Spring brings joy to many hearts – but not to those of hay fever sufferers. Dr Moisés Calderón, head of clinical trials at the Royal Brompton Hospital in London, discusses how immunotherapy can help.

Hay fever or seasonal allergic rhinitis occurs because an individual’s immune system is extremely sensitive to pollen, most commonly grass pollen. One in four adults in the UK suffers from allergic rhinitis; over half of these people are allergic to grass pollen. Allergic rhinitis can disrupt sleep, reduce work productivity, affect studies or make it difficult to enjoy outdoor activities during summer months.

Incidence and impact
For many people the term allergy describes a moderate ailment that causes a few people some minor inconvenience, particularly in the
summer months when grass- pollen levels are high and people suffer from hay fever or grass pollen induced seasonal allergic rhinitis, to give the disease its true medical term.

However, according to a House of Commons report from 2004, allergies affect 30% of UK adults and 40% of UK children. In any one year, one-fifth of the UK population will seek treatment for some form of allergy and 18 million people in the UK will develop an allergy at some point in their lives.

A clinical study investigating the effect that hay fever has on GCSE exam grades has shown that when a student with hay fever sits summer exams there is a 40% risk of them dropping a grade from their winter mock exams. This increases to a 70% risk if the student is on a sedating anti- histamine.

What is immunotherapy?
When an individual who is sensitive to pollen inhales pollen their body overreacts, leading to symptoms such as itchy eyes, a runny or blocked nose, sneezing and wheezing.

Immunotherapy is a long- term treatment for allergy that helps to reduce an individual’s reaction to an allergen. Allergens are usually harmless, but in individuals sensitised to allergens the symptoms experienced can be so severe that they affect everyday life.
Allergens can be airborne pollen, such as the grass pollen that causes seasonal allergic rhinitis (hay fever) or the allergen could be from an animal such as a cat or a dog, or from bee or wasp venom.
In any case the immuno-therapy is administered either by tablet or subcutaneous injection. Each dose contains a small amount of the allergen to which that individual is allergic. Immunotherapy is usually recommended for those patients who still experience significant symptoms despite using standard medicines such as antihistamines and steroid nasal sprays or for those patients who have a severe reaction to a bee or wasp sting.

The principle of how immunotherapy works is similar to that of a vaccination, such as the flu vaccinations that are given annually in the autumn. By regularly introducing a small amount of the specific allergen that causes the allergic reaction, the body’s immune system learns to tolerate the allergen and produce a normal immune response.

Administration
There are two administration methods recommended by the World Heath Organisation for specific immunotherapy; subcutaneous injection (SCIT) or sublingual oral administration (SLIT). The latter is a rapidly melting tablet that is placed under the tongue and absorbed into the oral mucosa.

Subcutaneous
In the case of subcutaneous immunotherapy, patients are given regular injections of a specific allergen, the quantity of the dose being increased over time. Since the mid 1980s it has been obligatory to give these injections in a specialist medical setting, usually an allergy clinic in a specialist allergy and immunology department, often only available in larger hospitals. This is because patients need close clinical monitoring for one hour after each injection due to a risk of severe reaction to the injection. For this reason subcutaneous immunotherapy is not recommended for patients with asthma.

Sublingual
Sublingual immunotherapy offers the same kind of benefits as injectable immunotherapy by regularly introducing a small amount of the allergen, such as grass pollen, that causes the allergic disease.
The body’s immune system becomes tolerant to the allergen and has a normalised immune response. It is recommended that the first dose is given under medical supervision so that a healthcare professional is available to discuss any side effects. These are typically localised including itching in the mouth. This may last for between ten minutes and one hour after each tablet for up to one week after starting therapy.

Effectiveness
Clinical studies have shown that patients with hay fever
taking SLIT for a continuous daily period of two years experience significant benefits compared with patients taking symptom relieving medication alone for the same period.
Patients taking SLIT closely monitored their hay fever symptoms and also their requirement for additional reliever medication during the hay fever season. Those patients taking SLIT reduced their hay fever symptoms by 44% compared with a group of patients taking symptom relieving medication alone for the same period.

Patients on SLIT also required 73% less reliever medication and eight out of ten patients on SLIT reported a better quality of life during the hay fever season compared with previous seasons when they were not taking immunotherapy.

SLIT and asthma
Unlike subcutaneous immunotherapy, sublingual immunotherapy can also be given to people suffering from mild to moderate asthma. An additional advantage of SLIT is that the medication can be taken each day at home. Given the relatively few hospital centres offering subcutaneous immunotherapy the development of sublingual immunotherapy opens up access to immunotherapy to a far broader group of patients.

Both types of immunotherapy take time to work. It is recommended that immunotherapy should be administered continuously for three years. However, immunotherapy has the potential of reducing the body’s response to an allergen for many years after treatment has stopped. Sublingual immunotherapy now offers a convenient treatment that can be administered at home that is well tolerated by patients allowing them a significant improvement in their quality of life.
If you believe that you could benefit from immunotherapy then you should consult your GP in the first instance to find out which therapy may be suitable for the allergic symptoms you are experiencing.

HayMax, the creation of former sales executive and hay fever sufferer, Max Wiseberg, is a combination of oils and beeswax, which he makes on his farm near Bedford.
He got the idea after smearing Vaseline under his nose to block the inhalation of pollen – but says that HayMax is a lot more effective and nicer to use.
‘Pollen sticks to the HayMax, instead of being inhaled,’ he says. ‘Yes, pollen will still enter the body, through the mouth, for example. But if you can reduce the amount that enters, you can reduce symptoms dramatically.’ He admits he has no medical training, and did not consult doctors during the development of HayMax. There have been no clinical trials, but since its launch in 2004 over 100,000 pots of HayMax have been sold. ‘No hay fever treatment works for
everyone,’ says Wiseberg. ‘But in the last three years I’ve heard of 13 people who said it did them no good and hundreds who said that it worked.’
One pot of HayMax, costing around £5, should last for most of the hay fever season and can be bought at Superdrug, Waitrose or on line at www.haymax.biz 01525 406600

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First Published in 2008

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