get tested to pinpoint exactly what you’re allergic to, if you haven’t done this already.

    How Often Do You Get Allergy Shots?

    With allergy shots, your allergist creates a shot formulation that’s based on your test results. You’ll need to get a shot from your allergist once or twice a week for 3-6 months. You’ll get the shot in your upper arm. It’ll contain a tiny amount of the thing you’re allergic to — pollen, pet dander, mold, dust mites, or bee venom, for example.

    Each week, your doctor will raise the amount of allergens in the shot until you reach a maintenance dose. Your doctor might recommend that you take an antihistamine before you get each treatment.

    Once you reach the maintenance dose, you can usually cut back on your visits (and shots) to every 2-4 weeks, a schedule you keep for 3-5 years or until your symptoms improve. “There seems to be some point within that window when the immune response changes,” Wada says.

    You’ll need to wait in your allergist’s office for about half an hour after each allergy shot to make sure you don’t have a serious reaction.

    With sublingual immunotherapy, your treatment will probably start 12-16 weeks before pollen season begins and last through pollen season. You take the first dose in the allergist’s office and the rest at home.

    How Soon Do Allergy Shots Help My Symptoms?

    The most obvious drawback for allergy shots is the time commitment. You must stick to a weekly schedule of allergist visits for months, and it could be years of monthly follow-ups before you see significant improvement.

    That said, symptoms generally start to improve within the first year of treatment and often continue to get better during the second year. By the third to fifth year, most people are free of allergy symptoms and may be able to stop getting shots.

    If your symptoms don’t improve after a year of shots, talk with your doctor about other treatment options.

    Allergy Shots Side Effects

    Aside from time, there’s the potential for a reaction to the treatment, since it has small amounts of the things you’re allergic to. For instance, you may have redness or swelling around the injection site if you get a shot, or you may have other symptoms.

    “Sometimes, patients report an increase in nose or eye symptoms, such as stuffy nose, runny nose, or itchy eyes,” says allergy immunologist Kathleen Dass, MD, of the Michigan Allergy, Asthma & Immunology Center. 

    It’s rare, but it’s also possible to have anaphylaxis, which is a severe allergic reaction involving hives, swelling, trouble breathing, dizziness, and loss of consciousness. That’s why you need to get the treatment in your allergist’s office and wait there for a while after each shot, Dass says.

    Sublingual immunotherapy treatments often cause mouth and throat irritation, Wada says. But they’re less likely to lead to anaphylaxis, research shows. 

    Does Insurance Cover Allergy Shots?

    Allergy shots can be expensive, but they’re generally covered by insurance. Check your plan. If you have a high-deductible health plan, you may have to pay out of pocket until you hit your deductible each year.

    If you’re thinking about sublingual treatment, you can get it only for allergies to ragweed, certain grasses, and dust mites. So if you’re having reactions to a different type of allergen, it’s not an option.

    How Well Do Allergy Shots Work?

    If you stick with allergy shots long enough, there’s a good chance you’ll see improvement or even an end to your allergy symptoms. About 85% of people with hay fever who get this type of treatment say their allergy symptoms get better.

    “That’s one of the things I find pretty neat as an allergist,” Wada says. “Typically, a lot of the treatments we have are geared toward treating the symptoms. This is one of the few things we have toward the root of the problem.”

    How Should I Prepare for Allergy Shots?

    You may want to avoid exercise or doing anything strenuous for 2 hours before and after your appointment. Exercise boosts blood flow to the tissues and may cause the allergens to spread throughout your body faster. It’s not likely to cause a serious problem, but it’s best to be safe.

    Tell your doctor about any other medicines or herbs and supplements you take. Some medications interfere with the treatment or raise the risk of side effects. You may need to stop allergy shots if you take these medications.

    If you’re pregnant or planning to get pregnant, ask your doctor whether you should continue to get allergy shots.

    What Should I Expect After Getting Allergy Shots?

    Usually, you’ll stay at the doctor’s office for about 30 minutes after you get an allergy shot. That’s to make sure you don’t get side effects like itchy eyes, shortness of breath, a runny nose, or a tight throat. If you get these symptoms after you leave, go back to your doctor’s office or to the nearest emergency room.

    Redness, swelling, or irritation right around the site of the injection is normal. These symptoms should go away in 4 to 8 hours.

    When Should I Call My Doctor?

    Get on the phone and go to the nearest emergency room if you have shortness of breath, a tight throat, or any other symptoms that worry you after getting your shot.

    Who Should Not Get Allergy Shots?

    They may be more risky for people with heart or lung disease, or who take certain medications. Tell your allergist about your health and any medicines you take, so you can decide if allergy shots are a good option for you.

