Allergy Desensitization Therapy and Its Long-Term Effects

Regarding desensitization therapy?

Hello, doctor.
When I was about five years old, I developed allergic asthma after a prolonged cough from a cold.
By the time I was in first grade, a physician at a provincial hospital provided me with desensitization therapy, which I remember lasting for about three years.
After puberty, my asthma became less noticeable, and for the next 20 years as an adult, I had no issues with allergic asthma.
I thought this meant I would never have problems in this area again.

Unexpectedly, two years ago, I frequently woke up feeling a dull pain near my sternum.
I consulted a cardiologist, who found no significant issues, and a gastroenterologist, who ruled out gastroesophageal reflux disease.
Both doctors suggested that it was due to excessive stress and autonomic nervous system dysregulation, prescribing me clonazepam.
While this medication helped me sleep better, it did not show significant improvement for the chest pain.

Earlier this year, I noticed a slight feeling of asthma (using accessory muscles), and I began to react to past allergens.
I underwent allergy testing at the hospital, and the results were similar to those from my childhood (many with a score of 4+ or higher).
My peak expiratory flow rate was measured at 56%, prompting my physician to prescribe antihistamines and bronchodilators.

I would like to ask:
1.
Is this situation confirmed as a recurrence? Is such a recurrence common?
2.
After having undergone desensitization therapy in childhood and experiencing a recurrence, can I undergo desensitization therapy again? Is there clinical data showing its effectiveness?
3.
If I cannot undergo desensitization therapy again, does this mean I will need to rely on medication for the rest of my life? Thank you very much!

Fuhua, 40~49 year old female. Ask Date: 2013/12/15

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your message.
Let me address your questions one by one.

1.
Asthma can indeed recur, although the symptoms are generally milder during relapses.
After undergoing desensitization therapy, there is a possibility of recurrence, but this typically occurs after a decade.
However, significant deterioration after more than 20 years is not particularly emphasized in the literature and is also rarely seen in practice.
I suggest you confirm with your attending physician whether there might be other underlying conditions.
2.
Desensitization therapy can be administered to both adults and children, although the literature generally suggests that the response is better when treatment occurs during childhood.
In cases where early treatment is effective but later relapses occur, physicians abroad may consider restarting desensitization therapy.
Currently, there are no objective clinical data available to reflect its efficacy, but literature from abroad indicates that desensitization therapy has shown good results in patients over 50 years old who are allergic to grass pollen, although there is no data on its effectiveness for middle-aged and older adults allergic to dust mites.
3.
If it is indeed allergic asthma and desensitization therapy is not an option, medication is a good choice.
Current medications have advanced significantly, and you can discuss with your physician the possibility of using the least amount of medication to control symptoms, while also adjusting your lifestyle and exercise routines for optimal results.

In summary, experiencing a relapse of asthma in middle age warrants closer attention.
Confirming whether it is a true asthma relapse is the first priority.
During the treatment period, it is essential to monitor any changes in your condition or inadequate responses to treatment, and adjustments to medication or further examinations may be necessary to ensure a smooth and safe follow-up treatment process.
Sincerely,
Department of Allergy, Immunology, and Rheumatology, Changhua Hospital, Ministry of Health and Welfare

Reply Date: 2013/12/15

More Info

Allergy desensitization therapy, also known as allergen immunotherapy, is a treatment designed to reduce sensitivity to allergens over time. It involves the gradual exposure to increasing amounts of the allergen, which helps the immune system build tolerance. Your experience with this therapy as a child, followed by a significant reduction in asthma symptoms during adolescence and adulthood, is not uncommon. Many individuals who undergo successful desensitization therapy experience long-term relief from allergic reactions and asthma symptoms.

1. Is this situation a confirmed relapse? Is such a relapse common?
Yes, your current symptoms suggest a relapse of your asthma and allergic reactions. It is not unusual for individuals who have previously experienced asthma or allergies to have a resurgence of symptoms later in life, especially if they are re-exposed to allergens or if there are changes in their environment or health status. Factors such as stress, respiratory infections, and changes in lifestyle can trigger a re-emergence of symptoms. In your case, the stress and autonomic nervous system dysregulation you mentioned could have contributed to the resurgence of your asthma symptoms.

2. Can you undergo desensitization therapy again after a relapse? Are there clinical data supporting its effectiveness?
Yes, it is possible to undergo desensitization therapy again after experiencing a relapse. Clinical studies have shown that allergen immunotherapy can be effective even after a period of symptom relief. The decision to re-initiate therapy should be made in consultation with an allergist or immunologist, who can assess your current condition and determine the most appropriate course of action. The effectiveness of re-treatment can vary based on individual circumstances, including the specific allergens involved and the duration since the last treatment.

3. If desensitization therapy is not an option, will you need to rely on medication for life?
If desensitization therapy is not feasible or if you choose not to pursue it, it does not necessarily mean you will need to rely on medication for the rest of your life. While many individuals with asthma and allergies do require ongoing medication to manage their symptoms, there are various treatment options available. These may include inhaled corticosteroids, bronchodilators, and antihistamines, among others. Additionally, lifestyle modifications, such as avoiding known allergens, maintaining a healthy diet, and managing stress, can also play a significant role in controlling symptoms.

In conclusion, your experience highlights the dynamic nature of asthma and allergies, which can change over time. It is essential to work closely with your healthcare provider to monitor your symptoms and adjust your treatment plan as needed. Regular follow-ups and open communication about your symptoms and concerns will help ensure that you receive the most effective care tailored to your needs. If you have further questions or concerns, consider seeking a second opinion from an allergist or pulmonologist who specializes in asthma management.

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