Liam Fox*
12 year old male, referred to the allergy clinic in 2007
History
Since 2003, Liam’s* mum tried everything to control his pollen allergies. His hay fever was so severe that he needed to use a salbutamol inhaler regularly during the pollen season and had even visited A&E for an attack of severe wheezing.
Liam’s* symptoms included a runny, itchy nose and itchy eyes. Oral antihistamines and topical steroids provided no sustained relief: Liam* had tried courses of 40mg oral steroids for three days, but when that was reduced to 30mg, the symptoms returned. Liam’s* GP started him on Singulair (montelukast) with some benefit, but this did not reduce his symptoms enough.
Treatment
Skin prick tests confirmed that Liam* was sensitive to both grass and tree pollen. In October 2008, Liam* started a course of specific immunotherapy with a registered subcutaneous treatment. Each injection was given to opposite arms at the same visit.
Initially Liam* developed large five to six centimetre swellings at both injection sites on reaching the top dose of 2000SU. But after year two these were no longer a problem. He was recalled for three consecutive years using the licensed protocol of six injections for each allergen, which were completed before the grass and tree pollen seasons started.
Results
Apart from the initial localised swellings, Liam* tolerated all the subcutaneous injections well. After year three, he experienced a significant reduction in symptoms, just in time for his first exams.
Since then Liam* has only needed a minimal amount of medication, with his hay fever assessment scores showing significantly reduced eye, nose and chest symptoms. Liam* no longer uses steroids or a bronchodilator – and with a new lease on life he’s now mad about sport.
* To protect patient-doctor confidentiality, the case studies are anonymous and patient pictures are fictional.