WHY DO ALLERGISTS LOVE ALLERGY SHOTS? By: Donald Senter, MD "Because they work" is the best and quickest way to answer this question. Many of the patients seen by allergists have already tried most of the many allergy medications that are on the market. Unfortunately many of these allergy sufferers have become chronic because of prolonged use of medications without a definitive diagnosis and treatment plan. In the early years of a patient with allergy problems, there is usually lots of itching, sneezing and runny nose. This is a classic pattern of IGE (allergic antibody) manifestation and may respond initially to H1 antihistamine blockade. All of the medications sold as antihistamines do benefit the above symptoms but some are much more effective than others. One highly advertised medication was reported on the FDA website to have only an 8% advantage over a placebo pill, but it still had successful sales on the market. For decades, patients reported antihistamines would quit working but could switch them and temporarily gain improvement. Now the more effective antihistamines quit working and nothing helps at all, indicating that the allergy is far more severe than medicines alone can treat. Short term symptoms are treated best with various allergy medications, provided control is sufficient to prevent complications, missed work or school. Many students and workers go to school or work daily only partially relieved of their allergy symptoms and struggle through the day. Once off work or out of class they may be too fatigued from the allergy battle or sedating medications that they do not enjoy their free time. Students with poorly controlled allergies have been reported to be 25% less productive in classroom work. When feeling ad they do not socialize well, and frequently are irritable and fatigued. The allergic cascade of chemical mediators released by a MAST cell upon allergic activation does include Histamine as earlier stated but also includes Leukotrienes, Prostaglandins, Proteases and Cytokines. The most important Cytokine, in my opinion, is ECF (Eosinophillic Chemotactic Factor). This is a message released by MAST cells to call all Eosinophils in the blood stream to migrate to the Battle Field. There, they release their highly acidic granules (which are irritating), to one's mucous membranes of the eyes, ears, nose, throat, sinuses, lungs, esophagus, stomach, small and large intestine, plus the skin - if it is involved (as in atopic dermatitis or hives). All of these mediators are prevalent in allergy and are the "hallmark" of the late allergic reaction. Airway of lungs as well as most likely the nose and sinuses are remodeled with mucosal changes that are difficult to ever completely reverse due to tissue damage. If one could prevent MAST Cells from de-granulating and reduce the production of the Allergic Antibody, then the above events might never happen. Some sort of shield or armor plate would be much appreciated by those suffering from more prolonged allergies. Previous Blog Entry Blog Home