Allergies... What is this “beast” and is it possible to defeat it? Every decade the number of allergy sufferers in the world increases geometric progression. This is facilitated by modern ecology, nutrition, and living conditions. Doctors give disappointing forecast This disease makes it very difficult to get rid of allergies. But already at the beginning of the 20th century, scientists found a method of allergy vaccination, which today is called allergen-specific immunotherapy, or ASIT for short.

It is impossible to say that the Asit therapy method is vaccination, although one of the names of Asit is specific vaccination. The method consists of introducing the causative allergen into the body in order to create immune resistance to it. Small doses of the allergen help create antibodies to the pathogen and improve the body's immunity. From vaccination, the method took over the rules for the preparation and administration of foreign substances and the calculation of the required dose. But the treatment itself bears little resemblance to a simple vaccination, and even more so during asit therapy no vaccinations are allowed!

About allergies

Allergies are exaggerated defensive reaction immune system body upon contact with an allergen. Allergens are often common things such as house dust, animal fur, food products and, of course, pollen from many plants. Contact with the irritant causes a person to sneeze, cough, tear, skin rashes. This leads to even more serious consequences:

• sleep disturbance;
• chronic fatigue;
• headaches;
• low performance.

All this has a serious impact impact on quality of life. And over the years, allergies can become more and more severe and lead to serious illnesses, such as bronchial asthma. Today there are many medications that can help relieve symptoms caused by an allergic reaction in the body. A person, knowing his problems, takes antiallergic drugs, making his life easier. In practice, there are only two treatment options for people suffering from allergies:

1. Symptomatic treatment, including taking antiallergy medications to relieve allergy symptoms.
2. ASIT, which eliminates not the symptoms, but the disease itself.

What is the ASIT therapy method?

Allergen-specific immunotherapy is aimed at treating the cause of the allergy, it retrains the immune system and restores normal balance to the level immune cells. And only such treatment can provide long-term, sustainable results.

How does this happen? Microscopic fractions of the causative allergen are introduced into the human body, gradually increasing the dose over time. The body gets used to the harmful allergen, producing antibodies to it, which helps to reduce and fade the reaction to the allergen.

This process is slow and requires a lot of patience and strict adherence to the treatment plan.

There are 2 stages of allergen introduction:

• initiating phase;
• maintenance phase.

During the first phase, they strive to find the maximum tolerated dose of the drug, so the patient is given an increasing dose of the allergen at short intervals.

The stage can take from 4 to 6 months.

The second stage is needed for sustainable remission, so the patient is administered the maximum dose found for several years with long breaks.

Treatment usually continues within 3 years.

Treatment should be carried out in specialized clinics from competent doctors.

To prescribe treatment, the immunologist-allergist gets acquainted with the patient’s medical history, performs diagnostics with the collection of tests and allergy samples, draws up a treatment regimen and plan. All treatment is recorded in detail in the contract for the provision of medical services.

There are two methods of treating asit therapy:

1. Sublingual or oral.
2. Subcutaneous.

The sublingual method or drops under the tongue is considered more convenient and faster, as it requires less time, is painless, can be performed at home and has fewer adverse reactions.

Subcutaneous treatment involves introducing allergens into the body with the help of injections. These procedures are performed strictly in clinics under the supervision of a doctor. The frequency of injections is once every 2-6 weeks. After the injection, you must be observed in the hospital for an hour to exclude anaphylactic shock or other adverse reactions.

TO general rules behavior of the patient during the course of Asit for allergies should include strict adherence to the treatment plan and strict control over general condition body. Any ailments should be reported to your doctor immediately.

During treatment with the ASIT method, your health may worsen and adverse reactions are possible.

Adverse reactions

Allergen-specific immunotherapy is an operation that interferes with the human immune system, so the body’s reaction is difficult to predict. When treated with this method, there may be both local and systemic reactions.

Local symptoms include itching, redness and swelling at the injection site.

Systemic reactions occur regardless of the site of injection of the allergen and often pose a threat to life. This is Quincke's edema, asthmatic attacks, anaphylactic shock. This also includes pain of various etiologies: in joints, in muscles, head. Often in case of systemic reactions it is necessary emergency assistance doctor with subsequent adjustment of the treatment plan.

To facilitate the treatment process, the doctor may additionally prescribe symptomatic drugs from a series of antiallergic and decongestant.

Asit is a difficult treatment method, why has it been in demand in world practice for more than 100 years?

Advantages of ASIT therapy

Correctly carried out treatment can rid a person of allergies completely. And this gives a completely different quality of life, compared to simply relieving allergy symptoms.

5% of those who have recovered completely forget about allergies, and for many, remission lasts up to 20 years.

Asit strongly reduces the risk of developing asthma and has a significant preventive effect.

There are spawn statistics side effects when conducting asit. For example, the frequency of occurrence anaphylactic shock is 0.0007%. Doctors attribute the occurrence of serious systemic reactions to the fact that the treatment is carried out not by an allergist, but by a doctor. general practice. Intervention in the immune system can only be performed by a qualified immunologist-allergist. If the treatment plan is followed, the ASIT procedure is safe.

