Nothing To Sneeze At
Weekly allergy shots might be history.
Problem: As many of us are reminded every spring and fall, the allergies that cause weepy red eyes, a stuffy nose, and even trouble breathing are quite common. It's estimated that about 35 percent of people in Westernized countries are affected by allergies—and, for completely unclear reasons, the rate has been increasing. There are basically three ways to treat allergies. You can eliminate exposure to allergens by removing them from the patient's environment—give away the cat, encase the mattress in impermeable plastic to trap and seal away dust mites, get rid of carpeting, and damp-mop instead of vacuuming. But sometimes that's not enough. Even after you give away the cat, he leaves behind tiny particles of the very allergenic protein from dried cat saliva—and it may be months or even years before the house is decontaminated. Because we can't completely eliminate allergens from our environment, allergy sufferers often continue to have some symptoms. Some medications can help, but they often have significant side effects and don't work for everyone. When drugs aren't enough, allergists often turn to immunotherapy. In immunotherapy, patients are repeatedly injected under the skin with small amounts of the allergen in doses that are slowly increased over time. Typically, the course of treatment requires about three to five years of injections administered in 50 to 70 doctor visits. The shots are painful and sometimes cause severe or even dangerous reactions. Many patients put up with allergies rather than deal with the nuisance and expense of immunotherapy, though a life-threatening allergy to, say, bee stings might make it worthwhile. Unfortunately, immunotherapy is not always successful. Perhaps 25 percent of patients will fail to get relief from their allergies, which is pretty annoying after five years of uncomfortable injections and as many as 70 doctor visits.
New study: It's not entirely clear how immunotherapy works, but it seems to depend on exposing the patient's immune system to the offending allergen in a way that stimulates a competing kind of immune response to suppress the production of the special class of antibodies that cause allergies. We depend on natural drainage mechanisms in the body to carry the contents of the shot from the injection site to the lymph node, where the immune system gets exposed to the allergen. But what if we could put the allergen directly into the lymph node, bypassing the slightly iffy transport system? As it turns out (and as some Swiss researchers have just published), this method seems very effective. The scientists studied patients with hay fever caused by allergies to grass pollen. Patients in one group were given conventional immunotherapy, receiving a total of 54 injections under the skin over three years. The other patients were given three injections directly into a lymph node over an eight-week period. The total dose of material injected into a lymph node was less than one-thousandth of the amount used for conventional immunotherapy.
Results: Both groups were evaluated three years after the first injection was administered, and the results were very impressive. Those who received three injections into the lymph node showed much earlier symptom improvement and needed far fewer medications to control their symptoms than the ones who received 54 conventional shots. By the end, both groups experienced similar symptom relief, and their skin tests showed nearly identical reductions in allergic responses. The new style of injection also resulted in substantially fewer mild reactions and none of the severe reactions seen in patients treated in the traditional way.
Conclusion: This promising new treatment seems so much easier and safer that it could well play an important role in how allergies are treated in the future. Of course, these results need to be replicated by other researchers, since they have only been reported from a single medical center. Besides, some of the authors of the paper have been granted a patent for this method of treatment, suggesting that there might be financial interests in play—always a reason for caution in evaluating a new treatment. However, if this method lives up to the promise suggested by this preliminary study, it could lead to a real improvement in the way we treat allergies. Severe allergies are no joke—they can reduce quality of life and sometimes have serious and even fatal results. We very much need new, more effective methods of treatment. I hope that this turns out to be one of them.
Sydney Spiesel is a pediatrician in Woodbridge, Conn., and clinical professor of pediatrics at Yale University's School of Medicine.
Photograph of a woman injecting herself by Stockbyte.