Accelerating My Immunotherapy Treatment - Allergy Shots

[nuclearpowerpants]

What is the limiting factor in deciding how quickly to administer allergy shots? Is it simply the occurrence of a local or systemic reaction? If the injections aren't creating any noticeable reactions would it be safe or advisable to increase the dosage strength or frequency?
I have received many different reports from various immunologists / allergists about recommended dosing amounts and frequencies. Some endorse a very gradual program over many years, others recommend a more rapid twice weekly injection program and others swear by the "rush" program over a couple of days or weeks.

When I began sublingual drops 6 months ago I soon noticed a great improvement in all of my symptoms, including nasal congestion, asthma, sleep disturbances and chronic headaches. Whenever my rhinitis eases I have far less fatigue and feel much better overall.
It's now summertime in Australia and my symptoms have returned with a vengeance.
My test results have also shown that I am responding well to the treatment, though it will still take years for me to reach maintenance dosage.
Because of this I am keen to reduce my allergies ASAP and make informed choices about accelerating my treatment.

From what I have read, it seems to be that if a patient can tolerate a rapid immunotherapy program with the aid of prednisone and antihistamines then the results are just as good as the gradual long-term option. Is this true in most cases? Is there a danger that rushing the treatment in any way could ultimately result in poorer outcomes? What if I could tolerate a faster program without the aid of prednisone?

In other words, I'm asking if the most rapid and efficient way to achieve the maintenance dose level is to increase the dose as much as you can tolerate each week OR if there is an important reason why the shots should not be increased rapidly.

(Be assured, I understand the dangers of anaphalaxys and will be responsible with my health.)

[David Tinkelman, M.D.]

It is not “simply the occurrence of a local or systemic reaction”; but the occurrence of a reaction is one of the parameters used.  With a reaction, depending somewhat on the severity of the reaction, the response is usually to reduce the dose/strength of the shot.  To some degree, the presence of a reaction is a confirmation of the appropriateness of the immunotherapy.

Rush immunotherapy must be tailored to the individual patient and that patient’s degree of responsiveness to prior testing and immunotherapy. This requires experience and judgment on the part of the allergist/immunologist.  In any event, the question to be answered is, What is the Rush?  What are the potential benefits and contraindications and these are best determined by the allergist who knows you well and, especially knows your history.

The fact that whenever the rhinitis eases you have far less fatigue and feel much better overall indicates that, immunotherapy aside,  the therapy for your rhinitis must, at all times be optimum.

You show signs of a heightened degree ofsummertime seasonal allergy, superimposed on your perennial disease. An increase in therapy, in anticipation of the summertime worsening might be much more effective than waiting until symptoms worsen.

Rapid immunotherapy program with the aid of prednisone and antihistamines oftentimes produces results are just as good as the gradual long-term option. It is very unlikely that this form or therapy would result in poorer outcomes.  

The administration of immunotherapy is a dynamic proce swith decisions made during the course of therapy;  if tolerated, shot dosage can often be increased rapidly but if there is a history of hyperactivity to shots and shots are being well tolerated,  trying to hurry the process along might not be worth the risk of having to start over again at lower dose levels.

You might also want to consider requesting a 2nd opinion at an academic institution such as National Jewish Health in Denver (my institution), Johns Hopkins, the Cleveland Clinic, the Scripps Clinic in La Jolla  or the Mayo Clinic.

[nuclearpowerpants]

Thank you for your detailed answer, it's very helpful.
My doctor has agreed to accelerate my vaccine regime since I have had such positive reactions so far to it.
My vaccine only contains two allergens: ragweed and dust-mite. My friend in the States is receiving a rush protocol for many dozens of different allergens. I mentioned this to my doctor who explained to me that putting too many different allergens into the mixture would mean having to lower the overall dosage and would be less effective in the long run. He also explained that my major allergens might be causing the minor ones, so treating the major ones would be enough.
Yet, many doctors in the States seem to disagree. How is there such opposing views in the field regarding this issue?
All I want to find is the *optimal treatment regime* and want to know what *the evidence supports*.