In this episode of the audio blog, Dr. Damask explains what inhalant allergies are and their prevalence in the US. She explores allergen immunotherapy, discusses the pros and con, highlights the lasting benefits, and encourages patient to discuss options to find the best individualized treatment plan.
Shelby Stockton (00:00):
Welcome to the Orlando ENT audio blog. I'm Shelby Stockton, and today I spoke with otolaryngologist Dr. Cecelia Damask about immunotherapy. Dr. Damask discusses common allergens and how to treat them. She specifically goes into how immunotherapy works to relieve allergies and the differences between allergy shots versus allergy drops. If you suffer from chronic allergies, this episode with Dr. Damask is a must-listen.
Hi, Dr. Damask. It's so nice to see you again.
Dr. Cecelia Damask (00:30):
Hi, nice to see you as well.
Shelby Stockton (00:32):
So today we're going to talk about immunotherapy, and I have a few questions for you, please. So the first one is, is what are inhalant allergies and how common are they in the United States?
Dr. Cecelia Damask (00:44):
Well, inhalant allergies are airborne substances that we inhale or we breathe in. And this includes allergens that can affect you year-round, things that are considered perennial allergens, or things that can affect you only seasonally. Typically, they cause symptoms of an itchy, watery, sneezy, blocked-up nose or potentially watery eyes. If you have asthma, inhalant allergies can also trigger or worsen those type of symptoms, things like wheezing or shortness of breath. Now, the perennial inhalant allergens are things that are present year-round, and this can be our pets. And that includes proteins that can be found in their fur or in their skin or even their urine or their saliva. And that's typically things like our cats and dogs. Also, dust mites are perennial. They're microscopic organisms that live in dust and fibers of different household objects like pillows or mattresses or carpeting. Cockroaches are also a common perennial inhalant allergen, and it's their feces and dead body parts that can affect us.
And then molds can also be considered a perennial allergen, and they have different spores that float around in the air. And this can include things like aspergillus, cladosporium, and alternaria. Now, our seasonal inhalant allergens typically include pollens. And that can be trees that we see in the springtime, that can be grasses, which we see in the summer, or that can be weeds that we see in the fall. Now, in terms of prevalence, allergic rhinitis is really common. It is common not only in Americans, but it's also common worldwide. It is one of the most frequent reasons that people visit the doctor is for allergic rhinitis symptomatology. And there has been some new data that recently came out from the CDC's National Center for Health Statistics. And we think that about a quarter of American adults have seasonal allergies. And almost 20%, maybe about 18 or 19% of American children have seasonal allergies, so really common problem that affects us.
Shelby Stockton (03:14):
Okay. Well, then what are some treatment options?
Dr. Cecelia Damask (03:17):
So what we can do is we can try to avoid the things that trigger symptomatology. So for those dust mites, we can try to cut down on their numbers and exposure to them doing things like washing our bedding in hot water, trying to cut down on upholstered things in our bedroom that can harbor dust. For our seasonal things like the pollens, we can spend time indoors and use the air conditioning to filter things out. Can also shower after exposure to get those pollens out of us or saline the inside of our nose to get those pollens out. However, doing things like avoidance is really difficult and it doesn't really completely end our reactions. So there are some over-the-counter and also prescription medications that we could do to try to manage our allergies. This can be things like oral antihistamines like Claritin, Zyrtec, Allegra, nasal steroid sprays like Flonase, Nasonex. Nasal antihistamine sprays like Patanase or Astelin. And then if you do have asthma, different asthma medications and inhalers, also saline irrigation as I mentioned. And then there's allergen immunotherapy.
Shelby Stockton (04:40):
Exactly, which thank you for setting me up. My next question for you is can you tell me about allergen immunotherapy and how it works?
Dr. Cecelia Damask (04:49):
Allergen immunotherapy is a form of a long-term treatment that can decrease symptoms for patients who have allergic conjunctivitis, which is allergy of the eye, allergic rhinitis, or allergic asthma. And what it does is it decreases our sensitivity to those different allergens. And it can actually lead to lasting relief of symptoms, even after patients stop doing immunotherapy. So this makes immunotherapy a really beneficial treatment and actually a very cost-effective treatment for patients. It works a lot like a vaccine. Your body responds to getting small amounts of a particular allergen in gradually increasing doses and it naturally develops immunity or tolerance to that allergen. It can be administered in different ways. It can be administered subcutaneously, which is a fancy term for giving the allergen under the skin by an injection with a needle, or it can be administered sublingually, which means that we place the treatment under our tongue in the form of something like a drop.
Shelby Stockton (06:03):
Okay. So what are the risks associated with allergy shots versus allergy drops?
Dr. Cecelia Damask (06:08):
So first and foremost, important to know that both shots and drops are really considered safe and effective treatment options. They can, however, induce a severe and potentially life-threatening reaction, something that's called anaphylaxis. And that happens very rarely but is potentially possible. And if anaphylaxis were to occur, it can affect different parts of our bodies. And these symptoms can run the gamut from something very mild to something that's actually very severe or life-threatening. There is a little bit higher of a risk of both local and systemic, meaning our whole body being involved reaction with those injections because you're actually getting it injected immediately to get a reaction. Or with sublingual, it still is possible, but it is much rarer for patients to have an anaphylactic reaction.
Shelby Stockton (07:10):
What percentage of patients in your practice are using shots versus drops?
Dr. Cecelia Damask (07:15):
So we come to that decision with a lot of discussion. I talk to patients about what's important to them. We talk about different costs, we talk about efficacy, we talk about convenience, we talk about safety and then decide what is the best individualized treatment approach for that particular patient. And I'd say probably about 60% of our patients opt to do injections where they come in the office once a week, and about 40% elect to do the drops that they self-administer at home.
Shelby Stockton (07:51):
That's so interesting. I would think you'd want to do the drops.
Dr. Cecelia Damask (07:54):
Yeah. So, there are a lot of factors that go into patients making a decision. Some people feel more comfortable coming in because there is that risk of anaphylaxis, although small and rare, still present. And they like to have it administered under guidance so that they feel safer. So it's a personal decision.
Shelby Stockton (08:17):
That makes sense. So how long do patients need treatment?
Dr. Cecelia Damask (08:22):
So we typically do treatment for at least three years to get maximal benefit. We tell patients that they can expect to start to see a decrease in their symptoms within that first year of starting immunotherapy, either shots or drops, but that we need to continue for at least three years to build up long-term maximal benefit.
Shelby Stockton (08:44):
Wow. Okay. What else, if anything, would you like to share with our listeners?
Dr. Cecelia Damask (08:49):
So I want to share that allergen immunotherapy really can lead to lasting benefits long after you stop your treatment of shots or drops. And this is because it actually changes the way that your body reacts to different allergens. And this can lead to a reduction in the need for medications, and that can make it really convenient and it can actually save you money in the long run because you're not having to buy medications either prescription or over-the-counter. And there is also evidence that allergen immunotherapy can prevent the onset of new allergies, can potentially prevent the onset of asthma in children or reduce symptoms of asthma in patients who already have asthma. So I think it's really a great treatment option and encourage patients to come in and talk to us about the different options so that we can formulate a treatment plan that is made just for them.
Shelby Stockton (09:50):
Doctor, thank you so much for your time. I really appreciate it.
Dr. Cecelia Damask (09:53):
Thank you.
