Question 1

How long does it take before my child starts seeing improvement from immunotherapy?

Accepted Answer

The honest answer is that immunotherapy works on a timeline that is different from most treatments families are used to, and setting the right expectation at the beginning is one of the most important things I do at the first immunotherapy consultation at Vatsalya Hospital, Varanasi. Most medications produce their effect quickly: an antihistamine reduces symptoms within an hour; an inhaler opens the airways within minutes. Immunotherapy is modifying the immune response at a fundamental level, and this biological change takes time. Most children begin to notice a meaningful reduction in their allergic symptoms during their first peak allergy season while on immunotherapy, which typically means somewhere between six and twelve months into treatment. This first noticeable improvement is often partial: symptoms that were severe become moderate, or the child begins to require their antihistamine or nasal spray less frequently rather than stopping it altogether. The immune changes continue to deepen as the treatment progresses. By the end of the second year, most children are showing a substantially more significant reduction in symptoms and medication requirements than they showed at the end of the first year. The full clinical benefit, and the sustained post-treatment benefit that is the defining feature of disease-modifying treatment, develops over the complete treatment course of three to five years. What I emphasise to families at Vatsalya Hospital is that the commitment to the full treatment duration is what delivers the lasting result. Stopping at eighteen months because the child feels significantly better is a very common pattern, and it is also the reason that many families report a gradual return of symptoms in the months after stopping early: the immune changes had not yet become durable. The benefit that persists for years after treatment is completed, which is what distinguishes immunotherapy from all other allergy treatments, requires the complete course to be achieved. The three-to-five-year commitment I ask of families is not arbitrary: it is the time the immune system needs to make a change that lasts, and every completed year of treatment is a step toward an outcome that medications alone cannot provide.

Written by Dr. Divyank Pathak, MBBS, MD (Paediatrics), IFPCCM, DPAA, FNPP, DPSM, FAAP, Director and Senior Consultant Paediatrician, Pediatric Critical Care and Allergy and Asthma Specialist, Vatsalya Superspeciality Children Hospital, Varanasi 221002. Phone: +91 9838713111.

Question 2

Are there any risks with the allergy injections and how are they managed if a reaction occurs?

Accepted Answer

There are risks with subcutaneous immunotherapy injections, and I want to be transparent and precise about what they are, how common they are, and how they are managed at Vatsalya Hospital, Varanasi, because this transparency is what allows families to make an informed decision about treatment. The risks divide into local reactions and systemic reactions. Local reactions at the injection site are the most common: a wheal, redness, and itching at the injection site that typically develops within twenty minutes and resolves within a few hours. These reactions are uncomfortable and indicate that the dose is approaching the upper range the child's immune system is ready for at that stage, but they are not dangerous. Their occurrence is a signal to the treating clinician to hold the dose rather than increasing it at the next visit until the reaction pattern settles. Systemic reactions, in which the immune response extends beyond the injection site, are less common but are the primary safety concern with SCIT. A mild systemic reaction might involve sneezing, rhinorrhea, urticaria (hives), or a mild sensation of warmth or itching distant from the injection site. A more significant systemic reaction can involve bronchospasm (tightening of the airways producing wheeze and breathlessness) or, rarely, anaphylaxis, a severe and potentially life-threatening systemic allergic response. The incidence of severe systemic reactions with SCIT in appropriately selected and managed patients is low, but it is not zero, which is why every SCIT injection is given in the clinic and not at home, and why every child remains under observation for thirty minutes after each injection, since the vast majority of systemic reactions occur within this window. At Vatsalya Hospital, the clinic is equipped to recognise and manage systemic reactions immediately: adrenaline (epinephrine), antihistamines, bronchodilators, and resuscitation equipment are immediately available, and I or a trained clinician is present throughout the observation period. The risk of systemic reaction is highest during the build-up phase when the dose is being escalated, and it is one of the reasons that poorly controlled asthma is a contraindication to SCIT injection on that visit: the airways are already in an inflamed, reactive state, and introducing an allergen dose in this context increases the systemic reaction risk substantially. The risk management framework for SCIT is well established, the safety record in appropriately managed patients is good, and the three-decade evidence base for SCIT reflects millions of doses administered safely worldwide. The commitment to thirty minutes of post-injection observation at Vatsalya Hospital is not optional: it is the safety net that makes SCIT a manageable risk rather than an unacceptable one.