Who is Asit therapy indicated for?

The effectiveness of the method has been proven especially in the following cases:

1. in the treatment of allergic year-round rhinitis;
2. for seasonal allergies and hay fever;
3. for bronchial asthma;
4. when reacting to dust mites;
5. for insect bites.

If it is not possible to avoid contact with the allergen, then the ASIT procedure will the best solution problems. Moreover, its effectiveness is higher, the milder the form of the disease. In case of severe allergies, when the patient has been treated with antihistamines for years, Asit may not give the expected effect. But in any case, after treatment with ASIT therapy, the patient’s condition will be stabilized, even if the reaction to the allergen remains, then the disease no longer progresses and doesn't go to serious illnesses, such as asthma.

Asit therapy is not carried out for allergic reactions to pets, bacterial and fungal infections.

Although allergen specific immunotherapy is used in medical practice quite widely, but there are contraindications for its implementation.

Contraindications of the method

Asit is contraindicated:

And also, this method is not used, if the patient has:

• atopic dermatitis;
• cold allergy;
• drug allergy;
• allergies to more than 3 types of irritants.

There are also a number of temporary restrictions for the use of Asit: exacerbation of chronic diseases, fever, injuries oral cavity with damage to the mucous membrane, inflammatory diseases oral cavity.

When to perform the procedure

Treatment is planned in advance and should begin during the period of remission from the disease.

For the treatment of seasonal allergies, the fall and winter season is usually used. Year-round allergies can be treated at any time of the year.

There are 3 periods of therapy for asitis:

1. Year-round. Used for allergies to dust and wool.
2. Pre-season. Used for allergies to flowering plants.
3. Pre-season.

Disadvantages of the procedure

The disadvantages of this method of treatment The following points can be noted:

• treatment can be carried out with only one drug at a time. For allergies to pollen and household dust, Asit therapy is carried out in different courses. In the form of preparations, allergens are produced both as a single component and combined into medicinal mixtures. But more than 3 stimuli are not used;
• many contraindications;
• limited range of allergens;
• the occurrence of adverse reactions;
• the cost of the entire treatment is high.

Price for course treatment asit

Price specific immunotherapy depends on the form of treatment and usually consists of the price for the doctor’s services, allergen tests and the cost of the drug itself. Sometimes you need to pass additional tests, which are also paid by the patient.

Average price of the first stage of treatment ranges from 10 to 20 thousand rubles.

When treated with injections, the price of the course is slightly more expensive; the number of infections per course can reach 50.

The general course of treatment for allergen-specific immunotherapy is measured in tens of thousands of rubles. But the opportunity normal life, without allergies, often opts for asit.

The decision always remains with the person.

One of the progressive methods of treating allergies is ASIT (allergen-specific immunotherapy). It represents precisely the elimination of a specific reaction of the immune system, and not the relief of symptoms. The method, known since the beginning of the twentieth century, is constantly being developed and improved by specialists.

What is ASIT therapy?

ASIT therapy is an allergy treatment technique aimed at introducing allergens into the human body in small doses. Gradually, increasing the dosage of the administered substances, the body becomes accustomed to the allergen. And this leads to the fact that the body stops responding to the stimulus.

For therapy, allergens are used that are based on the following components:

• proteins;
• polysaccharides.

Upon contact with the body, antibodies are produced that reduce the effect of the irritant. Correction immune status and curing allergies is the goal of ASIT.

Principle of treatment

Allergen-specific immunotherapy is a serious approach to allergy treatment that begins with diagnostic testing.

Diagnostics and prescription features

Diagnostic tests usually include:

• general analysis blood;
• spirography (for asthma patients);
• general urinalysis;
• allergy tests.

By analyzing all the collected data, the doctor prescribes treatment using the ASIT method. In this case, the following is selected:

• specific vaccine;
• dosage;
• method of vaccine administration;
• number of uses.

After starting therapy, the doctor may increase the dosage if the vaccine is well tolerated by the patient. The procedure should be carried out either in the office of an allergist or in inpatient conditions. This is necessary so that in case negative reaction patient's body for the vaccine, they were able to provide qualified assistance. In this regard, after the procedure, the patient must remain in the medical institution for at least another hour.

Procedure methods

Currently, several methods of introducing the vaccine into the body are used:

• by inhaling vapors of the drug from an inhaler;
• leading into the nasal cavity;
• oral;
• subcutaneous injections in the forearm area;

The most commonly used method is oral and subcutaneous administration.

Indications for use

The ASIT method is effective in the following cases:

• food allergies (depending on type);
• conjunctivitis;
• rhinitis, including seasonal;
• hives;
• compensation period of bronchial asthma.

If desired by the patient treatment course can be carried out under the following conditions:

• exposure of the human body to no more than three allergens at the same time;
• precisely identified allergen.

Contraindications and possible side effects

There may be contraindications to the use of therapy related to the patient’s health condition.

