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Allergies are annoying and can significantly impact daily life. Instead of just treating the symptoms, I wanted to address the root cause, which is why I chose to undergo grass pollen immunotherapy. In this article, I’ll share my experiences and explain how this treatment helps the immune system become less reactive to allergens.

For those who have been following my blog for a while, you might remember my article on allergies from 2017. If you're interested in general facts about allergies, please click here. In this post, I’ll focus primarily on allergy testing procedures, immunotherapy, and my personal experiences with them.

My Allergy History

I have been suffering from grass pollen allergies since I was 14. Although studies suggest that allergies are more common in children who spend less time outdoors, this wasn’t the case for me. As a child, I was always out on my bike, exploring the woods and fields. However, this did not spare me from allergies.

The main symptoms manifested as a runny nose and constant sneezing. Over the years, the symptoms worsened, but I mostly accepted the situation. It wasn’t until I was 26 that I had an allergy test done, which confirmed my suspicions: grass pollen was the main trigger for my allergic reactions. From that point on, I deepened my understanding of allergies, wrote an article on the subject, and tried to manage my symptoms with second-generation anti-asthmatic medications. I had considered immunotherapy several times but kept postponing it. In 2023, when the pollen season felt worse than ever, I made myself a promise: I never want to go through that again.

I wanted a long-term solution, so I decided to start immunotherapy. At the beginning, a new allergy test was necessary, as allergic reactions can change over time, and it’s important to get an up-to-date assessment of the triggers.

The PRICK Test (Percutaneous Reactivity Test)

The Prick Test is used to test for common allergens such as mold and dust mites, as well as specific allergens that might be suspected based on household pets and seasonal conditions. This procedure is standard in many allergy clinics.

In my case, the situation is as follows: we have a dog, two cats, and two rabbits at home. I don't experience any allergic reactions when in contact with the animals. Personally, I notice most symptoms exclusively during the grass pollen season, which is most intense in Austria during April, May, and June. During my Prick Test, all common grasses, herbs, and tree pollens were specifically tested.

The Prick Test examines the skin's direct reaction to specific allergens, with results becoming visible within minutes through localized allergic reactions on the skin. The great advantage of this test is that it allows the simultaneous examination of a wide range of allergens.

In my Prick Test, it became clear that grasses and ash were particularly irritating. The test also showed mild irritation to cat hair and plantain, as well as very minimal irritation to dog hair. Interestingly, I personally don't notice any reactions when in contact with our pets, even though the dog and cat sleep in our bed.

With these results, the following RAST Test (blood test) can specifically examine those allergens that reacted positively in the Prick Test.

The RAST Test (Radioallergosorbent Test) 🩸

Unlike the Prick Test, where the results are immediately visible, the analysis of the RAST Test typically takes a few days to weeks. Here are my results:

What Does This Mean?

IgE Antibodies: IgE antibodies are special defense substances in the blood that play a role in allergies. When you touch or inhale something that triggers an allergic reaction, your body produces these antibodies. Upon subsequent exposure to the allergen, these antibodies react, causing allergic symptoms. Simply put: the more IgE antibodies present in the blood, the stronger the reaction to specific allergens.

Total IgE: Even a total IgE level within the normal range, as in my case with 6.18 kU/L (kilo units per liter), does not automatically mean you're free from allergies. For reference, my value in 2017 was 7.51 kU/L.

This value only provides a general estimate of the amount of immunoglobulin E (IgE) in the blood. A normal total IgE level doesn't rule out specific allergies, nor is it a guarantee that allergies won't develop or worsen in the future. It serves as a rough guide rather than a precise indicator of an allergy.

Specific IgE: Specific IgE refers to the antibodies in the blood that target a particular allergen. Unlike the total IgE value, which offers a general overview, the specific IgE value provides more detailed information about sensitivity to certain allergens.

Interpretation of Classes:

In 2017, my specific IgE for grass pollen was 1.70 kUA/L, with the test conducted in July. In the most recent test in October 2023, the value was 0.99 kUA/L. Both values, 0.99 and 1.70 kUA/L, fall into class 2, indicating moderate sensitivity. The decrease might be due to the fact that grass pollen was no longer circulating at the time of the test, which could have lowered the IgE levels. However, it could also indicate that my allergy levels have genuinely improved. Regardless of the cause, the value suggests that immunotherapy would still be a good course of action.

Differences from the PRICK Test: Although my PRICK test showed an elevated reaction to ash pollen, the RAST test only indicated increased IgE antibodies for grass pollen. This could be due to cross-reactions between certain allergens. For example, some grass pollens contain proteins similar to tree pollens. Additionally, the PRICK test measures an immediate skin reaction to the allergen, while the RAST test measures the level of specific IgE antibodies in the blood. Therefore, one test might show greater sensitivity to an allergen than the other. This is why both tests are important: the PRICK test helps identify what irritates the skin, while the RAST test determines the IgE antibody levels.