Written by Dr. Divyank Pathak, MBBS, MD (Paediatrics), IFPCCM, DPAA, FNPP, DPSM, FAAP, Director and Senior Consultant Paediatrician, Pediatric Critical Care and Allergy and Asthma Specialist, Vatsalya Superspeciality Children Hospital, Varanasi 221002. Phone: +91 9838713111.

Question 3

How do you decide which allergens to include in my child's immunotherapy?

Accepted Answer

The allergen selection for immunotherapy is one of the most important clinical decisions in the entire treatment process, because immunotherapy works by modifying the immune response to a specific allergen, and it only works for allergens that are confirmed to be clinically relevant to the child's disease. Including allergens that the child is not sensitised to adds nothing. Missing allergens that are actually driving the child's symptoms will produce incomplete benefit. The decision is made through a combination of the clinical history, skin prick testing, and in selected cases specific serum IgE testing. Skin prick testing is the primary diagnostic tool. A small amount of standardised allergen extract from a panel of allergens relevant to the Varanasi region is placed on the forearm and introduced through a gentle prick in the skin. A positive test produces a wheal, a raised, itchy bump at the site, within fifteen to twenty minutes, indicating IgE-mediated sensitisation to that allergen. The allergens I test in Varanasi include house dust mite (Dermatophagoides pteronyssinus and Dermatophagoides farinae, the two most common HDM species), cockroach, local grass pollens, local tree pollens, weed pollens relevant to the Uttar Pradesh region, moulds, and animal danders where relevant. The results of skin prick testing tell me which allergens the child's immune system has sensitised against. But sensitisation alone is not sufficient to determine the immunotherapy formulation: I also need to establish that the sensitised allergen is clinically relevant, meaning that the child's symptoms occur or worsen with exposure to that specific allergen. A child who tests positive to grass pollen but whose symptoms are identical in grass season and out of it may have a primary HDM problem, not a grass problem. The clinical history and the skin prick test together establish which allergens are driving the disease, and only those allergens are included in the immunotherapy extract. At Vatsalya Hospital, Varanasi, I always go through the skin prick test results in detail with the family, explaining which sensitisations are clinically relevant and why those specific allergens have been selected for the immunotherapy formulation.

Written by Dr. Divyank Pathak, MBBS, MD (Paediatrics), IFPCCM, DPAA, FNPP, DPSM, FAAP, Director and Senior Consultant Paediatrician, Pediatric Critical Care and Allergy and Asthma Specialist, Vatsalya Superspeciality Children Hospital, Varanasi 221002. Phone: +91 9838713111.

Question 4

My child's allergy and asthma are well controlled on medication. Is immunotherapy still worth considering?

Accepted Answer

Yes, and this is one of the most important clinical conversations I have with families at Vatsalya Hospital, Varanasi, because well-controlled disease on medication and the question of whether to pursue immunotherapy are not mutually exclusive. They represent two fundamentally different levels of ambition in allergy treatment. Medication, when taken correctly and consistently, can control allergy and asthma symptoms effectively. A child on an inhaled corticosteroid, a nasal steroid spray, and an antihistamine may have no episodes and function normally. This is a successful outcome by the standard of symptom management. But the medication is doing something specific: it is suppressing the inflammatory consequences of an immune response that continues unchanged. Every pollen season, every exposure to house dust mite, every contact with the specific allergen, the same immune reaction occurs, and the medication manages its effects. Stop the medication, and the symptoms return. Immunotherapy is a different ambition. The goal is to change the immune response itself: to train the immune system to tolerate the specific allergen rather than react against it, so that over time the body encounters that allergen without triggering the allergic cascade at all. This is why immunotherapy is the only treatment in allergy described as disease-modifying. The clinical reasons to consider immunotherapy even in a well-controlled child include: the wish to reduce or eliminate the need for ongoing daily medication and its associated cost and inconvenience; the opportunity to prevent the natural history of allergic disease from advancing, since allergic rhinitis can progress to asthma in a proportion of untreated children, and immunotherapy is one of the few interventions shown to reduce this progression; and the desire for lasting benefit beyond the treatment period rather than symptom control that ends when the medication is stopped. The practical consideration is the commitment: three to five years of regular injections or daily drops at home. The conversation about whether to pursue immunotherapy is one I am happy to have in detail at Vatsalya Hospital, Varanasi, and the answer depends on the specific child, their allergen profile, and what the family's goals for treatment are.

