What's The Rush?

A new ap­proach to fast al­lergy re­lief.

Wellness Update - - Hiv -

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

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