My Official Diagnosis: Grass pollen allergy 

How Does Immunotherapy Work?

As previously explained, the immune system of an allergic person produces specific antibodies known as immunoglobulin E (IgE) when coming into contact with an allergen. These IgE antibodies bind to mast cells and basophils in the body. Upon subsequent contact with the allergen, the allergens bind to the IgE antibodies on the surface of these cells, causing them to release histamine and other chemicals that trigger allergic symptoms.

Immunotherapy aims to gradually acclimate the immune system to allergens through injections or tablets to minimize or eliminate allergic reactions. The dose of the allergen is gradually increased to promote the immune system's tolerance to the allergen.

Injections or Tablets?

Immunotherapy can be administered either through injections or via tablets or drops. Depending on the diagnosis, the allergist will determine the appropriate treatment method.

• Subcutaneous Immunotherapy (SCIT):
  This involves injections administered by a doctor. This is the more traditional method and is often used for patients with multiple allergies or more severe allergy symptoms. (Subcutaneous refers to administering medications or vaccines into the fatty tissue just beneath the skin, rather than into the muscle as with typical vaccinations. This method is often chosen because it tends to be less painful and allows for a slower release of the medication into the bloodstream.)
  
  

• Sublingual Immunotherapy (SLIT):
  This method involves tablets or drops placed under the tongue. SLIT is often more convenient, as it can be performed at home.
  
  

• Epicutaneous Immunotherapy (EPIT):
  In this approach, allergen extracts are applied to the skin, often using a special patch that contains the allergens. However, this method is not as widely used or well-researched as SCIT or SLIT. The goal is to stimulate an immune response through the skin without injections or oral medications.
  
  

And Which Method is Most Effective?

Both SCIT (subcutaneous immunotherapy) and SLIT (sublingual immunotherapy) are considered very effective for treating allergies. SCIT has long been established and has proven effective for many types of allergies. In comparison, SLIT's effectiveness may not quite match that of SCIT for some allergies. EPIT, on the other hand, is less well-researched and has generally been found to be less effective than SCIT and SLIT.

Tolerance Development

Over time, the immune system learns to tolerate the allergen, a process known as desensitization. The immune system begins producing less reactive antibodies, known as immunoglobulin G (IgG), and fewer IgE antibodies. Additionally, a type of immune cell known as regulatory T cells is activated. These cells help modulate the immune response to the allergen and reduce inflammatory reactions.

Effectiveness and Long-Term Outcomes

The effectiveness and duration of tolerance development can vary depending on the type of immunotherapy and individual genetic factors. There are three categories to distinguish:

Long-Term Tolerance: There are cases where individuals develop permanent tolerance to the allergen after completing their immunotherapy course. This means that their allergic reactions are significantly reduced or even completely eliminated, and these improvements persist even after the therapy ends.

Need for Additional Therapy: In most cases, individuals require further treatments or support through medication to manage their symptoms, especially if they are allergic to multiple allergens.

Continuous Treatment: Sometimes, it is recommended to continue immunotherapy annually in cycles to maintain tolerance to the allergen.

What Does Immunotherapy Cost?

This is probably the most important question for many, but unfortunately, I can't give a definite answer. In many countries, immunotherapy can be quite expensive, often costing hundreds to thousands of dollars or euros. I am fortunate to live in Austria, where the costs for tests and subsequent immunotherapy are fully covered by health insurance. For me, the entire process is free of charge. If you want to know how much such a therapy would cost for you, you should check with your insurance provider or consult a specialist.

When Is the Best Time to Start Immunotherapy?

If you have an allergy to specific types of pollen, like me, that are prevalent in the spring and summer, it’s best to start the therapy during the off-season, meaning in the fall and winter months when pollen is less or not circulating. Even though it doesn’t affect the success of the immunotherapy, it’s easier to interpret symptoms after an injection or tablet intake when you’re not being influenced by circulating allergens. This makes it easier to monitor the therapy.

Which Therapy Am I Undergoing?

At the end of October 2023, I had my allergy test at the allergy clinic. I was recommended for subcutaneous immunotherapy. Based on the clinic's test results, medication was specially prepared for my grass pollen allergy. It took about a month before I received it. The medication must be kept refrigerated to maintain its stability. At the end of November 2023, I began the immunotherapy. Before each injection, I take an antihistamine (in my case, cetirizine) about an hour in advance to alleviate any possible symptoms. Below, I list the injections and the associated time commitment to give you an insight into the process of immunotherapy. Please note that the procedure may vary depending on the type of allergy and therapy. For me, it started with one injection per week and later transitioned to one injection per month.