Related reading:

Allergen Immunotherapy for Children: How It Works, Who It Helps, and What the Treatment Involves
Childhood Asthma: A Complete Guide to Diagnosis, Treatment, and Long-Term Control
Pediatric Allergy and Asthma: Symptoms, Causes, and Care Tips
Pediatric and Neonatal Pulmonology: Breathing Life into Healthy Childhood
Written by Dr. Divyank Pathak, MBBS, MD (Paediatrics), IFPCCM, DPAA, FNPP, DPSM, FAAP, Director and Senior Consultant Paediatrician, Pediatric Critical Care and Allergy and Asthma Specialist, Vatsalya Superspeciality Children Hospital, Varanasi 221002. Phone: +91 9838713111.

Question 5

Can allergen immunotherapy prevent my child from developing asthma if they currently only have allergic rhinitis?

Accepted Answer

This is one of the most important and clinically exciting questions in allergy medicine, and the answer based on current clinical evidence is: yes, allergen immunotherapy in children with allergic rhinitis appears to reduce the risk of progressing to asthma. This evidence is one of the most compelling arguments for considering immunotherapy in a child whose disease is currently limited to rhinitis, particularly in children with a strong family history of asthma, significant allergen sensitisation, and rhinitis that is poorly controlled despite pharmacotherapy. The allergic march - the progression from eczema to rhinitis to asthma - is not universal and not inevitable. The immune mechanisms driving rhinitis and those driving asthma are closely related, and interrupting the immune dysregulation at the rhinitis stage with immunotherapy appears, in several well-conducted studies, to reduce the probability of the next step in the march occurring. The mechanism is the same as for symptom reduction: immunotherapy shifts the immune response from allergen reactivity toward tolerance, and this shift at the mucosal immune level affects both the nasal and bronchial surfaces of the unified airway. For a child in Varanasi with confirmed house dust mite sensitisation and allergic rhinitis who has not yet developed asthma, considering immunotherapy at this stage - rather than waiting for asthma to develop and then treating both conditions - represents an opportunity to intervene at a point in the disease trajectory where the intervention may change what the next ten years of that child's respiratory health look like.

To book a consultation with Dr. Divyank Pathak at Vatsalya Superspeciality Children Hospital, Mahavir Road, Varanasi, call +91 9838713111 or visit linqmd.com/doctor/divyank-pathak

Written by Dr. Divyank Pathak, MBBS, MD (Pediatrics), IFPCCM, DPAA (Diploma in Paediatric Allergy and Asthma), FNPP, DPSM (USA), FAAP, Director and Senior Consultant Paediatrician, Pediatric Critical Care and Allergy and Asthma Specialist, Vatsalya Superspeciality Children Hospital, Mahavir Road, Orderly Bazar, Varanasi, Uttar Pradesh 221002. Phone: +91 9838713111.

Question 6

What happens if we stop allergen immunotherapy before the full course is completed?

Accepted Answer

Stopping allergen immunotherapy before the full three to five year course is completed is the most common cause of relapse and one of the most preventable reasons for treatment failure. The immune tolerance that immunotherapy produces is not an immediate switch it is a gradual process of immune re-education that takes time to consolidate into durable, self-sustaining tolerance. In the first year or two of treatment, symptoms improve significantly, and this improvement is real. But at this stage, the immune system has not yet fully consolidated the tolerant state it has learned to respond less aggressively, but this learning is not yet stable enough to persist without continued allergen presentation. When immunotherapy is stopped at this point, typically because the improvement in symptoms has made the family feel that treatment is no longer needed, the immune system gradually reverts toward its original allergic response pattern. Symptoms return sometimes quickly, sometimes over months and the family then faces the choice of restarting a full course or managing symptoms pharmacologically indefinitely. In contrast, children who complete the full recommended course consistently show more durable benefit the immune tolerance they have developed persists for years after the last dose. The clinical message I give every family starting immunotherapy is: the symptom improvement you see at one or two years is real, it is the treatment working, and it is also the reason to continue because completing the course is what turns a temporary improvement into a lasting one.