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  • I Was Allergic to Cats. Until Suddenly, I Wasn’t.

    I Was Allergic to Cats. Until Suddenly, I Wasn’t.

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    Of all the nicknames I have for my cat Calvin—Fluffernutter, Chonk-a-Donk, Fuzzy Lumpkin, Jerky McJerkface—Bumpus Maximus may be the most apt. Every night, when I crawl into bed, Calvin hops onto my pillow, purrs, and bonks his head affectionately against mine. It’s adorable, and a little bit gross. Tiny tufts of fur jet into my nose; flecks of spittle smear onto my cheeks.

    Just shy of a decade ago, cuddling a cat this aggressively would have left me in dire straits. From early childhood through my early 20s, I nursed a serious allergy that made it impossible for me to safely interact with most felines, much less adopt them. Just a few minutes of exposure was enough to make my eyes water and clog my nasal passages with snot. Within an hour, my throat would swell and my chest would erupt in crimson hives.

    Then, sometime in the early 2010s, my misery came to an abrupt and baffling end. With no apparent interventions, my cat allergy disappeared. Stray whiffs of dander, sufficient to send my body into conniptions mere months before, couldn’t even compel my nose to twitch. My body just up and decided that the former bane of its existence was suddenly totally chill.

    What I went through is, technically speaking, “completely weird,” says Kimberly Blumenthal, an allergist and immunologist at Massachusetts General Hospital. Some allergies do naturally fade with time, but short of allergy shots, which don’t always work, “we think of cat allergy as a permanent diagnosis,” Blumenthal told me. One solution that’s often proposed? “Get rid of your cat.”

    My case is an anomaly, but its oddness is not. Although experts have a broad sense of how allergies play out in the body, far less is known about what causes them to come and go—an enigma that’s becoming more worrying as rates of allergy continue to climb. Nailing down how, when, and why these chronic conditions vanish could help researchers engineer those circumstances more often for allergy sufferers—in ways that are actually under our control, and not just by chance.

    All allergies, at their core, are molecular screwups: an immune system mistakenly flagging a harmless substance as dangerous and attacking it. In the classic version, an allergen, be it a fleck of almond or grass or dog, evokes the ire of certain immune cells, prompting them to churn out an antibody called IgE. IgE drags the allergen like a hostage over to other defensive cells and molecules to rile them up too. A blaze of inflammation-promoting signals, including histamine, end up getting released, sparking bouts of itching, redness, and swelling. Blood vessels dilate; mucus floods out in gobs. At their most extreme, these reactions get so gnarly that they can kill.

    Just about every step of this chain reaction is essential to produce a bona fide allergy—which means that intervening at any of several points can shut the cascade down. People whose bodies make less IgE over time can become less sensitive to allergens. The same seems to be true for those who start producing more of another antibody, called IgG4, that can counteract IgE. Some people also dispatch a molecule known as IL-10 that can tell immune cells to cool their heels even in the midst of IgE’s perpetual scream.

    All this and more can eventually persuade a body to lose its phobia of an allergen, a phenomenon known as tolerance. But because there is not a single way in which allergy manifests, it stands to reason that there won’t be a single way in which it disappears. “We don’t fully understand how these things go away,” says Zachary Rubin, a pediatrician at Oak Brook Allergists, in Illinois.

    Read: What they aren’t telling you about hypoallergenic dogs

    Tolerance does display a few trends. Sometimes, it unfurls naturally as people get older, especially as they approach their 60s (though allergies can appear in old age as well). Other diagnoses can go poof amid the changes that unfold as children zip through the physiological and hormonal changes brought on by toddlerhood, adolescence, and the teen years. As many as 60 to 80 percent of milk, wheat, and egg allergies can peace out by puberty—a pattern that might also be related to the instability of the allergens involved. Certain snippets of milk and egg proteins, for instance, can unravel in the presence of heat or stomach acid, making the molecules “less allergenic,” and giving the body ample opportunity to reappraise them as benign, says Anna Nowak-Węgrzyn, a pediatric allergist and immunologist at NYU Langone Health. About 80 to 90 percent of penicillin allergies, too, disappear within 10 years of when they’re first detected, more if you count the ones that are improperly diagnosed, as Blumenthal has found.

    Other allergies are more likely to be lifers without dedicated intervention—among them, issues with peanuts, tree nuts, shellfish, pollen, and pets. Part of the reason may be that some of these allergens are super tough to neutralize or purge. The main cat allergen, a protein called “Fel d 1” that’s found in feline saliva, urine, and gland secretions, can linger for six months after a cat vacates the premises. It can get airborne, and glom on to surfaces; it’s been found in schools and churches and buses and hospitals, “even in space,” Blumenthal told me.

