Asit efficiency. Allergen-specific immunotherapy (ASIT). Scheme of asit therapy

One of the progressive methods of allergy treatment is ASIT (allergen-specific immunotherapy). It is precisely the elimination of a specific reaction of the immune system, and not the relief of symptoms. The method, known since the beginning of the 20th century, is constantly being developed and improved by specialists.

What is ASIT therapy?

ASIT therapy is an allergy treatment technique aimed at introducing small doses of allergens into the human body. Gradually, increasing the dosage of the injected substances, the body gets used to the allergen. And this leads to the fact that the body stops responding to the stimulus.

For therapy, allergens are used, which are based on the following components:

• proteins;
• polysaccharides.

Upon contact with the body, antibodies are produced that reduce the effect of the irritant. Correction immune status and curing allergies is the goal of ASIT.

The principle of treatment

Allergen-specific immunotherapy is a serious approach to the treatment of allergies that begins with diagnostic tests.

Diagnostics and features of the appointment

Diagnostic tests usually include:

• general blood analysis;
• spirography (for asthma patients);
• general urine analysis;
• allergy tests.

By analyzing all the collected data, the doctor prescribes treatment with the ASIT method. This selects:

• specific vaccine;
• dosage;
• method of vaccine administration;
• number of applications.

After starting therapy, the doctor may increase the dosage if the vaccine is well tolerated by patients. The procedure should be carried out either in the office of an allergist or in a hospital. This is necessary in order to backlash the patient's body for the vaccine, they were able to provide qualified assistance. In this regard, after the procedure, the patient must be at least an hour in a medical institution.

Procedure methods

Currently, several methods of introducing a vaccine into the body are used:

• by inhaling the vapors of the drug from the inhaler;
• leading into the nasal cavity;
• oral;
• subcutaneous injections in the forearm;

The most commonly used method is the oral method and subcutaneous administration.

Indications for use

The ASIT method is effective in such cases:

• food allergies (depending on the type);
• conjunctivitis;
• rhinitis, including seasonal;
• hives;
• compensation period bronchial asthma.

If desired by the patient treatment course can be carried out on following conditions:

• exposure to the human body of no more than three allergens at the same time;
• well-defined allergen.

Contraindications and possible side effects

There may be contraindications to the use of therapy associated with the state of health of the patient.

Contraindications

Among the list of diseases and circumstances that prohibit the ASIT method:

• the age of the child is up to 5 years;
• mental illness;
• pronounced pathologies of a systemic nature, in particular endocrine;
• taking beta blockers;
• severe bronchial asthma;
• oncological diseases;
• rheumatism;
• tuberculosis;
• liver or kidney disease.

ASIT is not suitable for the following types of allergies:

• allergic to more than three allergens;
• to the cold;
• atopic dermatitis;
• photodermatitis;
• for mold;
• on fungal spores;
• medical;
• with the occurrence of Quincke's edema;
• on animal saliva.

Features of use during pregnancy

In most cases, if ASIT treatment was started before pregnancy, it is continued. But it is not recommended to only start treatment with this method during pregnancy. In any case, notification of the doctor about the patient's condition is required.

Side effects

The response to ASIT in patients may not be predictable in advance.

Kinds adverse reactions:

1. Systemic, which does not depend on the method of contact with the allergen. Among the manifestations are Quincke's edema, soreness of muscles and joints, etc.
2. Local, which is concentrated at the injection site. It can manifest itself in the form of swelling, redness, itching, etc.

Cause of occurrence side effects may be:

• use of an expired vaccine;
• violation of the ways of storing the drug;
• incorrect dosage calculation, etc.

With a side effect of a systemic nature, after the injection, the patient is assisted by the use of such treatment:

1. Apply a tourniquet above the injection site.
2. Adrenaline is injected at the injection site of the previous injection.
3. Eufillin is administered intravenously for bronchospasm.
4. An antihistamine is administered intravenously.

After removing the symptoms of an adverse reaction, the patient is kept under observation for another day.

Preliminary preparation of the patient for ASIT

ASIT therapy requires special training patient. Restrictions on the appointment of travel times apply to seasonal allergic reactions. In this case, treatment should be completed in advance, before the onset of dangerous season. For allergies that are not tied to the seasons, such as the flowering periods of certain plants, therapy can be done at any time.

Important! Allergen-specific therapy requires a state of remission.

Preparatory activities:

1. Accurate determination of the allergen by the method of allergy tests.
2. Minimizing (and best of all - completely eliminating) the patient's contact with the allergen.
3. Reception antihistamines should be discontinued one week prior to therapy. The exception is a severe form of the disease. In this case, without antihistamines it is desirable to withstand at least three days.
4. Absence at the time of initiation of treatment of allergy diseases (flu, respiratory infections and etc.).

Treatment scheme

Depending on the severity and form of the disease, the doctor makes a choice in favor of one of the treatment regimens for the disease.

Scheme mild treatment degree of allergy

The treatment regimen is selected individually for each patient and has two stages:

1. Imitating. This scheme is adopted for mild forms of the disease. Its duration is up to one and a half months. During this period, the dosage is determined by the doctor.
2. Supportive. At this stage, the vaccine enters the body in two ways: orally - three times a week; by injection - once a week.

Severe (advanced allergy) treatment regimen

The same two steps are followed:

1. Simulating (more than 120 days).
2. Maintenance (six months).

Quick schemes

Such schemes are considered less effective than the previous ones. The disadvantages include a high likelihood of side effects. A fast scheme can be carried out only when the patient is in a hospital under constant medical supervision.