To book a consultation with Dr. Divyank Pathak at Vatsalya Superspeciality Children Hospital, Mahavir Road, Varanasi, call +91 9838713111 or visit linqmd.com/doctor/divyank-pathak
Written by Dr. Divyank Pathak, MBBS, MD (Pediatrics), IFPCCM, DPAA (Diploma in Paediatric Allergy and Asthma), FNPP, DPSM (USA), FAAP, Director and Senior Consultant Paediatrician, Pediatric Critical Care and Allergy and Asthma Specialist, Vatsalya Superspeciality Children Hospital, Mahavir Road, Orderly Bazar, Varanasi, Uttar Pradesh 221002. Phone: +91 9838713111.

Question 7

Can my child take SLIT (sublingual immunotherapy) drops at home or does every dose need to be given in the clinic?

Accepted Answer

Sublingual immunotherapy - SLIT - is specifically designed for home administration, and this is the feature that distinguishes it most practically from SCIT and that makes it the immunotherapy route I most often recommend for families in Eastern Uttar Pradesh who live at significant distances from Varanasi or whose children cannot attend clinic weekly. After the initial consultation at Vatsalya Superspeciality Children Hospital, where allergy has been confirmed and the decision to proceed with SLIT has been made, the first few doses may be administered under observation in the clinic to ensure there are no significant early reactions. After this initial period, the remainder of the course is taken at home - daily drops placed under the tongue, held there for one to two minutes without swallowing, then swallowed. The drops are taken every day, including weekends, without clinic attendance. The family is given clear instructions for what to do if a reaction occurs (very rare with SLIT), and there are regular follow-up appointments at the clinic to assess symptom response, adjust the allergen schedule, and monitor progress. The most common side effect is a mild local reaction under the tongue - tingling, mild swelling - particularly in the early weeks, which typically resolves quickly and does not require treatment. Serious systemic reactions to SLIT are significantly less frequent than with SCIT. The critical factor for SLIT success is daily consistency - gaps in administration reduce efficacy, so the drops must be taken every day throughout the treatment course.

To book a consultation with Dr. Divyank Pathak at Vatsalya Superspeciality Children Hospital, Mahavir Road, Varanasi, call +91 9838713111.

Written by Dr. Divyank Pathak, MBBS, MD (Pediatrics), IFPCCM, DPAA (Diploma in Paediatric Allergy and Asthma), FNPP, DPSM (USA), FAAP, Director and Senior Consultant Paediatrician, Pediatric Critical Care and Allergy and Asthma Specialist, Vatsalya Superspeciality Children Hospital, Mahavir Road, Orderly Bazar, Varanasi, Uttar Pradesh 221002. Phone: +91 9838713111.

Related:

Allergen Immunotherapy for Childhood Asthma: The Treatment That Changes the Disease, Not Just the Symptoms

Childhood Asthma: A Complete Guide to Diagnosis, Treatment, and Long-Term Control

Question 8

How long does allergen immunotherapy take before my child's symptoms improve?

Accepted Answer

Allergen immunotherapy works progressively rather than immediately - which is one of the most important things for families to understand before starting treatment, because setting realistic expectations about the timeline prevents early discontinuation of a treatment that will eventually produce significant benefit. The first changes families typically notice are a reduction in the frequency and severity of allergic rhinitis symptoms - less sneezing, less nasal congestion, less morning misery - beginning within the first six months of treatment. Asthma symptoms and reliever inhaler use tend to improve somewhat later, with meaningful reductions in exacerbation frequency and severity becoming more evident by the end of the first year. Over the second and third years of treatment, the improvement deepens: medication requirements reduce progressively, and the seasonal peaks that previously produced significant disease exacerbation become less pronounced. The greatest clinical benefit is seen after completing the full three to five year course, and the durability of benefit - the persistence of improved allergen tolerance after treatment ends - is strongest in children who complete the full course rather than stopping once symptoms have improved. Stopping immunotherapy early because symptoms have improved is one of the most common reasons for relapse: the immune tolerance is still being consolidated at the point where symptoms have reduced, and completing the full course is what makes the benefit last beyond the treatment period.

