Useful facts on allergy vaccination (allergivaksinasjon)
Useful information concerning allergy vaccination – NAAF fact sheet
Allergy vaccination is a treatment option in long-term and severe allergy where the patient benefits from normal drug treatment have proved unsatisfactory. The treatment is also called ‘hyposensitisation’ or ‘specific immunotherapy’. Allergy vaccination is based on administering small doses containing extracts of the allergen to which the individual reacts.
Cortisone injections against allergies are not the same thing as allergy vaccinations. Cortisone injections should only be used in situations where there is a need for immediate treatment of serious symptoms and when other treatment has not been effective.
Allergy vaccinations are given by administering extracts of the allergen to which the person reacts, as injections under the skin. The first dose is so low that an allergic reaction will not be triggered in most people. In weekly injections over 8 weeks, the amount of allergen is gradually increased, until a maximum dose is reached. This dose is then given every 8 weeks for a period of 3-5 years. In this way, tolerance can be developed to the allergens used in the treatment
Which conditions can the treatment be used for?
Allergy vaccination can be used to treat several forms of pollen allergy, such as birch and grass. The treatment is also used to reduce the risk of life-threatening reactions in patients with serious bee or wasp allergy. In certain cases, individuals are vaccinated against animal mites and dust mite allergies. Studies have shown that allergy vaccination can protect against subsequent development of asthma or provide better control of an allergic asthma.
The tablet-based grass pollen vaccination medicine Grazax is approved for treatment of adults and children from 5 years old who suffer from grass pollen allergy. This is an orodispersible tablet that contains an allergen extract of pollen from Timothy-grass (timotei).
Who can receive this treatment?
Before allergy vaccination is considered, normal allergy treatment with antihistamines and local medications for eye and nose symptoms should be thoroughly explored. If the symptoms persist in spite of these medications, allergy vaccination may be a good alternative.
Allergy vaccination is not recommended for children below the age of 5 years, or for patients with uncontrolled asthma, serious cardiovascular disease or cancer. The treatment should not be commenced during pregnancy.
Allergy vaccination must not be started during the pollen season and dosage programs must be completed before the pollen season begins. For example, a dosage program for birch must take place in the period July – February, for grass in the period September – April and for mugwort/wormwood the period is October – April.
Allergy vaccination is carried out on the condition that allergy has been confirmed via a skin prick test and/or blood test. Lung function assessment must also be carried out before treatment commences.
The cost of pollen vaccines are refunded by the National Insurance scheme or according to the blue prescription regulations. For other vaccines, an individual refund must be applied for.
For tablet-based allergy vaccination with Grazax, one orodispersible tablet is given daily for three years. Treatment should be started four months prior to the pollen season.
Grazax gives the right to reimbursement for those with moderate to serious season-dependent grass pollen allergy for a minimum of 2 years, and where alternative forms of treatment do not provide adequate control of the condition, or cause adverse effects. Reimbursement is also on the condition that the patient does not receive injections of other allergen extracts. The right to reimbursement applies to children from 5 years old to adults.
Where is the treatment given?
Allergy vaccination is chiefly administered by specialists in pulmonary medicine, Ear, Nose and Throat specialists and paediatricians with specialist allergological expertise.
Allergy vaccination may only commence following thorough investigation, allergy testing and lung-function tests conducted by a specialist. Referral to a specialist may be made via a general practitioner.
Risk of adverse effects
Allergy vaccination is associated with a certain risk of adverse effects. These may range from mild symptoms such as a stuffy nose, itchy eyes and throat, to serious or life-threatening symptoms in the form of breathing difficulties or allergic shock. The risk is greatest immediately after an injection. The treatment should therefore take place at specialist clinics where emergency equipment is always on-hand for the management of any serious reactions. The person injected should not leave the treating clinic for 30 minutes after the final dose is administered. During the first 24 hours after an injection, patients may also experience local reactions such as swelling of the skin. Strenuous physical activity should be avoided for 24 hours after the injection is given.
The most common adverse effects from tablet vaccination such as Grazax are local allergic reactions in the mouth, in the form of tingling/itching and swelling under the tongue. In most people, these symptoms will disappear during the first few weeks after commencing treatment.
What are the effects of the treatment?
There is documentation that allergy vaccination is an effective form of treatment which can reduce allergy symptoms, improve allergy-related quality of life and reduce the need for other allergy medication. For most people, the effect will be permanent. Some individuals, however, will not experience significant improvement, and it is not possible to select in advance exactly which persons will benefit from the treatment.
Allergy vaccination is in itself a relatively time-consuming and expensive form of treatment. The risk of adverse effects, coupled with the fact that not all individuals will experience improvement following the treatment, must be considered carefully before selecting this form of treatment.
Development of new and improved forms of immunotherapy will hopefully provide safer treatment and better results in the future.
Facts concerning allergy vaccination have been drawn up in consultation with NAAF’s medical board