Allergy shots in patients with Multiple Sclerosis
Question:
4/1/2020
I saw a patient today who expressed an interest in allergen immunotherapy. He was diagnosed with multiple sclerosis (MS) in Dec 2018. Thus far his MS has been relatively mild with only 2 flares in the past year on tecfidara. I was wondering if there are any data regarding safety of AIT in MS patients? In a Pubmed search I found a single paper describing onset of MS following AIT. PMID: 14634270
Answer:
I know of no evidence that allergy shots are or should be contraindicated in MS patients. I have had two patients with MS on Allergy Immunotherapy, with no observed ill effects. On the contrary, both did very well and enjoyed a significant decrease in symptoms and improved quality of life.
A review article (1) looking at association with autoimmune disease and allergy immunotherapy concluded that “the development of autoimmune disease in allergic patients treated with SIT is rare. Nevertheless, as a principle of caution, it seems reasonable to carefully evaluate the indication for SIT, that is, risks versus benefits, in patients with established autoimmune disease or a strong family history of autoimmune disease”.
I searched an MS blog (https://www.msworld.org/forum) where that question was posted. Several individuals with MS responded that they were or had been on allergy shots without ill effects and interestingly reported tolerating them better than allergy medications.
In summary, evidence is lacking regarding an increased risk that allergy immunotherapy poses increased risk in a patient with multiple sclerosis. Based on this, I feel the risk is very low that allergy immunotherapy would be expected to worsen your patient’s MS. If allergy symptoms are further impacting your patient’s quality of life, then discuss of risk versus benefit and make the decision together.
(1) Linneberg A, Madsen F, Skaaby T. Allergen-specific immunotherapy and risk of autoimmune disease. Curr Opin Allergy Clin Immunol. 2012;12(6):635–639.
Respectfully submitted
Jeffrey G Demain, MD, FAAAAI