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.
