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Assignment

Assignment

Introduction

Allergen immunotherapy, also known as allergen desensitization and allergy shots, is a type of immunotherapy in which a patient with an allergic disorder receives serial vaccinations with small doses of an allergen in order to induce immunologic tolerance to the allergen.

The term immunotherapy refers to the treatment of disease by inducing, enhancing, or suppressing an immune response. Immunotherapies that induce or enhance an immune response are classified as activation immunotherapies; an example of an application of activation immunotherapy is cancer immunotherapy, which attempts to stimulate the immune system to attack cancer cells. Allergen immunotherapy is an example of suppression immunotherapy in which the goal is to reduce or suppress an immune response. This Nursing Practice & Skill paper focuses on allergen immunotherapy administered by subcutaneous (SQ) injections (Blunt 2010, 1620-1621).

Allergen immunotherapy is usually administered in serial SQ injections, typically given in the upper arm. Treatment may also be administered in sublingual (SL) drops. Injections or SL drops that contain small amounts of the purified allergen extracts (i.e., allergy vaccine) are administered on a schedule of 1-3 times per week initially, and eventually once per month. One dose of allergen immunotherapy provides just enough specific allergen(s) to stimulate an immunoglobulin E (IgE) response in the immune system but not enough of a response to induce an allergic reaction. The body becomes gradually accustomed (i.e., desensitized) to the allergen(s) through repeated exposure over time and the immune system builds up a tolerance to the given allergen(s). Over time, the physician increases the dose of the allergen(s) to which the patient is exposed. As a result of allergen immunotherapy, allergy symptoms gradually reduce in 3-5 years (Abramson & Weiner 1995, 969-974).

Allergen immunotherapy typically is provided in clinics and physicians' offices that have supplemental oxygen and emergency medical equipment in case of anaphylaxis. Allergen immunotherapy is ordered by a physician and is typically administered by a registered nurse with appropriate training. Depending upon the patient's preference, family members and visitors may remain with the patient during the injections

Discussion

Desired Outcome of Allergen Immunotherapy

Allergen immunotherapy is ordered for treatment of allergic disorders, including rhinitis, conjunctivitis, and asthma for patients with allergic reactions to pollens, dust mites, cockroaches, mold, pet dander, and insect stings, in the following situations:

When allergy medications do not adequately control symptoms

When allergy medications result in adverse side effects or interact with other medications being taken

To reduce long-term dependence on allergy medications

For insect sting reactions

Patients with a history of allergies confirmed by positive skin tests are potential candidates for allergen immunotherapy. Patients with suspected allergy to insect stings must have a history of reaction and demonstrate, through allergy testing, specific IgE antibodies to Hymenoptera (i.e., a large order of insects including ants, wasps, and bees) venom

Importance of Allergen Immunotherapy

Allergen immunotherapy has the potential to reduce serum levels of circulating IgE, a class of immunoglobulins that has an important role in allergy. Allergic reactions can be uncomfortable or even life-threatening (e.g., leading to anaphylaxis). Allergen immunotherapy may be valuable for patients with severe allergies, those ...