    Read: The next weird way we’re changing cats

    For hangers-on like these, allergists can try to nudge the body toward tolerance through shots or mouth drops that introduce bits of an allergen over months or years, basically the immunological version of exposure therapy. In some cases, it works: Dosing people with Fel d 1 can at least improve a cat allergy, but it’s hardly a sure hit. Researchers haven’t even fully sussed out how allergy shots induce tolerance—just that “they work well for a lot of patients,” Rubin told me. The world of allergy research as a whole is something of a Wild West: Some people are truly, genuinely, hypersensitive to water touching their skin; others have gotten allergies because of organ transplants, apparently inheriting their donor’s sensitivity as amped-up immune cells hitched a ride.

    Part of the trouble is that allergy can involve just about every nook and cranny of the immune system; to study its wax and wane, scientists have to repeatedly look at people’s blood, gut, or airway to figure out what sorts of cells and molecules are lurking about, all while tracking their symptoms and exposures, which doesn’t come easy or cheap. And fully disentangling the nuances of bygone allergies isn’t just about better understanding people who are the rule. It’s about delving into the exceptions to it too.

    How frustratingly little we know about allergies is compounded by the fact that the world is becoming a more allergic place. A lot of the why remains murky, but researchers think that part of the problem can be traced to the perils of modern living: the wider use of antibiotics; the shifts in eating patterns; the squeaky-cleanness of so many contemporary childhoods, focused heavily on time indoors. About 50 million people in the U.S. alone experience allergies each year—some of them little more than a nuisance, others potentially deadly when triggered without immediate treatment. Allergies can diminish quality of life. They can limit the areas where people can safely rent an apartment, or the places where they can safely dine. They can hamper access to lifesaving treatments, leaving doctors scrambling to find alternative therapies that don’t harm more than they help.

    But if allergies can rise this steeply with the times, maybe they can resolve rapidly too. New antibody-based treatments could help silence the body’s alarm sensors and quell IgE’s rampage. Some researchers are even looking into how fecal transplants that port the gut microbiome of tolerant people into allergy sufferers might help certain food sensitivities subside. Anne Liu, an allergist and immunologist at Stanford, is also hopeful that “the incidence of new food allergies will decline over the next 10 years,” as more advances come through. After years of advising parents against introducing their kids to sometimes-allergenic substances such as milk and peanuts too young, experts are now encouraging early exposures, in the hopes of teaching tolerance. And the more researchers learn about how allergies naturally abate, the better they might be able to safely replicate fade-outs.

    One instructive example could come from cases quite opposite to mine: longtime pet owners who develop allergies to their animals after spending some time away from them. That’s what happened to Stefanie Mezigian, of Michigan. After spending her entire childhood with her cat, Thumper, Mezigian was dismayed to find herself sneezing and sniffling when she visited home the summer after her freshman year of college. Years later, Mezigian seems to have built a partial tolerance up again; she now has another cat, Jack, and plans to keep felines in her life for good—both for companionship and to wrangle her immune system’s woes. “If I go without cats, that seems to be when I develop problems,” she told me.

    It’s a reasonable thought to have, Liu told me. People in Mezigian’s situation probably have the reactive IgE bopping around their body their entire life. But maybe during a fur-free stretch, the immune system, trying to be “parsimonious,” stops making molecules that rein in the allergy, she said. The immune system is nothing if not malleable, and a bit diva-esque: Set one thing off kilter, and an entire network of molecules and cells can revamp its approach to the world.

    I may never know why my cat allergy ghosted me. Maybe I got infected by a virus that gently rewired my immune system; maybe my hormone levels went into flux. Maybe it was the stress, or joy, of graduating college and starting grad school; maybe my diet or microbiome changed in just the right way, at just the right time. Perhaps it’s pointless to guess. Allergy, like the rest of the immune system, is a hot, complicated mess—a common fixture of modern living that many of us take for granted, but that remains, in so many cases, a mystery. All I can do is hope my cat allergy stays gone, though there’s no telling if it will. “I have no idea,” Nowak-Węgrzyn told me. “I’m just happy for you. Go enjoy your cats.”

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    Katherine J. Wu

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  • What They Aren’t Telling You About Hypoallergenic Dogs

    What They Aren’t Telling You About Hypoallergenic Dogs

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    As someone with dog allergies who nevertheless has been around many dogs as a trainer, a fosterer, and an owner, Candice has learned not to trust the promise of a “hypoallergenic” dog. She’s met low-shedding, hypoallergenic poodles and Portuguese water dogs that supposedly shouldn’t trigger her allergies yet very much did. But she has also met fluffy, longhaired breeds such as huskies and spitzes that set off nary a sneeze. “I’ve had more misery with short-haired dogs,” she told me. That includes her own Belgian Malinois, Fiore, with whom her symptoms got so bad that she started allergy shots. Fiore’s equally furry full sister Fernando, though? Totally fine. No reaction!