Contraindications

Among the list of diseases and circumstances that prohibit the ASIT method:

• child's age under 5 years;
• mental illness;
• pronounced pathologies of a systemic nature, in particular endocrine ones;
• taking beta blockers;
• severe bronchial asthma;
• oncological diseases;
• rheumatism;
• tuberculosis;
• liver or kidney diseases.

ASIT is not suitable for the following types of allergies:

• allergies to more than three allergens;
• to the cold;
• atopic dermatitis;
• photodermatitis;
• for mold;
• for fungal spores;
• medicinal;
• in case of Quincke's edema;
• on animal saliva.

Features of use during pregnancy

In most cases, if ASIT treatment was started before pregnancy, it is continued. But it is not recommended to start treatment with this method only during pregnancy. In any case, notification of the doctor about the patient's condition is required.

Side effects

The response to ASIT in patients may not be predicted in advance.

Types of adverse reactions:

1. Systemic, which does not depend on the method of contact with the allergen. Manifestations include Quincke's edema, soreness of muscles and joints, etc.
2. Local, which is concentrated at the site of vaccine administration. It may manifest itself in the form of swelling, redness, itching, etc.

The cause of side effects may be:

• use of expired vaccine;
• violation of drug storage methods;
• incorrect dosage calculation, etc.

In case of a systemic side effect, after the injection, the patient is treated with the following treatment:

1. Apply a tourniquet above the vaccine injection site.
2. An injection of adrenaline is given at the site of the previous injection.
3. Eufillin is administered intravenously for bronchospasm.
4. An antihistamine is administered intravenously.

After the symptoms of the adverse reaction have subsided, the patient is kept under observation for another day.

Preliminary preparation of the patient for ASIT

ASIT therapy requires special training patient. Restrictions on the timing of passage apply to seasonal allergic reactions. In this case, treatment must be completed in advance, before the onset of the dangerous season. For allergies that are not tied to seasons, such as the flowering periods of certain plants, therapy can be completed at any time.

Important! To undergo allergen-specific therapy, a state of remission is necessary.

Preparatory activities:

1. Accurate identification of the allergen using allergy testing.
2. Minimizing (and best of all, completely eliminating) the patient’s contact with the allergen.
3. Antihistamines should be discontinued one week before therapy. The exception is a severe form of the disease. In this case, it is advisable to wait at least three days without antihistamines.
4. Absence of allergy diseases (influenza, respiratory infections etc.).

Treatment scheme

Depending on the severity and form of the disease, the doctor makes a choice in favor of one of the treatment regimens for the disease.

Treatment regimen mild degree allergies

The treatment regimen is selected individually for each patient and has two stages:

1. Imitating. This scheme is used for mild forms of the disease. Its duration is up to one and a half months. During this period, the doctor sets the dosage.
2. Supportive. At this stage, the vaccine enters the body in two ways: orally – three times during the week; by injection - once a week.

Treatment regimen for severe (advanced allergy)

The same two steps are followed:

1. Simulating (more than 120 days).
2. Supportive (six months).

Quick schemes

Such schemes are considered less effective than previous ones. The disadvantages include the high likelihood of side effects. The rapid regimen can only be carried out while the patient is in a hospital under constant medical supervision.

To the number fast circuits treatments include:

• shock, in which the vaccine enters the body at intervals of 120 minutes throughout the day;
• fulminant, when the vaccine is administered every 3 hours for 3 days;
• accelerated - administration three times a day.

Advantages and disadvantages of using ASIT therapy

Since ASIT is long-term treatment, designed for strict adherence to the rules of following medical recommendations by the patient, then the patient should be patient. The path to recovery can be long: from several months to several years.

Advantages of the method:

• prevents the transition from light form illness to severe;
• improvement of well-being;
• elimination of allergy symptoms and long-term remission;
• prevention of allergic reactions to other allergens;
• reducing the amount of antihistamines taken or completely stopping them.

Important! The result of therapy largely depends on individual characteristics body and strict adherence to doctor’s instructions.

The effectiveness of treatment depends on the following circumstances:

1. Strict adherence by the patient to the recommendations of the allergist.
2. The course of treatment was correctly selected and started at initial stage diseases.
3. Vaccines must be of high quality, with good timing suitability.

For your information! According to statistics, 9 out of 10 people treated allergic runny nose, after ASIT they recover completely.

In addition to the undeniable advantages, the ASIT method also has a number of disadvantages, including:

• the presence of the likelihood of side effects, which is significant with this method;
• high cost of treatment (up to 1000 for one vaccination, and several tens of thousands for a full course);
• a large number of contraindications;
• duration of treatment;
• Treatment can be carried out for children only from five years of age;
• Treatment cannot be given to people over 60;
• limited list of allergens that can be treated.

Price for ASIT

Depending on the city and specific clinic, as well as the type of allergy and severity of the disease, the cost of treatment may vary.

Price includes:

• vaccination;
• conducting skin tests;
• taking tests;
• consultation with an allergist, etc.