Rapid treatments include:

• shock, in which the vaccine enters the body at intervals of 120 minutes throughout the day;
• fulminant, when the vaccine is administered for 3 days every 3 hours;
• accelerated - the introduction of three times a day.

Advantages and disadvantages of using ASIT therapy

Since ASIT is long-term treatment, designed for strict adherence to the rules of following the patient's medical recommendations, then the patient should be patient. The path to recovery can be long: from several months to several years.

Advantages of the method:

• prevents the transition from a mild form of the disease to a severe one;
• improving well-being;
• elimination of allergy symptoms and long-term remission;
• prevention of an allergic reaction to other allergens;
• a decrease in the number of accepted or complete failure antihistamines.

Important! The outcome of therapy depends largely on individual characteristics body and strict adherence to the doctor's instructions.

The effectiveness of treatment depends on such circumstances:

1. Strict adherence by the patient to the recommendations of the allergist.
2. The course of treatment is correctly selected and started on initial stage illness.
3. Vaccines must be of high quality good timing validity.

Note! According to statistics, 9 out of 10 people treated allergic rhinitis, after ASIT fully recover.

In addition to undeniable advantages, the ASIT method also has a number of disadvantages, including:

• the presence of the likelihood of side effects, which is significant with this method;
• high cost of treatment (up to 1000 for one vaccination, and several tens of thousands for full course);
• a large number of contraindications;
• duration of treatment;
• treatment can be carried out for children only from the age of five;
• people over 60 should not be treated;
• a limited list of allergens that can be treated.

Price for ASIT

Depending on the city and specific clinic, as well as the type of allergy and the severity of the disease, the cost of treatment may vary.

The price includes:

• vaccination;
• conducting skin tests;
• delivery of tests;
• consultation with an allergist, etc.

The initial cost for ASIT in Moscow looks something like this:

For St. Petersburg prices for ASIT:

ASIT: Reviews

The specificity of ASIT therapy is such that the responses of patients vary greatly. In some cases, allergen-specific therapy has brought tangible results and cure. In some patients, therapy did not give the result that the patient would like. It is impossible to predict in advance the effectiveness of ASIT treatment, since much depends on the characteristics of the organism and its reactions. Sergey Novikov, 36 years old, Moscow

I suffered from allergies for years during the flowering season of birch catkins. I had to take antihistamines in large quantities, but every year it got worse. I learned about ASIT treatment from my friend. I considered it innovative, so I decided to try it. The therapy was in the form of injections. The improvement is very noticeable. Completed four courses. Antihistamines are now put away in the first aid kit, I no longer carry them with me. Karina Lazareva, 29 years old, Samara

The ASIT method helps me cope with dust allergies. I have only completed one course so far. The symptoms became less severe. I think that it is necessary, as recommended by my doctor, to undergo a few more courses of treatment.

Nowadays, allergies are common: according to the latest data, one in five people in the world suffer from allergies.

This disease, as a rule, cannot be completely cured, you can only try to limit a person's access to possible allergens.

That is why the topic of allergy treatment is so relevant in modern medicine, and searches effective ways its elimination is still ongoing.

In this article, we will look at one of the most effective methods of dealing with allergies: allergen-specific immunotherapy, abbreviated ASIT.

This type of immunotherapy has been successfully used since 1911 and is widely used in medical practice.

What is allergen-specific immunotherapy (ASIT)?

Allergen-specific immunotherapy is a type of therapy aimed at reducing hypersensitivity immune system of the patient to a particular irritant.

ASIT was first performed at the beginning of the 20th century by English allergists Leonard Noon and John Freeman for the treatment of pollinosis, or "hay fever".

The goal of this therapy is “teach” the immune system to the allergen so that subsequently this irritant does not cause an allergic reaction in the body.

On the this moment ASIT is the only way impact not on the symptoms of allergies, but on the very cause that caused it.

When and why is it used?

ASIT is more often used in relation to those types of allergies, with allergens of which contact is inevitable.

The ASIT procedure is often prescribed for the following manifestations:

• hay fever, that is, a reaction to the pollen of plants during their flowering;
• bronchial asthma, including hormone-dependent;
• allergic rhinitis;
• allergic conjunctivitis;
• allergic reaction to household irritants, for example, a dust mite;
• allergic reaction to wasp and bee stings.

It should be remembered that ASIT is most effective in mild forms of allergies. It is better to start therapy before the body is fully accustomed to antihistamines and cannot do without them.

ASIT can be done aged 5 to 55 years. Up to 7 years, the sublingual method should be used. ASIT is used for IgE-mediated allergies.

In people with allergies, during the period of allergic exposure (that is, when the body has access to irritants), there is increased content IgE antibodies(immunoglobulins) in the blood.

When IgE antibodies come into contact with allergens, an allergic reaction occurs.

With allergen-specific immunotherapy, there is a decrease in the production of IgE antibodies, blocking IgG antibodies appear, and further development allergies do not occur.

Undeniable advantages of ASIT for allergies are:

1. this therapy allows you not to use antihistamines for a long time;
2. ASIT prevents the occurrence of severe forms of the disease;
3. in some cases contributes to the complete elimination of allergies.

How is allergy treated with this method

The principle of allergen-specific immunotherapy is sequential introduction into the body the patient of drugs created on the basis of allergens to which he has been found to be particularly sensitive.

The dose of allergens is gradually increased depending on the type of allergy, condition and reaction of the patient.

