Immunotherapy for hay fever: When to start

Cough, runny nose, watery eyes, itching, exhaustion, breathing problems: pollen allergies are quite difficult for those affected. There are allergy medications. However, only allergen immunotherapy, also known as hyposensitization, addresses the cause of hay fever.

How exactly does allergen immunotherapy work?

To understand how it works, you first need to know how allergic reactions occur in our body.

“In allergy patients, the immune system is misdirected. It is therefore directed against actually harmless environmental components such as pollen from trees or grasses or house dust mite excrement,” says allergist Prof. Oliver Pfaar. He is senior physician and head of the rhinology and allergology section at the University Hospital in Marburg.

The immune system sees a danger where there is none. “In hay fever patients, this leads to sneezing, a runny nose and coughing. After all, the body wants to protect itself from this supposed pathogen,” explains Pfaar.

However, with targeted therapy, the immune system can be re-educated. “So far, hyposensitization has been the only treatment method that can address the cause,” says Anja Schwalfenberg. She is a graduate biologist and works in patient counseling for the German Allergy and Asthma Association (DAAB).

“The therapy is particularly important for long-lasting symptoms,” she says. The patient regularly receives therapeutic preparations, which should allow the immune system to get used to the trigger of the allergy.

How are the preparations administered?

This is typically done with a syringe. In medicine, there is then talk of subcutaneous therapy. “The so-called maintenance dose is administered about every four weeks and injected under the skin on the upper arm. This is done in the doctor’s practice, followed by an observation period of at least 30 minutes,” says Anja Schwalfenberg.

There is also the so-called sublingual approach: The allergen is placed under the tongue by the patient himself in the form of tablets or drops – on a daily basis.

“With one of them you have to go to the doctor every four to six weeks, with the other the patient has to do it himself regularly and think about it. Then there is no one who can control it,” says Oliver Pfaar.

However, it is crucial for successful therapy that patients stick with it. “Success can only be achieved if the therapy is carried out regularly and not terminated prematurely,” confirms Anja Schwalfenberg.

How long does hyposensitization last?

It doesn’t work without patience. “Normally, hyposensitization is carried out over three years,” says Anja Schwalfenberg.

This is also well documented with study results, adds Pfaar. According to his observation, patients benefit from the treatment in the first year. “Sometimes they even feel significantly better than if they only took medication in the first year, which of course they can continue to do.”

Pfaar is referring to allergy medication. “Sprays and tablets only work against the current symptoms, but cannot act against the underlying immunologically triggered disease.” Because the symptoms improve in the first year of treatment, those affected often need less medication.

Where do I go if I think allergen immunotherapy would make sense for me?

A doctor can assess whether allergen immunotherapy is an option for a patient. “Doctors should either have additional training in allergology or have sufficient experience with this therapy,” says Anja Schwalfenberg.

For specific complaints, it helps to turn to specialists: “In the case of hay fever, ENT doctors can help, in the case of existing allergic asthma, lung specialists can help,” says Schwalfenberg. Oliver Pfaar points out that general practitioners, dermatologists or pediatricians often have a corresponding focus.

Do I have to expect side effects?

Hardly. “As a rule, and in the hands of experienced colleagues, allergen immunotherapy is very safe. This applies to both the subcutaneous and the sublingual route,” says Oliver Pfaar.

There are often slight local reactions such as swelling around the puncture site or itching of the oral mucosa. But they only appear for a short time.

When do I start?

The pollen-poor time in autumn and winter is a good time to start pollen immunotherapy. “In the case of year-round allergens, i.e. an existing allergy to house dust mites or mold spores, for example, there is not necessarily a specification as to when you should start,” says Oliver Pfaar.

A decision that is ultimately made by the allergist. He or she carries out diagnostics and can assess how much those affected can benefit from the allergen immunotherapy. And which form of therapy is the best.

“And preferably as early as possible,” says Schwalfenberg. But even in the later course of an allergy, alleviation of the symptoms can be achieved with hyposensitization.

Who bears the costs?

“In Germany, this therapy is covered by health insurance companies. It’s different in other European countries,” says Oliver Pfaar.

Of course, this is an immense investment in patients, says Anja Schwalfenberg. “Therefore, adherence to therapy is very important so that the costs are worthwhile and the therapy can be successful.”