The initial cost for ASIT in Moscow looks something like this:

For St. Petersburg prices for ASIT:

ASIT: Reviews

The specificity of ASIT therapy is such that patient reviews vary greatly. In a number of cases, allergen-specific therapy brought tangible results and cure. In some patients, therapy did not give the result that the patient would have wanted. It is impossible to predict in advance the effectiveness of ASIT treatment, since much depends on the characteristics of the body and its reactions. Sergey Novikov, 36 years old, Moscow

I suffered from allergies for years during the flowering period of birch catkins. Had to take antihistamines large quantities, but year by year it got worse. I learned about ASIT treatment from a friend of mine. I thought it was innovative, so I decided to try it. I received therapy in the form of injections. The improvement is very noticeable. I took four courses. Antihistamines are now put away in the first aid kit; I no longer carry them with me. Karina Lazareva, 29 years old, Samara

The ASIT method helps me cope with dust allergies. I have only completed one course now. The symptoms became less severe. I think that it is necessary, as my doctor recommends, to undergo several more courses of treatment.

ASIT is 105 years old, but this method of treating allergies remains to this day the only way change the body’s attitude towards the allergen and reduce (or even prevent) an allergic reaction. How does this work? Is it dangerous? What types of allergies can be cured with ASIT? Our expert tells us - Evgenia VODNITSKAYA, second category doctor, allergist-immunologist medical center"AllergoCity".

POSSIBLE CONTRAINDICATIONS

SPECIALIST CONSULTATION REQUIRED

What is allergen-specific immunotherapy

The principle of operation of ASIT is based on the principle of a vaccine - only instead of a virus or bacteria, an allergen to which a person has increased sensitivity acts as an antigen.

Unlike vaccination, one injection of the allergen is not enough here - the dose is administered continuously over a long period of time, gradually increasing. As a result successful treatment the intensity of the reaction is reduced or reduced to zero, the development of more severe forms allergies and expanding the range of allergens.

Expert commentary

Allergen-specific immunotherapy is a treatment method in which treatment is carried out with small doses of a causally significant allergen. This treatment method can significantly reduce the manifestations of allergies upon contact with an allergen, and in some cases, completely get rid of symptoms. Rare, but treatment fails in some patients. The effect of treatment is assessed after 2 years of therapy; if it is absent, treatment is stopped.

Who is prescribed ASIT?

Such therapy is indicated in cases where the allergy is obvious, its cause is clearly traceable and confirmed during the examination (for this it is necessary to do skin allergy tests or a special blood test).

In other words, if for several seasons now you have been sneezing and bursting into tears when you see blooming birch and sensitivity to birch pollen is confirmed by tests, ASIT is your method.

Expert commentary

Indications:

1. Allergic rhinoconjunctivitis.

2. Bronchial asthma.

Allergen-specific therapy is carried out only if there is a clear connection between the appearance of symptoms upon contact with the allergen. If tests reveal sensitization, but clinical manifestations no, there is no treatment. With seasonal sensitization, it is necessary that exacerbations of allergies occur for two seasons in a row; with household sensitization, clinical manifestations must last for at least 6 months. Confirmation of sensitization by skin testing or determination of specific IgE is mandatory.

What types of allergies does ASIT treat?

Unfortunately, not all types of allergies can be treated with this method. Currently in Russia, treatment with ASIT drugs is carried out for 2 types of allergens:

• allergy to plant pollen (treatment can only be started outside the flowering season);
• household allergies(treatment can be started at any time).

Expert commentary

Treatment is possible for allergies to plant pollen and household allergens: house dust mites. In our country there are no registered drugs for the treatment of allergies to animals and hymenoptera; such drugs are available abroad.

How is the treatment carried out?

The main thing you should prepare for if you choose this method: the treatment will take a long time. The classic course of ASIT is designed for at least 3 years (or even 5 years) - this is how long it takes the body to form a stable immunity to the allergen.

Treatment is divided into two phases

First phase - dose set. At this stage of treatment, the dose of the administered allergen is gradually increased. This is done very slowly and under strict medical supervision to avoid unwanted reactions.

Second phase - maintenance dosage. At this stage, the effect of therapy is consolidated.

There are two main types of treatment

Injection method. During this treatment, a drug with allergens is injected subcutaneously into the lower third of the shoulder. First, the allergen is diluted to a ratio of 1: 1,000,000 (10ˉ⁶), then the dose begins to gradually increase. After reaching the therapeutic concentration, maintenance therapy begins. The main inconvenience of this method is that at first injections must be given daily or every other day (then less frequently), always in a doctor’s office and under his supervision. It can be especially difficult to follow this rule if a child is undergoing therapy.

Sublingual (sublingual) method. This treatment regimen is considered milder and side effects occur less frequently, although the risk remains here too. The main advantage of the method: the drugs - drops or tablets - can be taken at home, which means that such frequent visits to an allergist are not required, although strict medical supervision is also necessary with this method of treatment.

Expert commentary

Treatment is possible from 5 years of age. If this seasonal allergies, treatment begins in the autumn-winter period (depending on the drug), if household - at any time.