To do this, use special allergenic extracts made from irritants to which the patient is allergic: plant pollen, dust, insect venom and others.

There are several methods of using drugs with ASIT from allergies:

• as subcutaneous injection;
• intranasally, in the form of nasal drops;
• sublingual, that is, tablets for resorption under the tongue;
• orally, in the form of drops in the mouth;
• inhaler.

The treatment plan is drawn up by an allergist-immunologist after examining the patient and studying the results of his tests.

Procedures are carried out in a medical office under the supervision of a physician. If it is a subcutaneous injection, then it is done in the forearm.

After taking the drug, you must remain under the supervision of a doctor for at least 40 minutes. If the patient's condition is severe, hospitalization is required.

Therapy is carried out in courses. As a rule, the total duration of treatment lasts at least a year. The frequency of injections during the course of immunotherapy is determined by the attending physician.

Unfortunately, this method treatment is not suitable for eliminating allergies to cold, because. there is no obvious allergen. How to treat cold allergy, read this article.

What drugs are prescribed for ASIT

For the treatment of ASIT, preparations based on water-salt extracts, as well as adjuvant allergens, are used.

There are 3 dosage forms:

1. drops;
2. suspensions for injection;
3. tablets.

The best known drugs are Staloral(manufactured by the Stallergen plant), injection solutions manufactured by Microgen, Lays(Lofarma) and Fostal(JSC "Stallerzhen").

For example, Staloral "Birch Pollen Allergen" is designed to gradually reduce the sensitivity of the immune system to pollen. Besides, it is a prophylactic.

This allergen is released in the form of sublingual drops in 10 ml vials with a dispenser. There are initial and maintenance courses of this drug.

During the initial course of ASIT, the percentage of the allergen content in the preparation increases and then remains unchanged for the maintenance course.

The drug is kept in the mouth for 2 minutes, then it can be swallowed. Treatment with two courses of this drug carried out within 2-3 years.

An analogue of Staloral is the drug Fostal. It is also produced by Stallergen. It is a subcutaneous injection. It is available in packs containing 4 vials of 5 ml. It also consists of an initial and a supporting course.

The Russian company Microgen produces water-salt extracts. These are mainly tree and plant pollen allergens.

Lays preparations from the Italian company Lofarma are available in the form of tablets, which makes them much easier to take..

Also in the treatment of ASIT sometimes prescribed additional drugs . It can be antihistamine medicines, antipyretic and decongestants, if necessary.

Contraindications and side effects

When conducting ASIT with drugs, care should be taken, as there are a number of contraindications, as well as side effects may occur.

The main contraindications are as follows:

• severe allergy;
• cardiovascular diseases;
• insufficient adult age;
• open form of tuberculosis;
• immunodeficiency;
• oncological diseases;
• severe mental illness;
• thyroid problems.

In the presence of these factors, the immune system already experiences heavy load, that's why exposure to allergens can aggravate the situation.

As with any type of treatment, ASIT can cause side effects. These can be both local, which include swelling, itching and irritation at the injection site, and more serious problems e.g. cough, manifestations of rhinitis, asthma attacks.

If side effects occur, the doctor should take Urgent measures. After that, hospitalization for a day is required.

Application during pregnancy

There is no clear answer to the question of whether allergen-specific immunotherapy can be performed during pregnancy.

However, the danger of treating allergies with ASIT during pregnancy has not been proven.

In particular, if immunotherapy started before pregnancy, then it should be continued during pregnancy.

Allergies during pregnancy not only greatly complicate the life of the mother, but also negatively affects the development of the fetus. Those allergensthat caused an allergy in the mother may subsequently act in the same way on the child.

When conducting ASIT allergens do not harm the child because they do not cross the placenta.

It should be remembered that if before pregnancy a woman could use the usual anti-allergy drugs, now the list of drugs allowed to her is limited.

During pregnancy, a woman should in no case self-medicate and take drugs at her discretion. Only a doctor can prescribe safe remedies.

A woman in position can take some antihistamines, such as Suprastin or Claritin. However, do not forget about the possible side effects.

conclusions

In general, allergy-specific immunotherapy is a proven and effective method the fight against allergies and is rated positively by most doctors.

Her efficiency depends, firstly, from correct diagnosis, and secondly, from correct execution all her procedures.

Despite the rather long duration of treatment, many patients agree to it.

If a person is healthy during therapy, he carefully follows all the doctor's instructions and reports any reactions of the body to the allergen, ASIT with more likely will be successful and there is a chance to get rid of from such an unpleasant feature of the body as an allergy.

Related videos

Everything you need to know about ASIT, as a method of treating the cause of an allergy, and not its symptoms, is detailed in the video below:

In contact with

Attention to all allergy sufferers: today we tell you how to use the time between allergic seasons to good use. What is ASIT, how does it work and why are we talking about it in November, when the allergy season has long ended?

For reference: the treatment of the causes of the disease, and not its symptoms, is called radical. And allergen-specific immunotherapy is the main (and according to some sources, the only) method of radical treatment of allergies.

Before that, they wrote about allergenic pollen and its monitoring and the mechanism of the appearance of an allergic reaction. We advise you to refresh your memory and look through those articles again. Then it will be easier to read this one.

To begin with - the results of the allergy season 2016

At 400x magnification, the specialist determined whose pollen it was. After that, a report was published on the concentration of pollen in the air for yesterday.

