While immunotherapy is a highly effective solution for children with allergies, it is usually the "last line of treatment," because it does have disadvantages, says Dr. Robert Wood, a pediatric allergist from the Johns Hopkins Children's Center in Baltimore, Maryland. In fact, only about 10 percent of pediatric allergy patients end up taking the entire course of immunotherapy, he says. "Ninety percent can be handled through medications and avoidance. Most people prefer the medications." According to Dr. Wood, allergy medications are safe for long-term use.
Allergy shots require a significant commitment of time over a three- to five-year period, Dr. Wood adds. "If the patient is not compliant, it won't work." Another drawback is the risk of a severe allergic reaction, he says. Shots must be performed in a doctor's office, where the patient can be monitored for any reactions. Dr. Wood further explains that shots are not recommended for children younger than five for several reasons—because of the greater risk of severe allergic reactions in young children's immature immune systems, and also due to difficulties younger children may have in cooperating with the immunotherapy program.
According to the AAAAI, there are two types of adverse reactions that can occur with immunotherapy. Local reactions, which involve redness and swelling at the injection site, are fairly common and can happen immediately or several hours after treatment. Systemic reactions are much less common and can include sneezing, nasal congestion or hives, or rarely a more serious reaction called anaphylaxis can cause swelling in the throat, wheezing or a sensation of tightness in the chest, nausea, or dizziness. Most systemic reactions develop within 30 minutes of an allergy injection and must be treated immediately, according to the AAAAI. For that reason, allergists require patients to remain in the office for 30 minutes after an injection.
New Treatment Options
Several promising new treatment options for allergies are under development, say Dr. Wood and Dr. Cox, including under-the-tongue allergy drops (already in use in Europe), which can be given to children younger than five. The use of probiotics, beneficial bacteria that may protect against allergies and asthma, is another new option. Xolair, an asthma drug, is also being tested as a treatment for deadly peanut and latex allergies. Physicians are intrigued by the so-called "hygiene hypothesis," says Dr. Cox, which links allergies to reduced exposure to germs through declining family sizes, more limited exposure to animals and higher general standards of cleanliness. The theory raises the possibility that repeated exposure to microbes at an early age, by having siblings, owning a pet, or attending day care, for example, may actually prevent immune systems from overreacting to potential allergens.
While scratch testing and immunotherapy are standard components of treatment for children suffering from allergies, some physicians follow a different path. Dr. Doris Rapp, a board-certified pediatric allergist, says she used traditional approaches to allergies for 18 years, and then began incorporating principles of "environmental medicine" into her practice.