Sublingual medications can be used at home, but the first dose of the drug is always taken in the doctor's office and in the future you must regularly see an allergist.

Possible adverse reactions and contraindications

IN in rare cases When performing ASIT (especially by injection), adverse reactions, both local and systemic, are possible.

Localallergicreactions can develop within 20-30 minutes after injection and manifest as swelling, itching and redness at the injection site. Such phenomena are not dangerous, but may be the basis for dose adjustment.

Systemic allergic reactions may occur within a few minutes (in rare cases within 30-60 minutes) after the injection. Such reactions are a reason to revise or even cancel the treatment program.

At strict adherence rules, side effects occur extremely rarely and their manifestations are promptly corrected by the doctor.

Specific immunotherapy aims to reduce the patient's sensitivity to a causally significant allergen and prevent the formation of complexes between IgE antibodies fixed on the target cell and the allergen.

For more than 80 years (L. Noon, 1911), the principle of repeated administration of subclinical doses of specific allergens to patients in order to reduce hyperreactivity has been used, but the mechanisms of specific immunotherapy have not been fully studied.

Nevertheless, the original principle: the introduction of small doses of the allergen in order to reduce the risk of provoking an anaphylactic reaction and increasing antiallergic protection remains unshakable.

A number of position articles on SIT point to high efficiency this type of therapy.

The World Health Organization, together with leading associations of allergists, recommends that instead of the terms: specific hyposensitization, specific immunotherapy, allergen-specific immunotherapy - use for the name of the immunotherapy method allergic diseases the following designations: allergen immunotherapy, specific allergy vaccination, specific allergen vaccination, allergen vaccine, therapeutic vaccines for allergic diseases (January 1997 - WHO Position paper In Allergen Immunotherapy: Therapeutic vaccines for allergic diseases.

History of SIT

Starting with works English doctors L. Noon and G. Freeman (1911), specific hyposensitization or specific immunotherapy is prescribed for allergic diseases caused by immediate, anaphylactic type reactions. The SIT method has taken a strong place in the treatment of atopic diseases, the etiological factors of which are plant pollen, house dust, some insect allergens, molds, yeast-like fungi, etc. The use of SIT gives a high clinical effect.

The rationale for specific therapy in these cases is the identification of a specific IgE response to these allergens in patients as a leading indicator for prescribing SIT. Another condition for prescribing SIT for atropic diseases is the impossibility of eliminating a causally significant allergen from the patient or preventing the patient’s contact with etiological factor diseases.

It is quite clear that in this case, preparations of pollen and dust allergens justifiably occupy a leading place among therapeutic agents for SIT. IN recent years“non-eliminable” include mold fungi, allergy to which is detected in most patients bronchial asthma living in rooms with high humidity.

In the formation of infectious-allergic asthma important role play allergens of those microbes that live in the lower respiratory tract patients with infectious-allergic (infection-dependent) bronchial asthma.

J. Bousquet and F. Michel, considering the past, present and future of the method of specific immunotherapy, indicate that in recent years there has been significant progress in the quality of SIT performed by patients: therapeutic forms of allergens have been improved, optimal drug administration regimens have been developed, and ways to monitor the effectiveness of SIT , the possibilities for assessing “in vitro” indicators of positive changes in the immune system during allergen-specific therapy have been expanded. As a result of all the above shifts, SIT becomes reliable controlled method treatment of allergic diseases.

The main events that contributed to the improvement, recognition of mechanisms, and development of the SIT control system can be divided into seven stages in historical terms.

The first stage was led by the work of L. Noon and G. Freeman (1911) - the first work on immunotherapy. This stage can, apparently, be conditionally called empirical, because during these years (before 1920) positive experience in clinical application SIT.

Second important event, the beginning of the next extremely significant stage of research, summarizing attempts different authors To understand the mechanisms of SIT, R. A. Cooke (1920 - 1930) worked on identifying “blocking” antibodies in patients treated with SIT and studying the role of these antibodies in antiallergic immunity.

In 1931, G. Freeman proposed a shortened version of the SIT course, trying to reduce the intervals between allergen injections and change the doses of therapeutic allergens. These works served as a starting point for subsequent manipulations associated with change classical scheme SIT, which involved a gradual increase in the dose of the administered allergen at strictly designated time intervals. Despite the risk of inducing anaphylactic-type reactions with a short course of SIT, in a number of cases it was possible to obtain a good therapeutic effect as a result of specific treatment.

A new milestone on the path to improving the quality of SIT was the work of N. Bruun (1960), who first introduced the principle of the double-blind method in SIT. The principle of the double-blind method made it possible to obtain objective data on the effectiveness of the therapy and to compare the results of observations on SIT obtained in different clinics, by different specialists.

However, the decisive event in understanding the mechanisms of SIT was the work of K. Ishizaka, S. G. Johansson (1968) on IgE antibodies and a more in-depth analysis of the mechanisms of allergic reactions immediate type and allergen-specific antiallergic therapy.