In the Pollen Club application, data from biologists was supplemented with user data: observations of allergy sufferers about their well-being with reference to geolocation. The result is a risk map for allergy sufferers that is updated in real time and takes into account a specific type of allergen.

This service was called Pollen. Traffic jams. Observations this year showed that the user's risk score correlated well with the allergen concentration that biologists calculated.

Pollen Club promises to publish a more detailed study on this topic, it will be interesting to see it. Also, the site administration promised detailed results pollen monitoring work in 2016, analytical materials and prototypes new version mobile application Pollen Club. We look forward to all of this. In the meantime, we begin preparations for the 2017 allergy season.

How to deal with allergies: general information

• The entry of an allergen into the body and the appearance of specific antibodies to it
• Activation of mast and other cells of the immune system
• Isolation of signal proteins, chemokines, from mast cells, due to which itching, coughing and other allergic symptoms appear

Winter is coming, and at the moment, the actions of an allergic person in chronological order look like this:

1. End of autumn - winter: start the ASIT procedure.
   Why: start a “restructuring” of the immune system so that it learns to respond to an allergen without pronounced allergic symptoms.
2. End of winter - beginning of spring: buy masks, a vacuum cleaner with a HEPA filter and other passive protection equipment.
   Why: meet the flowering season fully armed, reduce contact with the allergen, reduce the risk of an allergic reaction.
3. Late spring - early autumn: use antihistamines and hormonal preparations, cromolic acid preparations, and other medicines for allergy symptoms.
   Why: reduce the intensity of allergic symptoms, make life easier during the flowering season.

Who is ASIT for?

1. Patients with hay fever (seasonal allergy to pollen)
2. Patients with allergies to house dust, animal dander and other household allergens
3. Patients with a severe reaction to insect stings

What is ASIT

The goal of ASIT is to get a different response to the same input signal (causal allergen). Not an allergic response with rashes, tears and coughing, but an immune response without allergy symptoms.

As the ASIT procedure progresses, the body reacts to the usual background doses of the allergen less and less, and after the end of the course it stops responding altogether. The period of time for which the patient is free from allergies is called remission. According to the website of the Research Institute of Vaccines and Serums. I.I. Mechnikov, remission after ASIT lasts up to 20 years, and 5% of patients generally get rid of allergies forever.

How ASIT works

We remind you: class E immunoglobulins, or simply IgE, are the key "participants" of the allergic response, they trigger a hypersensitive reaction to the allergen. Later, scientists found that ASIT slows down the growth of IgE levels in the blood. And after repeated courses of ASIT, the concentration of IgE antibodies even decreases compared to the initial one.

With the development of medicine and biology, it became clear that ASIT affects not only IgE, but also other parts of the allergic reaction.

Main effects of ASIT

• The level of IgE decreases.
• Are produced "blocking" IgG antibodies that bind the allergen but do not trigger an allergic response. The more allergen molecules bind to IgG, the less they get on IgE and the lower the likelihood of an allergic reaction.
• There are fewer mast cells in the tissues (it is they who secrete chemokines - substances that cause allergy symptoms). Fewer mast cells - fewer chemokines - fewer symptoms.
• In addition, mast cells themselves release chemokines more slowly after ASIT, which also facilitates an allergic reaction.
• ASIT also affects other immune cells: Th1 and Th2. In a nutshell: the former suppress the allergic response, the latter, on the contrary, contribute to its development. Usually these cells are in dynamic balance, but with ASIT there are more Th1 cells, which means that the allergic response becomes weaker.

What does ASIT treatment look like?

1. Preparation: Allergy Diagnosis
2. Initiating phase: development of allergen-specific tolerance
3. Maintenance phase: consolidation of the achieved effect

Stage one: preparation

After that, it is necessary to conduct a diagnosis: determine the cause-dependent allergen and the body's sensitivity to it. This can be done with skin allergy tests. This is when 15-20 different allergens are dripped onto the skin or even into small incisions on the skin. Where there is a visible reaction (swelling of a certain size, peeling, redness), there is a causal allergen.

If a patient has a reaction to several allergens at once, mixtures of therapeutic allergens can be used for ASIT. The exception is mutually suppressing allergens. For example, pollen and allergens of house dust mites, cockroaches, mold fungi. In such a mixture, pollen allergens degrade and do not participate in therapy.

Skin testing is one of the most accessible methods for diagnosing allergies, but it has a number of limitations:

• The patient must be over 5 years of age. In children, the body can naturally change its reactions to many allergens. Therefore, the risk of a false negative reaction to the sample is high.
• 30 days must have passed since the last allergic exacerbation.
• 1-2 weeks should have passed since the last dose of the antihistamine drug (the period depends on the specific drug). If the "antihistamine" is still in the blood, a false negative reaction is also possible.

The doctor determines the level of immunoglobulins in the blood serum, and according to it - the level of danger and the nature of the development of allergies. Moreover, one sample can be used to understand how the patient reacts to 40 different allergens. To do this, there is a special scale with popular allergens.

There are other types of allergy tests, but now we will not go into details. The main thing is that according to the samples, the doctor determines what exactly the patient is allergic to and how strongly it manifests itself. You can proceed to the second stage.

Stage Two: The Initiating Phase

The classic way to introduce an allergen into the body is subcutaneous, or SCIT(SCIT, subcutaneous immunotherapy). Just a poke in the shoulder.

From the face of this girl, it is obvious that injections are not suitable for everyone. In Russia injection form ASIT for children under 5 years of age is generally prohibited. In pediatric practice, the non-injection ASIT method is used - sublingual, or SLIT(SLIT, sublingual immunotherapy). In this case, the drug is not in a syringe, but in drops or tablets that must be dissolved under the tongue.