To book a consultation with Dr. Divyank Pathak at Vatsalya Superspeciality Children Hospital, Mahavir Road, Varanasi, call +91 9838713111.

Written by Dr. Divyank Pathak, MBBS, MD (Pediatrics), IFPCCM, DPAA (Diploma in Paediatric Allergy and Asthma), FNPP, DPSM (USA), FAAP, Director and Senior Consultant Paediatrician, Pediatric Critical Care and Allergy and Asthma Specialist, Vatsalya Superspeciality Children Hospital, Mahavir Road, Orderly Bazar, Varanasi, Uttar Pradesh 221002. Phone: +91 9838713111.

Question 9

Can children with asthma play sports and exercise normally?

Accepted Answer

Yes. Children with well-controlled asthma can and should participate in sports and physical activity. Exercise is beneficial for respiratory health, cardiovascular fitness, and healthy weight, all of which improve asthma control over the long term.
Exercise-induced bronchoconstriction, where airways narrow during physical exertion, is real and does need to be identified and managed. But the goal of that management is to make activity possible, not to restrict it. A blanket instruction to avoid sports is one of the most quality-of-life-limiting and clinically unnecessary interventions we can apply to a child with asthma. Practical management includes ensuring adequate pre-exercise bronchodilator use where prescribed, identifying and avoiding specific environmental triggers such as cold air or high-pollen environments, and building activity tolerance gradually. I provide every family with specific exercise guidance rather than generic restrictions, and I work with schools where needed to ensure that teachers understand their child's condition and asthma action plan.

Written by Dr Divyank Pathak, MBBS, MD (Pediatrics), IFPCCM, DPAA, FNPP, DPSM, FAAP, Director and Senior Consultant Paediatrician, Pediatric Critical Care and Allergy and Asthma Specialist, Vatsalya Superspeciality Children Hospital, Mahavir Road, Varanasi, Uttar Pradesh 221002.

Question 10

What is allergen immunotherapy and is it available for children in Varanasi?

Accepted Answer

Yes. Allergen immunotherapy is available at Vatsalya Superspeciality Children Hospital, Varanasi, and I offer it to appropriate patients as part of the dedicated paediatric allergy and asthma centre I lead.
Allergen immunotherapy is the only treatment that modifies the underlying allergic disease rather than suppressing its symptoms. It works by gradually exposing the immune system to increasing doses of the specific allergen, inducing a shift in the immune response that reduces allergic reactivity over time. Evidence supports its effectiveness in reducing asthma symptoms, improving lung function, reducing medication requirements, and in many cases preventing the development of new sensitivities. I offer both subcutaneous immunotherapy (SCIT, given as injections) and sublingual immunotherapy (SLIT, given as drops or tablets under the tongue). The choice depends on the specific allergen, the child's age and compliance, and the family's capacity for the treatment schedule. Immunotherapy is considered in children with confirmed allergen sensitisation whose asthma and associated rhinitis are not adequately controlled with standard pharmacotherapy.

Question 11

What does inhaler technique have to do with asthma control?

Accepted Answer

Poor inhaler technique is one of the most common and most underrecognised reasons for inadequate asthma control in children, even when the right medication has been prescribed.
A child using a metered-dose inhaler without a spacer delivers only a fraction of the dose to the lungs, with most of it depositing in the mouth and throat. A child using a dry powder inhaler without generating sufficient inspiratory flow achieves the same poor result. In both cases, the medication is being taken but not reaching the airways where it is needed. At every consultation I review inhaler technique directly with the child and the parent rather than assuming it is correct. A child whose asthma appears to be poorly controlled despite adequate medication doses, before any decision to step up treatment is made, should have inhaler technique formally reviewed. In my experience, correcting technique alone frequently resolves what appeared to be treatment-resistant asthma.