The vials are tailored to my specific allergy and individual levels, which is why they contain different concentrations. To avoid confusion, the vials are color-coded. The vials are assigned as follows:

I - Allergen extract from Timothy grass pollen (100 U) – Grey vial
II - Allergen extract from Timothy grass pollen (1000 U) – Green vial
III - Allergen extract from Timothy grass pollen (10,000 U) – Orange vial
VI - Allergen extract from Timothy grass pollen (100,000 U) – Red vial

After the successful buildup phase, the continuation therapy will proceed with the highest dosage of the strongest allergen extract (red vial).

My Immunotherapy Process

Build-up Phase – Weekly Injections:

• Immunotherapy session on November 22, 2023
  Treatment: Subcutaneous immunotherapy against grass pollen with an injection of 0.2 ml (Gray vial)
  Symptoms: None

• Immunotherapy session on November 29, 2023
  Treatment: Subcutaneous immunotherapy against grass pollen with an injection of 0.4 ml (Gray vial)
  Symptoms: None

• Immunotherapy session on December 6, 2023
  Treatment: Subcutaneous immunotherapy against grass pollen with an injection of 0.8 ml (Gray vial)
  Symptoms: None

• Immunotherapy session on December 13, 2023
  Treatment: Subcutaneous immunotherapy against grass pollen with an injection of 0.2 ml (Green vial)
  Symptoms: None

• Immunotherapy session on December 20, 2023
  Treatment: Subcutaneous immunotherapy against grass pollen with an injection of 0.4 ml (Green vial)
  Symptoms: None

• Note: No immunotherapy was conducted on December 27, 2023 as the clinic was closed for vacation. Due to this interruption, the dose will not be increased at the next therapy session.

• Immunotherapy session on January 3, 2024
  Treatment: Subcutaneous immunotherapy against grass pollen with an injection of 0.4 ml (Green vial)
  Symptoms: None

• Immunotherapy session on January 10, 2024
  Treatment: Subcutaneous immunotherapy against grass pollen with an injection of 0.8 ml (Green vial)
  Symptoms: None

• Immunotherapy session on January 17, 2024
  Treatment: Subcutaneous immunotherapy against grass pollen with an injection of 0.2 ml (Orange vial)
  Symptoms: None

• Immunotherapy session on January 24, 2024
  Treatment: Subcutaneous immunotherapy against grass pollen with an injection of 0.4 ml (Orange vial)
  Symptoms: None

• Immunotherapy session on January 31, 2024
  Treatment: Subcutaneous immunotherapy against grass pollen with an injection of 0.8 ml (Orange vial)
  Symptoms: About two hours after the injection, I experienced mild throat irritation and a runny nose, but these symptoms subsided shortly after. About four hours later, I noticed a significant increase in fatigue.

• Immunotherapy session on February 7, 2024
  Treatment: Subcutaneous immunotherapy against grass pollen with an injection of 0.1 ml (Red vial)
  Symptoms: Again, about two hours after the injection, I experienced mild throat irritation and a runny nose. I also noticed redness on my face resembling a rash or blemishes. These symptoms and the rash subsided after a few hours. Four hours after the injection, there was again pronounced fatigue.

• Immunotherapy session on February 14, 2024
  Treatment: Subcutaneous immunotherapy against grass pollen with an injection of 0.1 ml (Red vial)
  Note: Due to the more noticeable reactions after the last immunotherapy session, the dose was not increased this time.
  Symptoms: This time, the symptoms were noticeably milder compared to the previous session. The discomfort occurred again two hours after the session. The throat irritation was barely noticeable, and the rash on my face was very slight. The symptoms subsided shortly after. However, the fatigue was again significant, about four hours after the injection.

• Immunotherapy session on February 21, 2024
  Treatment: Subcutaneous immunotherapy against grass pollen with an injection of 0.8 ml (Orange vial)
  Note: Due to the milder but still noticeable symptoms after the previous session, the dose was reduced by one step this time.
  Symptoms: No symptoms occurred this time, except for the usual fatigue, which always appears about four hours after the injection.

• Immunotherapy session on February 28, 2024
  Treatment: Subcutaneous immunotherapy against grass pollen with an injection of 0.1 ml (Red vial)
  Symptoms: No symptoms, except for severe fatigue four hours after the injection.

• Immunotherapy session on March 6, 2024
  Treatment: Subcutaneous immunotherapy against grass pollen with an injection of 0.2 ml (Red vial)
  Symptoms: No symptoms, except for severe fatigue four hours after the injection.

• Immunotherapy session on March 13, 2024
  Treatment: Subcutaneous immunotherapy against grass pollen with an injection of 0.4 ml (Red vial)
  Symptoms: Mild facial rash and severe fatigue four hours after the injection.

