Hay fever: who does the allergy vaccination help?

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

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Bye, hay fever! Autumn is ideal for starting specific immunotherapy. A new test could soon predict who will actually be affected by the complex treatment.

In the meantime it often starts in winter: Lured by warm winds, the first pollen whirls through the air. For hay fever patients, the period of suffering begins earlier and earlier. Antihistamines can bring relief, but they only dampen the allergic reactions. .

"The causes of an allergy are currently only tackled by specific immunotherapy," says Dr. Adam Chaker, Head of the Allergy Outpatient Clinic at the University Clinic on the right of the Isar, in conversation with

Three-year therapy marathon

However, allergy sufferers have to put in some effort for the therapy formerly known as "desensitization": Depending on the drug, they have to inject one to two small and then steadily increasing doses of the allergen in question in the first one to six weeks. Such “vaccinations” against hay fever contain proteins from the pollen concerned, for example. You can't do it yourself: In the event that severe allergic reactions occur, the syringe must be placed in medical care.

Then another syringe is required every couple of weeks for three years. The idea behind it is to teach the body to tolerate the harmless proteins instead of reacting with an excessive immune response. "Basically, it works in a similar way to learning in the brain - we perceive stimuli that occur frequently less and less," says the researcher.

"Many drop out prematurely"

But there is a catch: "Many patients stop treatment prematurely," says Chaker. It is too complex and tedious for them. Above all, however, it does not help everyone, even if they hold out the therapy to the end.

The team around Chaker and his colleague Prof. Carsten Schmidt-Weber from the Helmholtz Zentrum München have now developed a method that can predict for which patients the syringe marathon is likely to pay off.

The Munich researchers meticulously observed how the human immune system reacts to the specific immunotherapy. And discovered some previously unknown mechanisms.

Above all, they have identified a new main actor in the allergy drama: the so-called regulatory B cells. They act as an antagonist to the immune cells that otherwise fuel the allergy. "The regulatory B cells have so far hardly been taken into account in this context," says the researcher. They appear especially in the first act of treatment. Only later do other immune cells step on the stage and take over their work: the regulatory T cells.

Early test shows chances of success

What is particularly exciting for patients, however, is that the chances of success of the therapy can be assessed early on from the number of regulatory B cells. If the body's defense system mobilizes a large number of them at the beginning of the therapy, and if the number of certain T cells (T17 cells) is particularly low at the same time, the treatment is very likely to work.

The researchers observed this connection in 30 of their 32 subjects who were severely affected by hay fever. After three years, they suffered fewer and less severe allergy symptoms, needed less medication and their quality of life had improved more. In the others, the condition even worsened - which, however, is more likely to be attributed to an atypical, aggressive course of the disease than to the therapy, suspects Chaker, who also knows such cases from his office hours.

Patience is required

“If our test is ready for series production, we could save patients with a low chance of success from expensive treatment. If the result is positive, however, the test provides good arguments for continuing the three-year therapy through to the end, ”explains Chaker.

Because the patients have to bring stamina with them - this is also underpinned by the study. For three years, the ratio of regulatory and allergy-firing cells meanders back and forth, also depending on the pollen load in the air. "If I break off during this period of oscillation, the probability is high that the vaccination will not work," says Chaker. Only after three years does the back and forth of the immune cells stabilize and the success is permanent.

Most patients, however, felt an improvement in the first year. "The mere fact that you go to the doctor reduces the symptoms," says the experienced allergist. Around 30 percent of the effect was due to such a placebo effect.

Conversely, if the symptoms are just as strong or stronger than in the previous year, this does not mean that the therapy is not working. “Maybe the pollen count is just a lot stronger during the season,” says Chaker. In the spring of 2018 alone, there was three times as much birch pollen on the road as usual and it was difficult for allergy sufferers. "In such cases, many stop the therapy even though it actually works," says the allergist.

Good chances for everyone who perseveres

Overall, the chances are good that the syringe marathon will also work. A pollen allergy sufferer has a 70 to 90 percent chance that the specific immunotherapy will work without any additional complications. This not only means fewer bothersome symptoms, fewer acute medication and a better quality of life - it also means a significantly reduced risk of hay fever turning into asthma. For people with a house dust allergy, against whom specific immunotherapy is also often used, it is slightly lower at 30 to 70 percent.

Why it doesn't work out sometimes

“But that only applies if the allergens are well characterized,” says the allergist. “Well characterized” means that you know exactly what the patients are allergic to. This is not easy to find out and should always be checked by an experienced allergist. Because if the right allergens are not in the vaccine ampoule, the specific immunotherapy cannot logically work.

Even in complicated cases, in which the patients have already developed allergic asthma or are allergic to many different allergens, things become more difficult and the success rate of immunotherapy decreases.

And which medication you choose could also have an impact on success. There are indications that therapeutic agents that act faster and shorten the annoying first dose increase phase from six to one week are less effective than the long version.

The most important message is, according to Chaker: “The allergy vaccination is working!” Now it is important to find out why some patients still do not benefit from it. The findings from the current study provide the first crucial basis for this.

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