Laurie Menk Otto, ND, MPH

Naturopathic Medicine | Portland, Oregon


2 Comments

Beyond Allegra and Flonase: Naturopathic Tips for Portland’s Allergy Season

Allergy treatment from Dr. Laurie Menk OttoYou know that feeling…the little itch in your nose or eyes. That’s when you know allergy season is on its way. Last year in Portland we had what felt like a very long allergy season. Did you know that you don’t have to suffer from allergies forever?

Immunotherapy is the only treatment for allergy that changes the way immune system reacts to allergens, ultimately leading to fewer or no symptoms after treatment. In other words, immunotherapy re-trains your body to stop reacting. I use sublingual immunotherapy or “allergy drops” to treat allergy. This treatment is very convenient—it’s as easy as taking drops under your tongue each day, and it does not require frequent office visits or shots. Relief can be felt as early as several weeks into treatment.

Your allergy drops are mixed specifically for your allergy. This is important, because drops allow you to receive treatment for all of your environmental allergens. Treating for just one or two allergens would not bring about strong symptom relief. If you are allergic to trees, dust, and dogs, you can be treated for all of them at the same time.

Is this different from taking an antihistamine?

Yes. Antihistamines and nasal sprays are often recommended to control allergy symptoms, but many people don’t like the side effects or don’t want to rely on medications forever. That’s where I can help develop treatment that is very specific to your symptoms.

What else can be done?

Identifying what you are allergic to, controlling your environment to reduce exposure, and starting immunotherapy are your best bets to feel lasting relief and stop symptoms for good.

First, allergy testing is used to identify exactly what you are reacting to. It’s an easy test that takes one hour, and you have results by the time you walk out the door. You will leave the appointment that day with a list of actions that you can take to remove allergens from your environment, which alone will help to reduce symptoms. But it doesn’t stop there. Diet or other changes can help to reduce symptoms further, and if you are looking for alternatives for symptom control, I can help you with other options.

When should I start?

Ideally, start the process of identifying your allergies with skin or blood tests at least three months before your allergy season. Allergy evaluation and immunotherapy, however, can be started at any time.

Make this your year to start treatment to end your allergies. Stay tuned for future installments on my blog to learn about naturopathic allergy treatment options, or give me a call to schedule a consultation.

 


Leave a comment

Immunotherapy FAQs

 

What is sublingual immunotherapy, and how does it work?
Sublingual immunotherapy is a treatment for hay fever type allergies.  Allergen extracts containing antigen are mixed with glycerin as a preservative and delivered in drops under the tongue. The formulation is specific to your allergy test results and symptom picture. Immunotherapy is used, in this case, to “re-train” the immune system away from the allergy-type reaction and towards a reaction that tolerates the same allergens without allergy symptoms.

How are allergy drops different from allergy shots or tablets?
SLIT works in a similar way to allergy shots, and use the same FDA-approved antigens, but the route of administration is drops under the tongue rather than shots. The main difference is that treatment is delivered at home on a daily basis, rather than at an allergist office. Allergy tablets treat single allergens or allergen types (grass, ragweed, dust) rather than multiple allergens and do not come in different dosages.

What kind of allergies are treated with allergy drops?
At our clinic, allergy to tree, grass and weed pollens, animals, dust, and mold are treated using SLIT. Your exact prescription is determined based upon the results of your allergy test. SLIT can treat allergy to multiple antigens at the same time.

Can food allergy be treated with SLIT?
Allergy to foods are treated with SLIT, and may be sought at an allergist’s office.

Who can be treated with SLIT?
At this clinic, anyone over age 3 is a good candidate for allergy treatment using SLIT. Some people may choose allergy drops over shots due to the convenience of in home administration, fewer doctor’s office visits, the safety profile, or if they don’t respond well to or tolerate shots well. Young children, people with asthma, highly sensitive people, and people with multiple allergies may choose to treat their allergies with SLIT rather than allergy shots. Anyone with uncontrolled asthma symptoms is not a good candidate for this type of allergy therapy.

How is the treatment managed?
There are two phases of treatment. The first phase of treatment is the “buildup phase” during which the dose of allergy drops is increased every week over a series of weeks or months. Appointments in buildup phase are held every 5 weeks. The second phase of treatment is the “maintenance phase,” where drops are at the highest dose and appointments are held every 10 weeks. Symptoms are monitored carefully to troubleshoot the best additional treatments.

Will medical insurance cover the costs?
At this time, most insurance companies cover the cost of diagnostic allergy testing and office visits. However, because allergy drops are an off-label use, they are not covered by insurance. Allergy drops often do qualify for HSA or flex spending reimbursement.

How long will I need to take allergy drops?
Most often, SLIT will be prescribed for 2-5 years, after which point the need for it will be reassessed. Benefits are often felt within in the first few months, with some variance among individuals. For the greatest symptom control (no reaction to what causes your allergy symptoms) 2-5 years is generally recommended. Please be aware that SLIT is intended for long-term use, and if discontinued early, benefits may not be experienced. This treatment “re-trains” the immune system over a period of time.

Are allergy drops safe? Are there studies that evaluate their effectiveness?
SLIT has been used in other countries for many years, and studies document their safety and effectiveness. The World Health Organization has endorsed SLIT as a viable alternative to allergy shots. The Cochrane Collaboration, which is the world’s most trusted international organization dedicated to reviewing health care treatment, concluded that allergy drop immunotherapy (SLIT) significantly reduced allergy symptoms and use of allergy medications.


Leave a comment

When is the best time to treat allergies using immunotherapy?

Birch tree catkin is a common allergen.

Birch tree catkin is a common allergen.

People often ask me this question when discussing treatment for allergies. Any proactive steps towards treating allergy and reducing associated inflammation is a good time. Treatment can be started at any time, however, there are certain times that are ideal for starting immunotherapy, especially for seasonal allergies to tree, grass, or weed pollens. The rationale is that you will experience fewer allergy type symptoms if you start when the allergens are not in large doses in the air.

To avoid making allergy symptoms worse, immunotherapy should be started at least 3 months before your peak allergen season hits. If you have completed allergy testing and identified what you are allergic to, you will know the general season in which your symptoms flare. Then, you can plan to start immunotherapy 3-6 months earlier. Trees, grasses, and weeds pollinate the spring, summer, and fall, respectively, with windows of overlap, leaving many feeling miserable for a few months, especially in the case of multiple allergies. To get a head start without increasing your symptoms, starting immunotherapy during the early winter months is a good bet.

If your allergies are to dust, mold, or pets, which are present year-round, treatment can be started at any time. Medications and supplements used to alleviate allergy symptoms can still be taken while taking allergy drops.

Dr. Laurie Menk Otto does skin (intradermal and skin prick) allergy testing, and sublingual immunotherapy, or “allergy drops” at her practice at Heart Spring Health. With winter approaching, it is a good time to make an appointment for an allergy evaluation and to discuss your symptom picture. Wouldn’t it be nice to get through your next allergy season with less sneezing, runny nose, and itchy eyes?