Sixth period from 1970 to 1990 was characterized by an abundance of work on improving medicinal allergens. Modification of VSE was carried out using glutaraldehyde, formalin and other chemical modifiers. A series of allergoid forms of pollen, mite and other allergens were tested, which showed their higher therapeutic qualities in comparison with VSE. During this period, the question of standardization of drugs administered to patients arises, which develops into the problem of studying the structure of the most relevant allergens and the relationship between the composition and properties of allergens.

The problems of epitope mapping of allergens and the creation of their recombinant analogues arise. These problems have been raised and partially solved in the last decade. The seventh stage is 1990 - 2000. The structure of more than 80 atopic allergens has been deciphered, new therapeutic drugs have been obtained based on chemical modification of the main pollen allergens, and a direction for creating allergen vaccines of the future is being developed. Currently, some pollen allergy vaccines have already been created (see section “Aeroallergens”).

Thus, a historical analysis of the implementation of SIT in allergology shows that the improvement of the SIT method was carried out in parallel with the emergence of new data on the mechanisms of allergic reactions.
This process continues to this day.

Allergen-specific immunotherapy (SIT):

- this is a method of antiallergic treatment;
- aimed at the pathogenesis of allergic diseases;
- used for the treatment of allergic diseases caused by sensitization to pollen, epidermal, insect, fungal, bacterial allergens;

Indications for the use of SIT are:

• impossibility of eliminating an etiologically significant allergen;
• presence of confirmation of IgE-dependent hypersensitivity of the patient to a specific allergen.

Allergen-specific immunotherapy method

Treatment is carried out by allergists only in allergological offices and hospitals.

The choice of allergen (allergens) for SIT is carried out on the basis of data from a specific allergological diagnosis previously performed on the patient.

Specific diagnosis of allergic diseases is usually called a set of methods aimed at identifying an allergen or a group of allergens, causing disease at the patient.

Specific allergy diagnostics include:

• identification allergy history,
• performing skin allergy tests,
• implementation of elimination tests according to indicators (cessation of contact of the patient with the allergen),
• specific laboratory allergy diagnostics (in vitro), which is carried out with the aim of clarifying the etiofactor and characterizing individual links in the pathogenesis of the disease.

Allergen-specific immunotherapy is prescribed only on the basis of data specific diagnostics, allowing to identify a causally significant allergen or allergens, the degree of sensitization to these factors, the type of allergic reaction to a specific allergen.

In accordance with allergy diagnostic data, 1 - 3 causally significant allergens are identified, with therapeutic forms of which SIT is carried out.

When prescribing SIT, an allergist selects patients with IgE-mediated clinical manifestations of allergy to a specific allergen. The experience of previous researchers on the effectiveness of SIT with these allergens is also taken into account.

The principles of selecting allergens for specific immunotherapy are based on the fact that allergens are used for treatment:

• the elimination of which is impossible from the environment where a patient with hypersensitivity to this allergen lives (pollen from trees, grasses, flowers, mites, fungal spores, insect venom), the selection of regional forms is most preferable;
• which undoubtedly cause provocation allergic symptoms in patients.

The effectiveness of SIT is determined by the quality of the therapeutic allergen, the accuracy of patient selection, which, in turn, depends on the quality of the specific diagnosis performed. For better effect SIT is necessary wide range allergens, both diagnostic and their therapeutic forms.

You should also carefully evaluate the rationale for prescribing SIT and the patient’s individual ability to carry out such long-term treatment (up to 3 years), because only consistency in this case is the key to a good result.

The effectiveness of SIT is determined by:

• quality of medicinal allergen;
• accuracy of patient selection (depends on the ability to carry out full-fledged specific diagnostics, which allows identifying causally significant allergens);
• confirmation of the connection between the clinical manifestations of the disease in patients and a specific IgE response to a given allergen.

A prerequisite for carrying out SIT is a preliminary assessment of the patient’s individual sensitivity to medicinal forms allergens, which is carried out using the skin-titration method. Along with performing a prick test with a therapeutic allergen, prick tests are carried out with a 0.01% solution of histamine dihydrochloride (control-positive test) and a standard test-control (or diluting) liquid. The prick test is carried out in accordance with Methodological recommendations No. 10/20 dated March 10, 1985 “Diagnosing allergies using a prick test (prick test).”

Skin tests are performed on back surface forearms. The day before testing, it is not allowed to administer adrenaline to the patient, since the latter can weaken the skin's response to the allergen.

Contact of the patient's skin with a specific allergen is allowed:

• by scarification: diluted allergen is applied to a slightly scarified, non-bleeding area of ​​skin;
• by injection (according to Prick): a drop of the allergen is applied to the skin, and then a needle is inserted a millimeter through the drop, after which it is quickly removed;
• by injecting 0.01 ml of this allergen into the skin (it is recommended to carry out an intradermal test after preliminary scarification).

The reaction is assessed after 15-20 minutes. A reaction in the form of a blister measuring 5 mm (++) or less than 10 mm with hyperemia and pseudopodia is considered positive (+++) (Table 15).