Allergists and allergy sufferers continue to argue about which is better - SCIT or SLIT, but both methods work. The main thing is to follow the schedule for taking the drug with a causative allergen.

Usually, the first doses of the allergen are administered every day or every other day, then less and less often. standard scheme there is no ASIT, the doctor determines the dosage of the allergen and the schedule of admission based on constant control behind the patient.

Usually, the initiating phase requires 3-6 months of regular intake of the allergen. Antihistamines should not be used during this time. That is why ASIT should be started in autumn and winter, when an allergic person can live without antihistamines.

• Accelerated: with subcutaneous injections of the allergen twice or even thrice a day, the course lasts 10-15 days.
• "Lightning fast": within 3 days after 3 hours, the patient is injected subcutaneously with the drug in equal doses along with adrenaline.
• "Shock" method: injections every 2 hours, 50 to 50 with adrenaline, and all this within one day.

So, tolerance to an allergen can be obtained by different schemes and for different time. But in any case, to consolidate it, you need to go through the last and longest stage of ASIT.

Stage three: maintenance phase

The maximum well-tolerated dose of the allergen is chosen as the maintenance dose.

ASIT efficiency

Physicians must:

• Diagnosis of allergy with a clearly established IgE-dependent nature of the disease
• Select a causative allergen for each patient
• Use commercial standardized medicinal forms allergens
• Correctly set up the patient for a long and painstaking work

• Come to appointments strictly according to the schedule: the first 3-6 months 1-2 times a week, and then another 3-5 years once a week or once a month
• Be sure to complete the treatment, even if it takes 5 years
• During the entire treatment, follow a diet, monitor hypoallergenic conditions and clearly follow all the doctor's instructions.

Example

Option number 1: The doctor forgot to tell the patient about this, but he does not understand why ASIT has been going on for the second year, and the allergy does not go away.

Option number 2: The doctor told the patient about this, but he occasionally indulges himself with an apple and thereby nullifies the entire therapeutic effect.

ASIT safety

Local reactions may occur at the injection site (in the case of SCIT) or oral cavity(in case of SLIT):

• Redness

• Headache
• Joint pain
• Feeling uncomfortable
• Mild manifestations of rhinitis or bronchial asthma
• Hives
• Quincke's edema
• Bronchial obstruction
• Anaphylactic shock
• Swelling of vital organs

Local reactions usually occur within the first 30 minutes after ingestion of the allergen. Systemic - in the first few minutes. It is assumed: the faster the systemic reaction appeared, the worse it is. But these reactions can occur an hour after taking the allergen. Therefore, the first 30-60 minutes after admission, the patient must remain in the hospital, so that in which case the doctor can help him.

A local reaction is a sign that the dose of the allergen was chosen incorrectly and should be reduced next time. A systemic reaction indicates more serious deviations from the norms of ASIT.

ASIT contraindications

• Severe immunopathological conditions and immunodeficiency
• Oncological diseases
• Severe mental disorders
• Severe asthma that cannot be controlled with pharmacotherapy
• Cardiovascular diseases that can cause complications with the use of adrenaline (epinephrine)

Conclusion

• It's like a hardening for allergy sufferers. The allergen can still trigger a hypersensitivity reaction, but it becomes more difficult to do so. And in 5% of cases it is completely impossible.
• This is a long procedure (3-5 years). And during all this time it is impossible to relax: neither the patient nor the doctor.
• With pollinosis, therapy should be carried out between flowering seasons. From the end of spring to the beginning of autumn, there is a break in therapy so as not to overload the immune system with allergens. If you are allergic to dust, ASIT is carried out at any time of the year.
• It is an effective therapy, albeit with side effects. If you follow all the rules for its implementation and undergo treatment under the supervision of an allergist in a specialized allergological unit, there is nothing to worry about.
• This therapy is not for everyone. Before starting an ASIT course, you need to be 100% sure that you are not in one of the risk groups.

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Allergen-Specific Immunotherapy - ASIT, also known as allergy shots - is a unique method of treating allergies that affects all stages of an allergic reaction and allows you to save lasting effect even after completion of treatment.

ASIT therapy - what is it?

Allergen-specific immunotherapy (allergy shots) long-acting) has been used for more than 100 years and today is the most effective method treatment of common allergic diseases, in particular, allergic rhinitis and conjunctivitis allergic asthma and insect allergy (to insect venom).

This form of therapy typically involves the subcutaneous administration of gradually increasing doses of the appropriate allergen to the patient until maximum dose will not be achieved - this allows you to develop immunological tolerance to allergens.

The main goal of allergen-specific immunotherapy is to reduce the symptoms caused by allergens and prevent recurrence of the disease in long term. Currently, ASIT is the only way that allows you to get rid of allergies for a long time.

ASIT efficiency

Immunotherapy can reduce the risk of developing a severe reaction to insect venom by up to 60%, however, after the end of immunotherapy, there is a residual risk (about 5-10%) of allergic reactions, but, as a rule, these reactions appear in a milder form.

Immunotherapy is effective tool treatment of allergic rhinitis in adults and children, especially those caused by seasonal allergens, such as plant pollen. About 90% of people who have completed a full course of immunotherapy report a complete recovery.

ASIT can also reduce the risk of developing asthma or reduce its symptoms.

