Many allergies could be resolved with immunotherapy, the so-called «vaccine»Which teaches the immune system to tolerate allergens that make the nose run and sneeze: the treatment program provides for the administration of gradually increasing doses of what is not tolerated, subcutaneously or sublingually, precisely to get used to not reacting. The treatment does not conflict with classic allergy therapies, which can be taken as needed in case of symptoms but which, thanks to allergen-specific immunotherapy, often become less necessary, because the consumption of drugs decreases for doses and number of administrations. In short, it works, and it now exists for most of the major allergies (mites, birch, grasses and so on). “The critical phase is the diagnosis: to set the right treatment you need to identify the specific allergen to which you react”, explains the president of AAIITO Riccardo Asero. “In fact, it can happen to be positive for many allergens according to classic tests, but then in reality the answer is against a so-called pan-allergen, a molecule common among several pollen: thanks to in vitro molecular tests it is therefore appropriate to understand the right target, to then set the most suitable immunotherapy. It is the only therapy that changes the natural history of the disease, the only one that changes the patient’s condition in the long term thanks to the so-called effect carry-over, for which even once the treatment has been suspended, one continues to remain tolerant to the allergen even for years ».
Prepared doctors
Allergies resolved for everyone, then? It is not so simple because, as Asero points out, “First of all it must be managed by adequately trained doctors, especially if it must be administered by injection: even if now the” vaccines “are purified and much improved products, reactions are always possible and monitoring is needed. Furthermore, the constant commitment of the patient is essential: immunotherapy is long and must be followed well for it to work, even the sublingual tablet must be taken regularly and precisely ».
In theory, any allergic person would have the indication to do it, precisely because thanks to the vaccine it is possible to recover from the allergy; in practice, many patients keep the symptoms of rhinitis allergic more or less complicated by asthma with inhaled cortisone, bronchodilators, antihistamine by mouth as needed.
Asero observes: “In these cases it is difficult to opt for immunotherapy, which instead is generally offered to those with sufficiently severe symptoms, a poor quality of life or asthma, which often regresses thanks to the vaccine”. Adds Gianenrico Senna, SIAAIC president, “It should be used especially in younger people and in those who have symptoms that have recently appeared: it prevents the march from rhinitis to asthma and seems to give better results when the allergy has not yet become chronic”.
Also for food allergies
Allergen-specific immunotherapy is also possible for peanut food allergy and drugs for egg, walnuts and hazelnuts are being prepared. Furthermore, as Maria Antonella Muraro, an allergist at the University of Padua, adds, “In the most difficult cases of allergy, when patients do not tolerate even the minimum dose for immunotherapy, it seems that some monoclonal antibodies already used for diseases such as atopic dermatitis or asthma: they have an immuno-modulating effect and reduce the reactivity of the immune system, thus making it possible to take the path of immunotherapy even in those who, for example, have a very serious food allergy ».
Resistances (and costs)
Despite the effectiveness, it is estimated that allergy vaccines are used in less than 5% of cases, although it is hypothesized that use would be adequate for at least twice as many allergy sufferers; the resistances are practical and economic because as Asero underlines “The reimbursement schemes are different according to the Region, in some immunotherapy is paid by the Health Service, in others not: an expense of 5-600 euros per year for some patients it may not be sustainable. “It must also be said that allergists have more than halved in the last twenty years, despite the fact that the sick have continued to grow: these therapies require close monitoring of the patient and in some situations the allergy services are in difficulty due to a lack of staff. “