    Candice—whose last name I’m not using for medical-privacy reasons—is not alone in discerning no rhyme or reason to which dogs she’s allergic to. In studies, scientists have found no difference in how much of the dog allergen Can f 1 is present in homes with hypoallergenic versus non-hypoallergenic breeds. One study found no difference in the amount of allergen on the fur of different dogs either. Another actually found more allergen on the fur of hypoallergenic breeds. Hypoallergenic doesn’t seem to mean much at all.

    “There’s really, truly no completely, 100 percent hypoallergenic dog. Even hairless dogs can make the allergen,” says John James, a spokesperson for the Asthma and Allergy Foundation of America. “It’s really a marketing term,” says David Stukus, an allergist at Nationwide Children’s Hospital and a member of AAFA’s Medical Scientific Council. When I asked several allergists around the country if perplexed owners ever come in allergic to their expensive, supposedly hypoallergenic dog, their answers were unequivocal: “All the time.” One of the biggest sources of misinformation on this topic is, in fact, a former U.S. president. “When President Obama was in office, they allegedly had a hypoallergenic dog because their daughter had allergies, and that didn’t help matters,” Stukus told me, referring to the Obamas’ first Portuguese water dog, Bo. “Everybody got Portuguese water dogs.”  And—surprise—they can still cause allergies.

    Technically, hypoallergenic means that a dog is less likely to cause allergies, not that it never causes allergies, though this distinction is often lost in colloquial use. But even then, there is no such thing as a consistently hypoallergenic breed. That’s because, although breeds that shed less fur or hair are commonly considered hypoallergenic, the fur or hair itself is not what causes allergies. Rather, it is proteins present in the dander, or small flakes of skin, or saliva. All dogs make these proteins, and all dogs have skin and saliva.

    It is true, though, that a person might find one dog less allergenic than another. The studies that couldn’t find a clear pattern of lower allergens in hypoallergenic breeds did find differences among individual dogs of the same breed. And a smaller dog is generally going to shed less dander than a big one. On size alone, “it does make sense that a chihuahua is less problematic than a Great Dane,” says Richard Lockey, an allergist at the University of South Florida. Dogs also make a whole suite of proteins that can cause allergies. The best known is Can f 1, although there are seven others. Some people might be more allergic to one of these proteins than another; some dogs might make more of one of these proteins than another. Whether a particular human actually ends up allergic to a particular dog depends on these details—and can’t be predicted from the breed alone. For this reason, doctors recommend that anyone with allergies spend time with a specific dog before taking it home. “I literally say, ‘Have your child hug them, rub their face on them.’ If nothing happens, that’s a good sign,” Stukus said.

    People who are allergic can also develop tolerance to a specific dog over time. Candice, for example, eventually developed a tolerance to her German-shepherd mix, Tesla, despite getting all watery-eyed and sneezy at first. In addition, allergy shots, also called immunotherapy, can help people build up tolerance by gradually increasing exposure to an allergen; Candice eventually resorted to them with Fiore. The inverse of this principle explains the Thanksgiving effect, where people who leave for college come home suddenly allergic to their childhood pet after not being exposed for a long time.

    Nasal steroid sprays and antihistamines such as Claritin and Allegra, which are available over the counter, can also be used to manage allergies these days. That wasn’t always the case, recalls Lockey, who began practicing medicine in the 1960s. Back then, there weren’t good medications for controlling allergies, and he would just tell patients to keep their pets outdoors. “That just doesn’t go anymore,” he told me. Now few dogs are kept exclusively outdoors, especially in cities. They sleep in our homes and even our beds. As dogs have become physically enmeshed in our lives, dog allergies can no longer be as easily ignored as when the animals lived outside.

    The myth of an allergy-free dog persists, though, and Stukus often sees this frustration play out in families with allergic kids. “This is the point that I hear all the time from families: It’s the grandparents,” he told me. Parents might quickly discover that their kids are allergic to “hypoallergenic” dogs. But grandparents, eager for their grandkids to visit, push back because their expensive pet is supposed to be hypoallergenic—“The Obamas had the same dog. It’s fine!”—only for the kids to end up coughing and miserable. He keeps hearing the same lament. “They just don’t understand,” the parents tell him, “that there’s no such thing as a hypoallergenic dog.”

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    Sarah Zhang

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