Allergy & Asthma Center Islamabad

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ORAL ALLERGY VACCINE (OAV) OR SUB LINGUAL IMMUNOTHERAPY (SLIT)

For the first time in UAE & Pakistan. Dr. Shahid was chief Allergy Centre & Allergy Vaccine Production in National Institute of Health for long time. He was trained by WHO in Production, QC and Standardization of Allergy Vaccines in USA. He is pioneer in production of Oral Allergy Vaccine in Asia in year 2000 when it was still research product in other parts of the world and in 2005 all his patients switched from injectable Allergy Shots to Oral Allergy Drops or SLIT.

Recommended by the World Allergy Organization to be safe and effective and minimal chances of reactions as compared to original injectable allergy shots

  • Specially for small children, very old people and patients who live abroad and there is no facility of injections
    Specially designed Bottles/Dispensers for Oral Vaccine

Important Message of Dr.Shahid

Allergy is genetically transmitted immune disease which progresses both in severity and frequency and may lead to serious diseases like Asthma or allergic reactions in spite of medicines like antiallergics and steroids. Allergic person has specific genes of allergy which are present in the cells of the body and are there for lifetime. SPECIFIC Oral Allergy Vaccine or even Allergy Shots are the only scientifically proven treatments for allergic diseases.
Although most patients respond with in first three months, but some may take about 6-8 months to respond. If you are having less than 50% improvement in the first 6 months then it may discontinued on discretion of the patient

How to take the Allergen Extract

The bottles are like a miniature soap dispenser and each bottle needs to be “Primed” when first used by pressing down completely a few times. Parents should administer doses to their children.The dose is measured in FULL PRESSES.

  • Take in the morning on an empty stomach Keep under tongue for at least 2 minutes, then swallow.
  • The drops have a sweet taste it may be unpleasant for some. Children can suck a lollie/sweet at the same time
  • Do NOT eat or drink anything for 15 minutes; the allergen is partially absorbed from under the tongue so if you eat/drink you may wash it away.
  • Avoid crunchy cereals in the morning; they can cut the mouth lining & increase irritation.
  • If you have had dental treatment or mouth ulcers, you may need to stop fora few days until it heals up, as broken mouth tissue may increase the risk of mouth irritation.
  • If you forget to take them in the morning, take before bedtime instead
  • If you are taking 2 separate extracts, it is best to separate them by 5-15 minutes if possible. Or you can take one in the morning and one in the evening if there are no significant side-effects in the first 2-3 weeks. If not possible, you can take them at the same time.

If you Stop Treatment Temporarily

  • If there has been less than a 1-week gap, go back to your usual dose.
  • If you have stopped for more than a week, go back to the beginning of the protocol and build up to the maintenance dose again

Side-effects of Oral Immunotherapy

  • Irritation or itching or swelling inside the mouth (common).
  • Stomach upset, stomach or chest pain (uncommon)
  • Throat swelling, tight chest, asthma, rash (rare)

Controlling Side-effects

  1. Mild side-effects can usually be controlled by temporarily reducing the dose or by taking an Anti-histamine the night before. The itchy mouth usually settles after 4-6 weeks so feel
  2. Free to take a daily antihistamine the night before if needed. Local itch can also by directing the liquid to under the side of the tongue if under the front of the tongue causes bad irritation.
  3. If more severe side-effects occur (e.g. throat swelling, difficulty breathing, bad stomach/chest pains), seek medical attention, stop treatment and contact
  4. Dr Shahid for further advice.

Ongoing bad Side-Effects

Let Dr Shahid Know!

  • If local itch and swelling does not settle, change the location of administration to behind the lower lip in front of the teeth, hold 2 minutes, and then swallow.
  • If nausea/stomach upset is bad, then hold in the mouth for 2-3 minutes, then spit out the allergen into the sink (not swallow). This may reduce effectiveness but is better than not being able to tolerate the treatment at all. The above advice is based on theoretical aspects, the distribution of cells in the mouth that trigger side-effects compared to immunotherapy benefit, one small trial presented at a European meeting in 2012 and expert advice.

Delivery Takes 1 Week by Courier

This will require forward planning by patients and their doctors to ensure that there are no gaps in treatment schedules due to extracts “running out”. Make sure you order more allergen no later than when you are on the second-last bottle of your Current supply. Keep the 1st dilute bottle in case you need to go back to it.
Important dates
Your initial allergen order will last 12 WEEKS
Allergen will run out in about 12 weeks.
You should order more allergen in 10th week with details about your progress
Suggest review

  • Your referral expires 6 MONTHS
  • Planned treatment (if works) is 3-5 yrs.
    If ineffective, options are those of:
  • Medication;
  • Higher oral doses; or
  • Switching to immunotherapy injections

Estimated costs are provided as a guide
Estimates are per allergen extract. Estimates are approximate since technique may determine actual allergen volume dispensed, and cost estimates are based on calculations, manufacturer and distributor costs that may change without notice.
Each bottle contains sufficient to last for about one month or 28days but one loses some volume (~ 2 doses) when priming the device for initial use or accumulation of air in the device so IT IS STRONGLY RECOMMENDED THAT THE CAP SHOULD BE LOSENED AND TIGHTEN AGAIN AFTER EVERY USE.

