Exploring injectable allergy medicines as the season extends

Epinephrine

Epinephrine is arguably the most well-known injectable allergy medication. This medication is intended to treat severe allergies, specifically those that result in anaphylaxis.

Many individuals with severe food allergies carry epinephrine injections in the form of an EpiPen, which is an epinephrine auto-injector. However, epinephrine can also be used to manage severe environmental allergies.

When exposed to an allergen that results in an anaphylactic reaction, an epinephrine injection can reduce or reverse the reaction, opening up airways, reducing swelling and minimizing hives and itching. The drug can also help maintain heart function and modulate blood pressure during these episodes.

This medication is not intended as a preventative tool or regular allergy treatment. Instead, it is a first-line emergency response medication for severe allergic reactions.

Side effects of this medication include difficulty breathing, irregular heartbeat, pale skin, sweating, nausea, vomiting, dizziness, weakness, tremors, headache and anxiety. Although not everyone will experience these side effects, those with side effects will see them resolve within a few hours.

Corticosteroids

Another treatment for allergies is corticosteroid injections, such as methylprednisolone and dexamethasone.

Corticosteroids are a complex class of drugs that work by reducing inflammation and suppressing the immune system. They can be used to manage a host of conditions, including rheumatoid arthritis, inflammatory bowel disease, asthma and allergies.

For allergies, long-acting corticosteroid injections minimize inflammation as the drug is slowly released into the body, which can alleviate or resolve allergy symptoms. The effects of these injections can last anywhere from three weeks to three months.

However, these drugs can result in many short- and long-term side effects. Short-term side effects include anxiety, insomnia, easy bruising, thinning skin, weight gain, mood swings, hypokalemia, hypertension and high blood sugar. Over time, prolonged use of corticosteroid injections can cause glaucoma, diabetes, cataracts and several other chronic healthcare conditions.

Corticosteroid injections can be administered intramuscularly or subcutaneously.

These drugs can be a powerful tool in managing severe allergic conditions. They offer quick relief and long-lasting effects, but their use should be carefully monitored to balance benefits with potential side effects.

Monoclonal antibodies

Monoclonal antibodies are laboratory-made proteins that stimulate the immune system. These treatments have been used to treat several diseases, including cancer, organ transplant rejection, autoimmune disorders, infectious diseases, migraines, osteoporosis, ocular conditions and high cholesterol.

Monoclonal antibody injections are a newer class of allergy treatment, effective for chronic allergic conditions like asthma and certain types of allergic rhinitis. They are designed to target specific proteins or cells involved in allergic reactions.

There are two common monoclonal antibodies for allergies:

• Omalizumab (Xolair). Omalizumab is used to treat moderate to severe allergic asthma and chronic idiopathic urticaria. It works by binding to IgE and preventing it from attaching to mast cells and basophils, reducing allergic reactions.
• Dupilumab (Dupixent). Dupilumab is approved for moderate to severe asthma, atopic dermatitis and chronic rhinosinusitis with nasal polyps. This monoclonal antibody inhibits IL-4 and IL-13 signaling, which reduces allergy-induced inflammation.

Unlike other allergy medications that might work to alleviate allergy symptoms, monoclonal antibodies provide a targeted therapy that addresses underlying allergy mechanisms.

According to a 2023 article in Allergo Journal International, "Anti-allergen antibody therapies are now being developed that are likely to change the therapy landscape of allergies as they progress through clinical testing. Anti-allergen antibody therapy, or passive immunization, has the potential to quickly and safely protect against allergic reactions while reaching a bigger population of allergic patients currently excluded from [allergy immunotherapy]."

Although the exact safety profile varies based on the type of monoclonal antibodies, some side effects of these treatments include injection site reactions, headaches, muscle pain, stomach pain, blood pressure changes, fever and shortness of breath.

Monoclonal antibodies represent a significant advancement in allergy treatment. They offer targeted and effective options for managing chronic allergic conditions and provide a new avenue for patients who might not respond adequately to traditional therapies.

Allergy immunotherapy

Another type of injectable allergy medication is allergy immunotherapies, also known as allergy shots. These treatments are long-term therapies used to reduce allergy symptoms over time.

Allergy immunotherapy aims to desensitize the immune system to specific allergens, reducing the severity of allergic reactions over time. It involves administering gradually increasing doses of the allergen to build tolerance.

There are two types of allergy immunotherapy. Subcutaneous immunotherapy (SCIT) is delivered via subcutaneous injection in the upper arm by a healthcare provider in a healthcare setting. The other type is sublingual immunotherapy (SLIT), which is delivered orally under the tongue. SCIT is more common than SLIT.

The American Academy of Allergy Asthma and Immunology (AAAAI) compares allergy shots to vaccinations. These treatments involve injecting a patient with a particular allergy at increasing doses so the patient develops immunity or tolerance to the allergen.

There are two phases for allergy shots: the build-up and maintenance phases. During the build-up phase, patients receive injections of the allergen with increasing doses up to two times per week. Although the length of the build-up phase varies by patient, it typically lasts between three and six months.

Once patients reach the effective dose, they enter the maintenance phase, where they only get injections every two to four weeks. The exact treatment protocol is based on multiple factors, including the patient, the allergen and the level of sensitivity.

Risks of these treatments include injection site reactions, allergy symptoms and, in rare cases, anaphylactic reactions.

The AAAAI notes, "Allergy shots decrease sensitivity to allergens and often lead to lasting relief of allergy symptoms even after treatment is stopped. This makes it a cost-effective, beneficial treatment approach for many people."

Allergy immunotherapy injections are a practical option for long-term management of specific allergies. They offer the potential for significant symptom relief and can improve the quality of life for individuals with persistent allergic reactions.

Veronica Salib has covered news related to the pharmaceutical and life sciences industry since 2022.