Prick test technique: with sterile prick test needles, separate for each patient and drug, an injection 1.5 mm deep is made into the skin of the patient’s forearm.

Table 15. Evaluation of skin testing results using the Prick method

The results are recorded in test reports.

The initial therapeutic concentration of the drug will be the one that gives a weakly positive (or questionable ±) reaction in the patient when titrating the allergy vaccine.

Returning to the history of the introduction of SIT in Russia, the development of hyposensitization methods is associated with the name of Academician A.D. Ado and his school, which began its activities with the organization of a research allergological laboratory 40 years ago (NIAL AMS USSR).

Classic scheme specific hyposensitization for bronchial asthma and hay fever, it was introduced into allergological practice by employees of the research allergological laboratory of the USSR Academy of Medical Sciences (Yu. A. Poroshina, N. V. Adrianova, S. M. Titova) (Table 16). In this case, the diagnostic allergen in appropriate dilutions was used for SIT.

Table 16. Scheme of specific hyposensitization, which was used in the Scientific Research Institute of the USSR Academy of Medical Sciences (1961 - 1980)

Khutueva S.X., Fedoseeva V.N.

In most cases, doctors say that allergies cannot be treated and a person experiencing seasonal ailments or suffering from insect bites will have to live with it all his life. The ASIT method, which was discovered and successfully tested at the beginning of the last century, is gaining increasing popularity. Thanks to modern research and developments can be said that a kind of allergy vaccine can not only relieve symptoms, as antihistamines do, but also eliminate the cause itself - the immune response to foreign agents.

Content:

What is ASIT therapy

ASIT is an abbreviation for one of the methods in the treatment of allergies, allergen-specific immunotherapy. The method is not new; its successful use was described back in 1911. During this time, a lot of research was carried out, and the accumulated experience made it possible to create effective drugs, which are selected individually for each specific patient.

ASIT is based on the introduction of an allergen into the body in small, gradually increasing doses. among the people this method called the “allergy vaccine.” The effect is that the body gradually gets used to the allergen, reactions to it stop. Thus, they say that allergy treatment has been successfully completed.

It is known that until the allergen is eliminated, allergy symptoms can be relieved only temporarily; after discontinuation or cessation of the medication and continued exposure to the allergen, they return. ASIT therapy is not just getting rid of the symptoms of allergic reactions, but rather treatment when the body stops reacting to allergens, that is, does not perceive them as a foreign object.

The basis of the drugs used in allergen-specific immunotherapy are polysaccharides and proteins. When they enter the body of a person suffering from allergies in small doses, they are designed to stimulate the production of antibodies. This is a kind of therapeutic and preventive procedure for correcting the immune status.

Efficiency

ASIT is a fairly lengthy procedure, which, depending on the progress of treatment, can reach several years. It is important to follow all doctor’s recommendations and prescriptions.

It is advisable to undergo an examination and start therapy at the first signs of an allergy; not only the success of the treatment depends on this, but also the duration of the course. Under no circumstances should you try something like ASIT on yourself (inhale small doses of pollen, eat microdoses of foods that cause allergic reactions, etc.). Such experiments can end badly.

Vaccines are calculated by a doctor based on the collected medical history. During production, they are cleaned of foreign impurities and possible irritants. They are used only in medical office and under the strict supervision of a physician. In case of development acute reaction, which is possible at any stage, the doctor will be able to provide necessary help and further adjust the treatment.

Indications

ASIT therapy is prescribed in the following cases:

• hay fever (seasonal allergy to pollen, manifested allergic rhinitis and conjunctivitis);
• bronchial asthma;
• allergy to insect bites;
• the patient’s desire to undergo an ASIT course.

Allergen-specific immunotherapy is not practiced for atopic dermatitis, allergies to atmospheric phenomena ( sun rays, cold), Quincke's edema, animal saliva, medicines, mushrooms and mold. Among other things, therapy is not carried out if a person has a reaction to more than 3 allergens. In this case, there is a risk that the immune system may not cope with the load.

It should be noted that the method is recommended if the allergy greatly affects the patient’s quality of life. For example, with an allergy to pollen, which persists from spring to autumn, to insect bites, which are difficult to avoid, to animal fur.

Video: Indications for ASIT therapy and its benefits

Contraindications for carrying out

Treatment is not carried out during the period of exacerbation of allergic reactions, since additional exposure to allergens can be harmful. It is also dangerous to take the course under the following conditions:

• identification of reactions to 4 or more allergens;
• diseases of the heart and blood vessels, circulatory system and hematopoiesis;
• tuberculosis, rheumatism in the acute stage;
• diseases endocrine system(especially pay attention to the presence of thyroid diseases);
• liver and kidney diseases;
• malignant tumors;
• mental disorders;
• childhood up to 5 years;
• at severe course bronchial asthma, when lung function is impaired.

If a woman becomes pregnant while undergoing ASIT, doctors allow the therapy to continue, since it does not affect the condition of the mother and the unborn baby. But starting the course during pregnancy is contraindicated.