FREQUENTLY ASKED QUESTIONS

SLIT or Oral Allergy Drops (No Needles, No Injections)

Allergen Immunotherapy is a type of preventive treatment for allergens such as pollen, mold, dust mites, foods and animal dander. While medications such as antihistamines and nasal sprays only treat the symptoms, Allergist prescribed appropriate Allergen immunotherapy treats the underlying cause of the allergic reaction by inducing Immune tolerance to these antigens. It is done by administration of gradually increasing amounts of the specific antigens.
Until recently, the only way to successfully administer Allergen Immunotherapy in the United States was by injections (allergy shots) at the Allergist’s office. Oral Allergy Drops or Sublingual immunotherapy is now being offered by many Allergists in the United States, most countries of Europe and is an injection-free procedure that offers patients the freedom to treat their allergies conveniently in their own home.

There are numerous advantages of sublingual immunotherapy:

Main Advantage:

  • No needles, No Injections, No Shots!Much Less
  • Risk of Systemic Anaphylactic Reaction, so that sublingual immunotherapy can be administered at home.
  • Time Savings: Treatment is administered once a day at home in a matter of minutes, eliminating the need for travel and wait in the doctor’s office, and the mandatory 30 minute post injection observation period that is required after allergy injections.(Average: 60 minutes in Allergist’s Office plus the to and fro travel time)
  • For patients living a great distance from the Allergist’s office or for patients who travel frequently, sublingual immunotherapy offers the only way they can get Immunotherapy.
  • For working people (including full time moms) with very busy schedules, for children who cannot miss school or sports, for professionals who cannot miss work , and for anyone who just does not have the time to go sit in the Allergist’s office every week, this is the solution.
After your complete Allergy Evaluation if the treatment plan designed for you includes Inhalant Allergen Immunotherapy, your Health Care Provider will discuss injection and sublingual immunotherapy alternatives with you. Depending on the route you choose, appropriate allergy vaccine kit will be prepared for you, usually within one week. We will then need to see you in the office to answer all your questions, to have you sign the consent forms, to have you take the first dose in our presence, to observe you for at least a half an hour for any reactions, and to give you detailed instructions. If it is sublingual vaccine, you may then take your treatment vials with you for administration of daily doses at home. We will provide you with written dosing guidelines and renewal instructions and answer all your questions.
Although treatment success varies from patient to patient, we anticipate improvement within the first few months of treatment. Maximum benefit may take a year or so of regular therapy. Adjustments to your dosing may be made as the treatment progresses and the vaccine vials are renewed. We will expect you to keep us informed about how you are responding to the treatment. Of course, we will see you for periodic office visits on a regular basis.
There are no age restrictions for sublingual immunotherapy, although it is rare to begin any form of immunotherapy prior to age five.
We have developed special SLIT or OAV dispenser and dose has been optimized for each patient. One accentuation of the OAV daily early morning according to following instructions and video. The Oral vaccine can be refilled at the end of every month or one can have the vaccine which will last for 3 months or more. We will need to see you in the office every three months at least thru the first year and then less often.
The allergy vaccines are provided in convenient Oral Allergy Vaccine Dispenser with a pump dropper mechanism that dispenses accurate and exact drop size. Dosing should be done in the morning, preferably before breakfast. Rinse your mouth real well, open your mouth, lift your tongue so it touches the palate, then place the correct number of Drops under the tongue and hold it there for 2 minutes. There will be some salivation. Let it spread the vaccine under the tongue. Resist the impulse to swallow for two minutes by the watch. You can then slowly swallow the vaccine. A minimum period of two minutes of contact is necessary to ensure that the dendritic cells in the mucosa can firmly grab the antigens for transfer to the lymph tissue. Do not spit out the vaccine (except in the very unlikely event that you notice symptoms such as severe itching or swelling of the tongue) and do not eat, drink or rinse your mouth for a period of 5 minutes after dosing. After that, there are no restrictions on eating or drinking.
Due to the glycerin additive mixed with the extract, there may be a slight sweet taste. However, since there are no taste buds under the tongue, most patients experience very little taste except momentarily when swallowing at the end.
All kinds of immunotherapy, carries extra risk if you are taking a beta-blocker medication (usually used for high blood pressure, fast heartbeat, heart rhythm problems or glaucoma). Please inform your other doctors and pharmacist to warn you if any beta blocker containing drug is prescribed to you. If so, or if you are not sure what the medication is, please call our office and discuss before taking any more dose of the vaccine.
Reported reactions to sublingual immunotherapy include itching of the tongue or lips (the most common reaction), gastrointestinal symptoms such as nausea and cramping, skin rashes including hives, and very rarely headaches. Systemic reactions (anaphylaxis) have been reported and may include symptoms such as throat tightness, wheezing, and a drop in blood pressure. These systemic reactions are extremely rare; there has never been a reported incidence of a fatal reaction to sublingual immunotherapy. However, you must always have an oral antihistamine available for mild local reactions, as well as an Epinephrine auto-injector (Epi-Pen®) available for systemic reactions. These precautionary measures will be discussed with you at the time sublingual immunotherapy is initiated.

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