Hyposensitization in hay fever

Desensitization is nothing more than an allergy vaccination in which the immune system becomes accustomed to the allergens. There are numerous treatment options, which are usually covered by health insurance. They can be performed on both adults and children. In the following we will present the treatment options.

Hyposensitization can have an effect on allergic colds, hay fever and allergies to animal dander and house dust.

When is hyposensitization an option?

Prerequisites for hyposensitization:

• It must be an immediate allergic reaction (symptoms appear shortly after exposure to the allergen)
• there is no good alternative, ie the allergy trigger cannot be avoided and medication does not work well
• with high levels of suffering
• Age over 5 years

No hyposensitization with:

• Asthma
• serious cardiovascular diseases
• Therapy with beta blockers
• Severe autoimmune diseases and immune deficiencies
• Current cancers
• during pregnancy

Risks and side effects of hyposensitization

During the acute treatment, redness, swelling and itching after the injection may occur at the injection site, but this usually disappears on its own after a short time. Fatigue and headaches are also possible consequences. In order to control rare, severe allergic reactions – such as severe itching, nausea and breathing and circulatory problems up to an anaphylactic shock – patients must remain under the doctor’s observation for the first half hour after the injection.

Rapid desensitization: 7 days to 4 weeks before the pollen season

Ideal for working people: Cluster immunotherapy is a turbo version of hyposensitization . As with the other forms of specific immunotherapy (SIT), the pollen allergy sufferer receives an injection in increasing concentrations of exactly the pollen that triggers the annoying hay fever symptoms (= allergens). This works in a similar way to a vaccination against an infectious disease. The immune system gradually learns not to react more or at least less strongly to the allergy trigger.

The cluster immunotherapy impresses with the significantly shorter basic treatment, the maintenance therapy is achieved more quickly. “With this new form of hyposensitization, two to three injections are administered at weekly intervals per treatment day – with a break of at least 30 minutes between the individual injections,” explains Prof. Ludger Klimek, head of the Wiesbaden Allergy Center. “In this way, the individual maximum dose is reached after just seven days to four weeks. This saves patients a lot of time. But above all, cluster immunotherapy works very well. It is therefore the ideal treatment for many allergy sufferers.” However, because the therapy, like any hyposensitization, can trigger allergic reactions, especially at the beginning, it must be closely monitored by a doctor.

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4 to 8 weeks before the pollen season

An alternative to the “rapid vaccination” is short-term immunotherapy . The doctor gives the patient four to eight injections with “his” allergens before the first pollen flight. “In this variant, too, the gradually increasing dose should make you less sensitive to the allergens,” says Klimek. “According to current knowledge, the recipe for success of any hyposensitization is that it activates regulating immune cells that protect against future allergic reactions. In this way, the body’s defense system can later protect itself from an allergic attack. This is, in the best sense of the word, help for self-help.”

However, particularly sensitive “hay fever sufferers” sometimes do not tolerate injections. If grass pollen is their enemy, they can switch to drip solutions. They are dropped under the tongue and then absorbed through the oral mucosa. Doctors also call this form of hyposensitization sublingual (Latin: under the tongue) immunotherapy (SLIT). Although this method does not initially sound as effective to the layperson as the injection method, numerous studies have proven its therapeutic effectiveness.

6 weeks to 4 months before the pollen season

A classic and also the most common form of immunotherapy is subcutaneous (Latin: under the skin) hyposensitization (SCIT). If you don’t want to rush through the injection cycles in the form of cluster or short-term therapy, you can choose the “more comfortable” model, in which the basic treatment can last up to four months on average. The doctor injects a standardized allergen solution with increasing doses under the skin on the upper arm weekly. Defense cells that patrol the skin tissue pick up the allergy trigger and alert the immune system. It still reacts to it, but weaker from time to time. The injection vaccination is continued until a maximum dose calculated by the doctor has been reached.

“Modern preparations achieve a high level of therapeutic success. Not only does the majority of hay fever patients benefit from this, but also those who are allergic to insect venom and house dust mites,” says Klimek. “This effect usually lasts for years after the end of therapy – often even for the rest of your life. Then you can actually speak of a cure.” Important to know: once the runny nose and burning eyes have set in, any type of SCIT, any form of hyposensitization generally comes too late.

Desensitization with 3 years duration

The following applies to all variants of specific immunotherapy: As soon as the maximum allergen dose has been reached, treatment is continued. The allergen solution is then injected under the skin about every four to six weeks for a period of about three years. This repeatedly lures the immune system out of reserve and ultimately makes it insensitive. Ideally, it learns to defend itself against the allergy trigger with harmless weapons. Instead of the allergy-promoting antibody IgE, it then produces the antibody type IgG, which is completely “tame” and does not trigger an allergy.

The so-called grass vaccine tablet is a permanent form of hyposensitization. Simply put one with the maximum dose of grass extracts under your tongue every day – and the sneezing attacks will come much less often. At the same time, you need less medication for hay fever symptoms. ENT doctor Prof. Ludger Klimek: “This immunotherapy by tablet is a great opportunity for people allergic to grass pollen, which after all make up around 70 percent of hay fever patients.” However, it is not suitable for the impatient: the grass vaccine tablet has to be sucked every day for three years will. That can be annoying.

Therapy success in hyposensitization

Many studies have shown that hyposensitization achieves good effects. An improvement in allergy symptoms such as a runny nose, itchy eyes and sneezing can be seen in the first year. As a rule, however, the full effect only becomes apparent after two to three years. However, there is no guarantee of success – while desensitization even relieves some people of their allergy symptoms, others feel no improvement at all.

Does specific immunotherapy also help against multiple allergies?

In principle, several allergies can also be treated in the case of hyposensitization, insofar as they meet the requirements for this treatment. However, it should be left with a combination of a maximum of two or three allergens in order to increase the chances of effectiveness.