Preparing for ASIT Allergy Treatment

For rate general condition organisms are assigned clinical analysis blood and urine, electrocardiogram, spirography (for persons with bronchial asthma). If no abnormalities are found in the body, they begin to diagnose an allergic disease.

During the period of exacerbation of the disease, allergological examinations are prohibited, as this may increase the manifestation of allergic reactions.

Therefore, to engage in the identification of allergens (if we are talking about pollen allergy) and skin tests are recommended during the remission of the disease, that is, in late autumn or winter.

A week before the start of treatment, antihistamines are canceled.

For the period of treatment, you should not load the body, you must completely exclude contact with the allergen in order to avoid the occurrence of severe allergic reactions.

Methods of conducting therapy

Immunotherapy for allergies can be done with injections (allergy treatment with injections), sublingual drops or tablets (sublingual method).

Injection method ASIT (PcASIT).

Subcutaneous immunotherapy (allergy shots) consists of a course of allergen extract vaccines that are injected under the patient's skin.

As a rule, allergen-specific immunotherapy consists of two stages: an initiating and maintenance phase.

During the initiation phase, the patient receives weekly doses of the allergen, starting at a very low dose and gradually increasing over 5 to 8 months. After this period, a person develops sufficient tolerance to the allergen.

During the maintenance phase, the patient receives an allergen maintenance injection every 4 weeks, usually for 3 to 5 years, after which the person is no longer bothered by allergy symptoms and therapy is discontinued.

Allergen-specific immunotherapy has a risk of developing anaphylactic reactions, fast development which may lead to lethal outcome therefore, it should only be administered under the direction of a physician trained in this therapy.

ASIT is performed only in medical clinics equipped with medicines to provide emergency assistance in case of anaphylaxis and other adverse reactions.

Sublingual method (SlASIT).

The essence of SLIT is to place the causative allergen on the mucous membrane under the tongue. The advantages of the method are that a person can treat allergies at home and avoid regular visits to the doctor. Also sublingual application has more low risk the development of serious allergic reactions, in contrast to the injection method of introducing the allergen. Parents of young children often prefer this ASIT course. The main disadvantage is the high cost of treatment.

It is worth knowing that insect allergy is not currently treated with the sublingual ASIT method.

The effectiveness of these methods is equivalent. Which method to give preference to a person decides at the appointment with an allergist.

Indications

ASIT (allergy shots) is prescribed when it is extremely difficult for a person to avoid contact with an allergen, most often this happens when they are allergic to pollen of trees and meadow grasses, ticks house dust. The same indication for the conduct is the lack of effect of antihistamines or adverse reactions to them.

A timely visit to a specialist always increases the success of treatment: the shorter the experience of allergy and the smaller the spectrum of allergens, the more effective specific immunotherapy will be.

Contraindications

• Sharp and chronic diseases in the acute phase
• Violations of the integrity of the oral mucosa (concerns the sublingual method of treatment)
• Heavy allergic diseases in an exacerbation phase (for example, uncontrolled bronchial asthma)
• Use of beta blockers

Particular attention should be paid to allergen-specific immunotherapy for a child under 5 years of age, pregnant women, the elderly, as well as patients with immunodeficiency and autoimmune diseases.

Immunotherapy is effective and fairly well tolerated by children. However, the safety of therapy in a child under 5 years of age has not been established, therefore, doctors must weigh all the risks and benefits of therapy in this category of patients.

Immunotherapy is not carried out for pregnant women, however, if the course of therapy was started before pregnancy, treatment can not be stopped and you can continue to receive a maintenance dose of the allergen.

Older people often have accompanying illnesses such as hypertension, arrhythmias, ischemic disease hearts, malignant tumors etc., which may increase the risk adverse effects conducting immunotherapy. If a person does not have these diseases, therapy can be carried out, since there are no age restrictions.

Side effects

Allergen-specific immunotherapy is generally safe and well tolerated by both adults and children. However, local and systemic reactions (disorders of the respiratory, digestive and other systems) can still occur.

Local manifestations, such as redness or itching of the skin at the injection site, are usually eliminated with the help of antihistamines and corticosteroid ointments (Hydrocortisone, Triderm, etc.).

Systemic allergic reactions develop in about 2% of patients. The most severe reaction is anaphylaxis. Symptoms of anaphylaxis appear as skin rashes, gastrointestinal disorders, lesions respiratory tract and cardiovascular systems s. Symptoms usually develop within 20-30 minutes after an allergen injection. Therefore, after a person has been vaccinated against allergies, he remains under the supervision of a doctor for 30-40 minutes.

Since the introduction of the allergen with the sublingual method is carried out without medical supervision, patients should be well instructed, in case possible occurrence side effects such as skin irritation, slight swelling or itching in the mouth, indigestion, nausea.

These symptoms can be relieved by temporarily reducing the dose of the drug or taking antihistamines. The risk of dangerous side effects arising from this type of treatment is extremely low.

Drugs used for immunotherapy

ASIT for allergies is carried out as foreign drugs, and preparations of Russian production.

When carrying out ASIT - the price depends on the allergens that are being treated, as well as on the form of release - injectables usually cheaper than sublingual ones.

The most popular drug for ASIT - Staloral (Stallergenes, France) is a leader in the field of immunotherapy. It is used in sublingual treatment (sublingually) for patients suffering from allergic rhinitis and allergic asthma. Composition - extracts of mites and birch pollen.

Alustal (Stallergenes, France). It is used in the injection method for the treatment of rhinitis, conjunctivitis, asthma. Composition - extracts of pollen of cereal (meadow) grasses and house dust mites.