How is ASIT performed?

If a doctor recommends undergoing allergen-specific immunotherapy, you should listen to his opinion, since without treatment, allergy symptoms will increase over time, and then it will be more difficult to cope with them. For example, it is possible to go allergic cough in bronchial asthma. With the constant use of antihistamines, addiction to them occurs, as a result, it becomes more difficult to relieve allergy symptoms each time.

Preparation for ASIT

The start date of the course is planned in advance. This should be a period without exacerbations, that is, remission of the disease. So, when treating hay fever, the autumn-winter period is chosen.

Before carrying out therapy, a number of studies are carried out:

• complete blood count and urinalysis;
• spirography (graphic recording of changes in lung volume) is carried out for those who suffer from bronchial asthma;
• allergy tests to known irritants.

After the diagnosis, the specialist creates an individual course of ASIT, calculating the composition of the vaccine, its dosage and duration of treatment. If the drug is well tolerated (which is determined within approximately two weeks), the volume is gradually increased.

Before starting the course, it is important to completely limit the patient from contact with the identified allergen; if this is not possible, reduce it to a minimum. After this, a complete refusal of antihistamines is made (at least 7 days before the start of therapy, in severe cases 3 days are allowed).

Schemes for conducting ASIT

The classic scheme includes simulating and supporting stages. The simulating stage for mild forms of allergies lasts up to 1.5 months. During this time, the allergist gradually moves from minimal to maximum dose vaccines. The maintenance stage involves administering the vaccine once a week or 10 days. If the drug is taken orally (orally or sublingually), then 2-3 times a week.

For the treatment of patients with prolonged allergies, the simulating stage lasts 4 months or more, the supporting stage lasts from six months.

After one course, a break is taken, the duration of which is determined by the doctor, after which another 1 or 2 courses of treatment are completed to consolidate the result. Many patients note significant improvements after the first course of therapy, some notice a complete disappearance of allergy symptoms.

In addition to the classical one, there are other, more radical courses:

• so-called accelerated vaccination, when the drug is administered 3 times a day;
• lightning – every 3 hours for 3 days;
• shock method - in one day with a break of 2 hours.

Short-term treatment is carried out only in a hospital. Unlike classical ASIT therapy, it has a high risk of complications and is not as effective.

Methods of drug administration

The vaccine can be administered in several ways:

• subcutaneously - microdoses of the allergen are injected into the forearm area;
• orally – taken orally;
• sublingual - under the tongue, from where the drug slowly penetrates into the blood;
• intranasally - in the form of drops or sprays introduced into the nasal cavity;
• inhalation - inhalation of vapors through an inhaler.

The most commonly used methods are subcutaneous and oral. For children, non-injection administration is preferable, since in this case the development of side effects is minimized.

Please note: General health in the initial stages it may worsen due to the active fight of the immune system against the allergen. Over time, this condition will pass.

Side effects

It is impossible to accurately predict what the immune response to the introduction of an allergen into the body will be. Reactions can be local and systemic in nature. Local reaction manifests itself directly where the drug was injected, in the form of redness, swelling and itching. Systemic reaction affects other organs and systems. This may be Quincke's edema, muscle pain, dizziness, headache and others.

If symptoms of a systemic allergic reaction appear, the doctor applies a tourniquet a few centimeters above the vaccine injection site, injects adrenaline and intravenously antihistamine. For bronchospasm, aminophylline is administered.

If such reactions develop, adjustments in treatment are required. The decision to completely stop therapy is made by the doctor if he sees a threat to the health and life of the patient.

Disadvantages of ASIT

The main disadvantage of therapy is the duration of treatment, which reaches several years in some patients. In addition, there are other disadvantages of course treatment:

• a small number of acceptable allergens (no more than 3), while many people have reactions to many substances or products;
• thorough examination before undergoing therapy and an impressive list of contraindications;
• low effectiveness in severe allergies;
• high risk development of side effects, which are sometimes quite serious.

ASIT therapy is paid service. The price of one vaccine ranges from 500-700 rubles (possibly higher). The duration of the course depends, first of all, on the body’s reaction and its “addiction” to allergens, so it is difficult to calculate the final cost of treatment at the initial stage.

Important: Every potential patient, when deciding to undergo ASIT, should be aware that in some cases it turns out to be ineffective. Even after repeated courses of vaccine administration, reactions return.

Video: What is allergen-specific immunotherapy. The most frequently asked questions and their answers

Cost of ASIT

The average cost in Russia varies depending on the region of residence and consists of a consultation with an allergist (about 1000-1500 rubles), preliminary diagnostics (skin tests with one allergen cost between 500-700 rubles), and a full course of therapy. In Moscow average price the course costs from 20,000 rubles (for one allergen), maintenance therapy – from 9,000 rubles. Often 1-2 repeated courses of treatment are required.

It should be understood that the cost will be individual for each patient. This depends on the average pricing policy of the region, the composition of the vaccine and the duration of the course.