Written by Dr Divyank Pathak, MBBS, MD (Pediatrics), IFPCCM, DPAA, FNPP, DPSM, FAAP, Director and Senior Consultant Paediatrician, Pediatric Critical Care and Allergy and Asthma Specialist, Vatsalya Superspeciality Children Hospital, Mahavir Road, Varanasi, Uttar Pradesh 221002.

Question 12

What is the allergic march and why does it matter for my child?

Accepted Answer

The allergic march, also called the atopic march, is the sequential development of allergic conditions in children that typically follows this pattern:

• Eczema (atopic dermatitis) in infancy, often the first sign of atopic predisposition

• Allergic rhinitis developing in toddlerhood or early childhood, causing persistent sneezing, runny nose, and nasal congestion

• Asthma developing later, often triggered by the same allergens driving rhinitis

These are not separate problems. They reflect the same underlying immune dysregulation expressing itself in different organs at different stages of development. A child being treated for asthma alone, without identifying and managing the allergic rhinitis that is driving upper airway inflammation and postnasal drip into the lower airway, will have persistently poorly controlled asthma. I evaluate every child with suspected asthma for the full range of atopic conditions as part of my assessment at Vatsalya Superspeciality Children Hospital, Varanasi.

Written by Dr Divyank Pathak, MBBS, MD (Pediatrics), IFPCCM, DPAA, FNPP, DPSM, FAAP, Director and Senior Consultant Paediatrician, Pediatric Critical Care and Allergy and Asthma Specialist, Vatsalya Superspeciality Children Hospital, Mahavir Road, Varanasi, Uttar Pradesh 221002.

Question 13

Can children with asthma and allergies lead normal lives?

Accepted Answer

&nbsp;With early diagnosis, personalized treatment, and proper management at home and school, children with asthma and allergies can participate in sports, school activities, and social events just like other children. Education on trigger management and medication adherence is key to a healthy, active life.

Question 14

How can I tell if my child has asthma or allergies?

Accepted Answer

Children with asthma may have recurring coughing, wheezing, or shortness of breath, often triggered by activity, allergens, or infections. Allergies may present with sneezing, runny nose, itchy eyes, rashes, or food reactions. If these symptoms are frequent or severe, consult a pediatric pulmonologist or allergist for proper evaluation.

Question 15

How is pediatric and neonatal lung health managed in a specialized pulmonology unit?

Accepted Answer

Children and newborns in a pediatric pulmonology unit receive continuous monitoring of breathing and oxygen levels, medications, respiratory support like oxygen or ventilation, and nutritional care. Environmental and allergen management is also important for chronic conditions like asthma. Families are educated on early warning signs and proper home care to ensure long-term lung health.

Question 16

What are the common respiratory problems in newborns and children?

Accepted Answer

Newborns and children can experience a range of respiratory issues. In neonates, common conditions include Respiratory Distress Syndrome (RDS), Meconium Aspiration Syndrome, and Persistent Pulmonary Hypertension of the Newborn (PPHN). In older children, conditions like asthma, bronchiolitis, pneumonia, and chronic cough are more frequent. Early diagnosis and specialized care are crucial for preventing complications.

Question 17

What kind of care can parents expect in a Pediatric Cardiac ICU?

Accepted Answer

In a Pediatric Cardiac ICU, children receive continuous monitoring of heart rate, blood pressure, oxygen levels, and other vital signs. Care includes specialized medications, respiratory support, nutritional management, and emergency interventions if needed. Parents are supported with education, guidance, and involvement in care decisions to ensure both the child’s recovery and family confidence.

Question 18

When should a child be admitted to a Pediatric Cardiac ICU?

Accepted Answer

A child should be admitted to the Pediatric Cardiac ICU if they have a congenital or acquired heart condition that requires close monitoring, post-surgical care, or advanced medical support. This includes children with heart failure, severe arrhythmias, pulmonary hypertension, or those recovering from cardiac surgery or catheter-based procedures.

Dr. Divyank Pathak

About Dr. Divyank Pathak