Elena Petrovna 10 497 views

Most qualified allergists argue that it is impossible to completely defeat allergies. Moreover, mild allergic reactions can progress into more severe pathologies.

When using this method of treatment in the immune system, complex reactions, which ultimately leads to the fact that the immune system stops responding to allergens as foreign proteins.

ASIT therapy is often referred to in medicine with other terms - the most famous of them:

• allergen immunotherapy;
• specific hyposensitization;
• allergy vaccination;
• specific immunotherapy.

The duration of ASIT therapy is calculated at least two years, at the end of the course of treatment, a long-term remission occurs or allergy symptoms decrease so much that the sick person no longer needs to be taken.

When was ASIT first used?

The first mention of specific immunotherapy is found in medical literature dated to the beginning of the 20th century.

At this time, allergen immunotherapy began to be actively used to eliminate allergies that occur after contact with tick and dust irritants.

ASIT therapy has been successfully used for the treatment of patients with asthma, year-round rhinitis, a hundred years ago.

First medicinal allergens were water-salt extracts of the established allergen.

To date, during specific hyposensitization use more advanced drugs with a prolonged mechanism of action.

Compared to previously used water-salt extracts, modern therapeutic allergens have many advantages:

• They are practically devoid of side effects;
• They have an enhanced therapeutic effect on the body;
• They have a minimum degree of allergenicity.

An example is .

Preparations for ASIT therapy are selected individually for each patient with allergies.

They can be:

• injection;
• in the form of drops or tablets;
• for sublingual administration.

ASIT principle

During ASIT therapy in the human body different ways a microscopic dose of the allergen extract is introduced, that is, the substance to which the sensitivity of the body is increased.

The dose of the allergen is increased gradually and this reduces hypersensitivity.

It has been established that an allergic reaction occurs as a result of certain changes in the human immune system. At the same time, a large number of IgE immunoglobulins and antibodies from class E, which are specific for each specific allergen, enter the bloodstream.

The contact of immunoglobulins and antibodies with the allergen causes the development of all allergy symptoms.

Allergen immunotherapy causes several changes in the body. This method of treatment causes the activation of lymphocytes responsible for the production of positive IgE immunoglobulins, and at the same time reduces the production of those lymphocytes that form antibodies.

As a result, the connection between the allergen and the immunoglobulin is blocked, and the conditions that trigger the hypersensitivity reaction are excluded.

ASIT therapy:

1. Eliminates manifestations of allergies;
2. Improves the quality of life;
3. Provides long-term remission;
4. Prevents the transition of mild forms of allergic reactions to more severe ones - anaphylactic shock, Quincke's edema, asthma;
5. It is the prevention of hypersensitivity to other types of allergens;
6. It leads to a dose reduction and in mild cases allows you to completely abandon antiallergic treatment.

The action of specific hyposensitization is determined by a dozen factors, including the individual reaction of each person.

In some patients, a noticeable improvement in general well-being appears after the end of the first course of ASIT therapy.

In others, only after a few years of course treatment, a stable remission occurs.

But repeated courses of treatment with therapeutic allergens are always necessary, their duration and frequency are determined by the allergist.

Specific immunotherapy is carried out in two stages:

• The first stage is the initiating phase. The main task at this stage is to achieve the maximum tolerated dose of the therapeutic allergen. The patient is gradually injected with an increasing concentration of the drug with the allergen at short intervals.
• The second phase, supporting. The goal is to achieve a stable remission. At this stage, the time intervals are extended, between which the maximum, always stable, dose of the allergen is introduced.

Indications for the appointment of Asit therapy

The effectiveness of allergen immunotherapy has been proven in the treatment of patients with:

• Seasonal allergies and hay fever;
• Perennial rhinitis allergic origin;
• An allergic reaction to the poison secreted by hymenoptera;
• Bronchial asthma.

ASIT therapy is prescribed under the following conditions:

• If a complete cessation contact with the allergen is impossible. This applies to cases of allergy to, plant pollen, reactions to.
• The allergen is accurately identified;
• Allergies develop when the body is exposed to no more than three allergens.

Contraindications

Specific hyposensitization, like any other method of treatment, has its contraindications.

To absolute contraindications ASIT therapy includes:

• Active malignant process in the body;
• Severe pathologies of the immune and cardiovascular systems;
• mental illness;
• Somatic diseases in the stage of decompensation;
• Pregnancy. However, if immunotherapy for allergies is started before pregnancy, then its course is not recommended to be interrupted;
• The patient's age is up to 5 years.

ASI therapy is not prescribed to patients if they have:

• , that is, an allergy develops to exposure to more than three types of irritants;
• Urticaria and angioedema;
• Allergy to fungal spores, mold,;
• Allergic reaction to non-pathogenic microflora.

With the pathologies and diseases listed above, the load on the immune system is increased several times, and additional stimulation of the immune system can lead to undesirable consequences.

By whom and where ASIT therapy is carried out

ASIT therapy should be carried out in medical institution. Injections are administered by a licensed nurse. An allergist should monitor the patient's condition.

Order of conduct

The effectiveness of hyposensitization of the body and the absence of side effects from treatment depends on how correctly all stages of immunotherapy with allergens are followed.

The doctor must tell the patient about how it is necessary to prepare the body, during what period it is possible to use drugs and what needs to be done after their administration.

Patient preparation.

