What's The Rush?
A new approach to fast allergy relief.
Rush Immunotherapy is a method for providing rapid relief from allergies. What is this new procedure and where does this fit into the treatments we already have?
Seasonal or persistent nasal itching, sneezing, runny nose, nasal congestion, sinus headaches, postnasal drainage, sleep disturbance because of nasal obstruction, as well as itching and burning of the eyes (allergic conjunctivitis) affects 10-25% of people in Western countries. Pollen and airborne substances arising from molds, animals, mites and other insects are common causes of these problems.
Allergic reactions in the lungs result in asthma in approximately 5% of the world’s population. Tightness in the chest, shortness of breath, wheezing, and coughing are common asthma symptoms. Asthma can limit activities, disrupt sleep, and have a very negative effect on quality of life. Acute respiratory tract infections or exposure to allergic triggers can cause severe or even fatal worsening of asthma. The goals of therapy for upper airway allergic reactions (allergic rhinitis, hay fever) include relief from annoying symptoms, relief from disturbed sleep, and avoidance of complications such as middle ear infections or sinus infections. Antihistamines, decongestants, nasal steroid sprays, and other nasal allergy sprays often provide relief.
The goals for asthma are control of the symptoms, prevention of limitations on activities, and protection from severe worsening during respiratory tract infections or exposures to allergic triggers. Bronchodilators, inhaled steroids, oral asthma medications, and other medications can provide symptomatic relief for some patients.
Allergic rhinitis, allergic conjuctivitis, and allergic asthma, often need immunotherapy (allergy shots). These injections provide control of symptoms and then resolution of the allergies. Currently this is the only therapy that can actually reduce or eliminate the body's unwanted allergic reactions to environmental substances.
Rush Immunotherapy is a new injection procedure that is revolutionizing how we treat allergies.
Traditional immunotherapy typically involves injections twice a week with increasing amounts of antigens (the substances that cause the allergies). This process usually takes 16 weeks to reach full treatment doses (maintenance doses).
The Rush Immunotherapy revolution has centered on the recently acquired knowledge that relief from allergy symptoms requires lower doses of antigens than are required to make the allergies go away entirely over time. Research in United States and Europe has led to Rush Immunotherapy procedures that allow us to reach levels of antigens that begin to relieve symptoms in one day rather than over a period of 2-3 months.
Patients are given high doses of allergy suppressing medication to minimize reactions at the sites of injections, or in the rest of the body. Typically 8 injections are given over a period of 5 hours and the patients are then observed for 2 more hours as the materials are absorbed into the body.
Rush immunotherapy can be a great convenience for patients with demanding work or school schedules. While the procedure requires a full day in the office, we avoid nearly 3/4 of the visits needed to build up to maintenance doses. A day in the office also affords time for the patient to ask questions about allergic disease and treatment. There is time to discuss and demonstrate how to deal with unexpected late allergic reactions.
As allergy symptoms improve after Rush Immunotherapy, patients are much more likely to return for the final doses to build up to maintenance. These higher doses are required not to relieve symptoms, but rather to gradually eliminate or markedly decrease the severity of the allergy itself.
Not everyone is a good candidate for Rush Immunotherapy. If asthma control is not stable, if lung functions are not near normal, Rush Immunotherapy may not be safe.
Preschool children may be good candidates from the point of view of clinical improvement, but being kept in a relatively small space can be very difficult for them. For many patients, Rush Immunotherapy is an alternative with several advantages over medications alone, or traditional immunotherapy.
Any form of immunotherapy carries a risk that the patient may have a troublesome reaction at the injection site, or that a more severe reaction involving the whole body may occur. This could include hives (urticaria), swelling of the eyes, lips, or other structures (angioedema), even anaphylaxis (reactions that cause trouble breathing or decreases in blood pressure).
The possibility of an allergic reaction is why allergists rely upon patient education, observation in the office after injections, and having an emergency plan for dealing with rare severe reactions. Rush Immunotherapy patients are taught about the characteristics of the late allergic reactions, are given medications to use in case of a reaction, and are taught the use of self-injectable epinephrine.
Rush Immunotherapy provides a method for achieving clinical improvement very rapidly and greatly reduces the number of visits required to achieve long lasting freedom from allergy. -Vicki Lyons, MD and Timothy J. Sullivan, MD