A close friend of mine suffers from severe allergies. For the last 9 months or so, she has had a large number of allergic reactions to the point of being in allergy mode almost all the time.
Her new doctor prescribed her an immuno_modulator drug, which I assume is intended to lower her immunological response.
That seems a sensible idea to me, but I guess it’s not without drawbacks. Does anybody have some experience with this kind of treatment?
ETA : Hmm…Could a mod be kind enough to correct the spelling mistakes in the thread’s title (imMuno-modulator and eXperience)? Thanks in advance
I assume you’re talking about leukotriene inhibitors like montelukast and zafirlukast?
They seem to work better for NSAID and aspirin allergies than many antihistamines. Data doesn’t indicate they’re better than antihistamines for other allergies in general.
I’ve put a fair number of patients on such meds, usually for asthma but also for chronic urticaria, severe atopic dermatitis, advanced dermatographia, with mixed results. Some are now under much better control, others found they made little difference.
I’ve not had many patients complain of significant side effects.
They’re certainly worth a therapeutic trial for patients with really problem allergies.
OK, I’ve only used that in my transplant patients, not my skin rash patients. But frankly the use of it topically as a second-line agent (after topical steroids) for severe allergic skin eruptions is pretty mainstream, and I’d not hesitate to use it as such. It seems as effective as moderate potency steroids without the risk of thinning the skin.
But it’s not been used for that many years for this purpose, so we don’t have a lot of long-term data yet.
However, if she’s taking it orally for allergies, that’s neither an approved use nor a common off-label use as far as I could determine. Tacrolimus was originally touted as being great for topical use because it penetrated the skin so easily, obviating the need to take it in pill form for skin problems.
That’s not to say it’s wrong to use it orally for intractable allergies, and I’d defer that decision to a competent allergist.
I’ve used tacrolimus as a topical preparation short term. It did the job, and more effectively than over the counter topical steroids did. The initial burning sensation with application on sore, allergic skin was unpleasant but I got used to it, and when healing occurred it diminished a great deal. I’ve never had it orally.
I have been on high dose oral steroids. I don’t like them. On the other hand, allergic emergency or chronic long-term allergies that are uncontrolled aren’t fun, either. Oral steroids do work… but they have unpleasant side effects such that I’m eager to get off them and reluctant to go on them. My spouse does not like me while I’m on them, either. Not to the point of divorce or anything, but they do have nasty mental effects that all too often doctors either don’t warn you about or downplay, and can be terrifying if you don’t know what they are or where they’re coming from. I personally find the emotional roller coaster much more unpleasant than the weight gain, water retention, and ravenous, doesn’t-ever-turn-off, never-satiated hunger prompted by those medications.
So, speaking as someone with limited but direct experience - the drugs that suppress the immune reactions aren’t fun. They can do a very good job of suppressing the reactions, but they’re also something where you’d want to taper down to a lower dose (or, preferably, get off entirely) pretty soon after you get their benefit.