The timing of ASIT therapy is planned in advance. The beginning of the introduction of drugs should fall on the period of remission of the disease.

If it's about seasonal allergies, then usually immunotherapy with allergens is prescribed for the autumn-winter months.

In case of year-round reactions to allergens, treatment is carried out against the background of the basic course of therapy, but remission of the disease must be achieved.

Patient preparation includes:

1. Carrying out to establish a specific allergen;
2. Exclusion of contact (or its reduction to the very minimum) with the identified allergen;
3. Stopping antihistamines. In mild forms of allergy, it is recommended to stop the drugs 7 days before ASIT therapy, in severe forms - 3 days.

During the period of administration of therapeutic allergens, a person must be absolutely healthy.

Rules to be followed.

To minimize possible negative reactions for therapeutic allergens must be observed following rules:

• Carry out the procedure strictly in a medical office, where there is everything medications to provide emergency assistance. Especially this point is mandatory for execution during the first manipulations.
• Remain in a medical facility under the supervision of a nurse or doctor for at least one hour after the administration of the drug.
• Report to the medical staff about all, even minor, changes in well-being.
• At independent use extracts of allergens strictly follow all the recommendations of the attending physician.

Schemes for ASIT therapy.

Schemes for immunotherapy with allergens are selected individually, but any of them is divided into imitating and maintenance phases.

Hyposensitization courses are repeatedly repeated. Usually there are three or four courses.

Forms of treatment with ASIT therapy.

Therapeutic allergens are currently administered in two ways, subcutaneously and sublingually.

With the subcutaneous method of ASIT therapy, allergens are administered once every 2-6 weeks.

The sublingual method involves the use of solutions or sublingual tablets.

Today, sublingual ASIT therapy is considered the most effective and safe.

Tablets and solutions are more easily tolerated by young children, and the therapeutic allergen is quickly absorbed by the mucous membrane and immediately activates the immune system.

But for the sublingual method, in addition to the main ones listed, there are a number of contraindications, these are:

• Ulcerative lesions and erosion of the oral cavity;
• Periodontal disease;
• rehabilitation period after surgical interventions in the oral cavity;
• Inflammatory diseases organs of the oral cavity;
• Gingivitis with bleeding gums.

In some cases, immunomodulatory drugs are prescribed to enhance ASIT therapy.

What are special prolonged allergens.

Prolonged allergens are those drugs whose effect lasts for a long time.

That is, they will affect the human immune system for a sufficiently long period of time, which allows you to change the specific reaction of the immune system to foreign proteins to the normal one.

The introduction of prolonged allergens is different least amount side reactions. Therefore, these drugs are suitable for prescribing ASIT therapy even for overly sensitive patients.

When to expect the effect of the procedure.

Conducting immunotherapy with allergens in most patients improves overall well-being after the end of the initial course, that is, after a few months.

A series of ASIT therapy courses over several years sometimes leads to the complete elimination of allergic reactions.

In allergology, a number of indicators are used, the evaluation of which will determine the effectiveness of allergen-specific immunotherapy. This is primarily a decrease in IgE compared with the tests performed before the start of therapy.

The use of ASIT therapy allows you to achieve:

• Relief of symptoms of allergic reactions. The severity of the manifestation of the disease decreases with each course, and the reaction to the allergen may completely disappear after several years of treatment;
• Reducing the frequency of use of antiallergic drugs;
• The transition of severe forms of allergies to milder ones;
• significant improvement vitality and well-being.

Age restrictions.

ASIT therapy is not carried out for children under 5 years of age. Top bar restrictions age category no, but still it is better to carry out this treatment for people not older than 60 years.

Possible adverse reactions

Therapeutic allergens undergo control studies and are released into production only with a small percentage of identified side effects.

But this does not guarantee that they will not individual reaction intolerance, it can be local and systemic.

To local manifestations side effects of ASIT therapy include the appearance of changes at the injection site, these are:

• puffiness;
• Hyperemia;

The systemic reaction is manifested:

• Quincke's edema;
• Anaphylactic shock;
• An attack of bronchial asthma.

In addition, there is often a general deterioration in well-being, expressed as a headache, aching muscles and joints, discomfort throughout the body.

A systemic reaction is considered dangerous for the body, which is why it is so important to be under the supervision of a doctor for the first 60 minutes after the administration of the drug.

If the health worker fixes signs indicating hypersensitivity to therapeutic allergens, then he will quickly provide the necessary medical assistance, it consists of:

• In the imposition of a tourniquet above the injection site;
• In the production of adrenaline directly into the area of ​​​​the previous injection;
• In the introduction with bronchospasm of eufillin into a vein;
• In the intravenous formulation of anti-shock and antihistamine drugs.

If the symptoms of systemic intolerance develop outside the walls of a medical institution, then it is imperative to call ambulance.

Measures to reduce adverse reactions

In order to reduce the likelihood of side effects, it is necessary to comply with all conditions for ASIT therapy.

First of all, it is required to establish the absence of all contraindications to treatment, it is definitely worth finding out the causative allergen.

During the period of immunotherapy with allergens, the patient must be completely healthy.

Allergists advise starting hypoallergenic therapy a few days before ASIT therapy. it is desirable to adhere to throughout the course of treatment.

Symptomatic drugs prescribed in addition

During specific hyposensitization, the allergist necessarily monitors the patient and evaluates the changes in well-being that have occurred.

If necessary, the doctor prescribes additional medications, these can be:

In addition to these drugs, the allergist may prescribe other drugs that help to cope with negative side reactions.