• Immunotherapy session on March 20, 2024
  Treatment: Subcutaneous immunotherapy against grass pollen with an injection of 0.6 ml (Red vial)
  Symptoms: Mild facial rash and severe fatigue four hours after the injection.

• Immunotherapy session on March 27, 2024
  Treatment: Subcutaneous immunotherapy against grass pollen with an injection of 0.8 ml (Red vial)
  Symptoms: Mild facial rash and severe fatigue four hours after the injection.

• Immunotherapy session on April 3, 2024
  Treatment: Subcutaneous immunotherapy against grass pollen with an injection of 1.0 ml (Red vial)
  Symptoms: Mild facial rash and severe fatigue four hours after the injection.

Continuation Therapy – Monthly Injections:

The build-up phase of immunotherapy was successfully completed. After that, I received monthly 1.0 ml injections from the red vial as part of the maintenance therapy. If stronger reactions occur, the dose is reduced and then gradually increased again. So far, this hasn’t been necessary for me. Since completing the build-up phase, I have not experienced any side effects at the maximum dose – neither fatigue nor skin rashes.

It is still unclear how long I will need to continue the therapy. The total duration of immunotherapy varies from person to person and can last several years.

Here is a brief overview of the maintenance phase up to today:

Each treatment involved subcutaneous allergy immunotherapy against grass pollen with the maximum dose of 1.0 ml injection from the red vial:

• Immunotherapy Session on April 29, 2024
  Symptoms: None

• Immunotherapy Session on May 29, 2024
  Symptoms: None

• Immunotherapy Session on June 27, 2024
  Symptoms: None

• Immunotherapy Session on July 15, 2024
  Note: Scheduled one week earlier due to the clinic's summer vacation.
  Symptoms: None

• Immunotherapy Session on August 14, 2024
  Symptoms: None

• Immunotherapy Session on September 11, 2024
  Symptoms: None

And that's how it will keep going at this interval!

If you'd like to continue following my immunotherapy progress, you can track it in the graphic below. I will keep it updated until the therapy is fully completed.

A Time-Consuming Matter

Before the injection, the average waiting time at the clinic was about 30 minutes. Afterward, an observation period of another 30 minutes was required. This was to detect any possible side effects immediately and to ensure that medical staff was nearby.

If you're considering immunotherapy, you should be aware that it is both time-consuming and lengthy. Therefore, only start it if you intend to follow through consistently. Like strength training and other long-term successful endeavors, it requires dedication and perseverance.

A tip from me: When I had to choose a clinic for my immunotherapy, I had several options. I visited the different practices and weighed which one best met my needs. In terms of professional competence, they were all at a similar level. However, my deciding criteria were: a spacious waiting room with at least one meter of space between each seat, friendly staff, and a doctor who takes enough time for his patients.

Since, depending on the therapy plan, you regularly spend time in a room with other patients, I think the size of the waiting room plays a crucial role. In a small waiting room, where you're at risk of being infected from all sides, the likelihood of getting sick yourself increases. By considering these criteria, you can significantly minimize this risk.

My Experience with the First Pollen Season

Grass pollen is present in Austria from approximately April/May to July/August. By that time, I had already completed the build-up phase of immunotherapy and was curious to see how I would fare this year. Being quite experimental by nature, I tested extreme cases—situations where I usually feel the allergy the most. During the peak of the grass pollen season, I deliberately mowed my lawn without taking antihistamines beforehand. My goal was to find out if the immunotherapy really works. And indeed: throughout the entire grass pollen season, even under extreme conditions, I experienced no symptoms.

In everyday life, I also noticed nothing of the allergy. Normally, the first signs appear in April—my nose starts running, and I sneeze more often. By mid-May, it's usually at its worst, and these symptoms continue until July. During this time, I typically need several packs of tissues per day and suffer from constant sneezing, with antihistamines providing only limited relief. This time, however, I had no symptoms at all. Whether hiking, working in the garden, or mowing the lawn—it was as if I had never had an allergy.

Despite this positive experience, I don't want to give the impression that immunotherapy always works this smoothly. Especially for people with significantly stronger allergies, it can take much longer for the therapy to show results. My treatment is also not yet complete, and I still need to visit the doctor monthly. However, according to my doctor and based on my own experience, the prognosis is very positive.

Closing Words

It’s better to tackle the root cause rather than just alleviate the symptoms. Untreated allergies can worsen and may even lead to asthma. Therefore, I recommend that if you’re affected, you consider immunotherapy and discuss it with your doctor. As my experience with immunotherapy shows, it may be very time-consuming and arduous, especially in the beginning, but in the long run, it is truly worth it.