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Question 7#

A 32-year-old woman complains of severe seasonal allergies. Every year from April through July she is miserable with sneezing, nasal congestion, and watery itchy eyes. Antihistamines, nasal corticosteroids, nasal saline washes, oral montelukast, and attempts to avoid potential antigens have proven unsuccessful. She requests referral to an allergist for “allergy shots.”

What advice should you give her about immunotherapy (hyposensitization) for her allergic symptoms? 

A) Immunotherapy is useful is asthma but not in allergic rhinitis
B) Immunotherapy is used in allergic rhinitis because there is no risk
C) The beneficial effect of immunotherapy goes away as soon as the shots are discontinued
D) Immunotherapy against respiratory organisms can decrease the incidence of bacterial sinusitis
E) Immunotherapy requires the identification of specific antigen by dermal or serum testing

Correct Answer is E

Comment:

Antigen immunotherapy has been proven to be more effective than placebo in the management of severe allergic rhinitis, but the specific antigen must be identified before allergy shots are begun. Ideally, the test result should correlate with the patient’s symptoms (time of year of attacks, exposure history, etc). Immunotherapy requires a long-term commitment; treatment duration of less than a year is ineffective. Once a 3- to 5-year course is completed, however, the beneficial effect can persist for years. Evidence for benefit in asthma is LESS compelling than in allergic rhinitis. The chief drawbacks to allergy shots are the time commitment, expense, and the risk of severe allergic reaction to the injected immunogen. Thirty to fifty deaths are reported each year from anaphylaxis to allergy shots. There is no evidence that specific immunotherapy to bacterial pathogens decreases the incidence of sinusitis or respiratory infections.