Accelerated Immunotherapy

[JJKVI]

I have chronic rhinitis sinusitis and am currently under the care of an allergist. I have three questions:

1) I am on an accelerated immunotherapy program b/c I want to get pregnant this spring and must reach my maintenance dose before conceiving. I receive 5 injections a week. My family is concerned that this may be too much as most people only receive 1-2 injections a week. Is this accelerated program safe? And, in general, why do small amounts of allergens in the shots build immunity but large amounts (that cause allergy symptoms) do not?
2) I have had sinus pressure & thick, cloudy (sometimes yellow) post-nasal drip and accompanying cough & throat clearing for 6 months. A recent 3 week round of prednisone relieved the constant thin dripping, but not the thick PND. My allergist is convinced the excess mucus is due to inflammation caused only by allergies. I have, however, insisted on being evaluated by an ENT. Can a doctor really conclusively rule out other causes of inflammation (ie, infection) simply based on mucus color and without performing diagnostic testing? I just want to know whether I am crazy for insisting on the ENT consult
3) Why is the drippy nose and post-nasal drip so much worse when I exercise? (No one has been able to explain this)

[National Jewish]

You have asked some excellent questions!

1.  It is safe to have an accelerated immunotherapy program.  In fact, there are several reports of doing these in a hospital in a few days!  This is not a recommendation, but just to assure you of the safety.
1a.  The whole concept of building immunity is that by injecting a small amount of a specific protein, such as ragweed or the flu virus, the immune system is stimulated to a minor degree.  Thus this does not cause allergy symptoms, but a "full dose" would.

2.  It is impossible to say that the mucus is due to allergies or to infection solely on the basis of just looking at the mucus.  It can be looked at under a microscope to see the cells involved or culture for infection.  The ENT may request a CT of the sinuses, which will more definitively tell you if there is a sinus infection.  I would do this also before becoming pregnant.

3.  The third question is actually fairly easy.  When you exercise you increase blood flow.  The blood flow goes to areas of inflammation.  Some people have worse headaches, others have joints that hurt more, and for you it’s your nose and sinuses.  This causes your drippy nose and postnasal drip to be worse.

[starion]

I have had RUSH Immunotherapy at National Jewish & got to my maintenance dose with a total of 20 shots over the course of two days (it would have probably been easier on me as patient if I had more time to stretch it out but it was the only time window we had to work with).
The keys to RUSH Immunotherapy is having a very experienced allergist to work with who is familar with RUSH IT & especially the increased risks & what to do promptly if there are any adverse reactions.  For me, we were doing spirometries before & 30 minutes after each allergy shot, plus I had to stay at the clinic from early in the morning until 2+ hours after my last shot to be sure any adverse reaction was noted & promptly & appropriately treated.  
It is not unreasonable to get a consultation about your mucous, since your current doctor doesn't have answers for you.
Hope this is helpful & good luck on your future pregnancy.
Starion

[JJKVI]

I saw the ENT today and reviewed my CT Scan which showed some inflammation but that passages are open. Also showed "pools of snot" (Dr's terminology, not mine) in my lower cheek area. He was not concerned by this and said it was probably not causing or contributing to my symptoms or the re-occurring colds that I am getting but gave me a prescription for Leviquin. If that doesn't clear it up then he "doesn't know what to tell me." He acted like it didn't matter if these "pools" cleared up or not.  I asked him why they would not drain if the passges are open and he didn't know and didn't seem to care. He didn't feel the need to see me again (whether I'm feeling better or not.) Does this sound right?? Any insight would be helpful.