The following information is for patients who may be considering immunotherapy (allergy shots or injections) as part of their allergy treatment plan. The goal of immunotherapy is to reduce allergic sensitivities. Treatment involves a series of injections given on a regular weekly or bi-weekly basis. The kinds of allergy injections prescribed, as well as the number and frequency of the injections, will be described in a discussion with your doctor. The prescription is based on your particular symptoms, your examination and your test results. Allergy injections are started at a low dosage. The strength and amount of the injections are gradually increased over a period of months, until you reach the highest dosage that has been prescribed by your doctor or a level above which there is a reaction. You'll then continue "maintenance" injections at this level. The best maintenance dosage for an individual is one that achieves relief of symptoms without unpleasant side effects. Improvement of allergy symptoms will be gradual. About 85% to 90% of patients given allergy injections receive significant reduction in their allergic symptoms. However, improvements usually occur over a period of three to six months. The maximum benefit may not be reached until 12 to 24 months into treatment. The duration of immunotherapy treatment varies greatly. The minimum treatment period for most patients is three to five years, but in many cases longer periods of treatment are beneficial or necessary. In general, the injections should be continued until about one year beyond the time when allergic symptoms have come under control. Thus, the total duration of treatment has to be individualized. The duration depends on the nature of the allergic problem, the rate and completeness of recovery, and whether symptoms return when immunotherapy is discontinued. Because allergy injections are extracts of substances to which you are allergic, you and your doctor will need to be alert to any signs that you are having an allergic reaction to the injection. Early indications of a reaction are described in the accompanying Immunotherapy: Frequently Asked Questions and Answers and the Consent for Administration of Allergy Injections. You will be asked to read and sign the consent before beginning your immunotherapy. If you begin to develop local swelling (greater than two inches) at the injection site or have any other symptoms that you feel are due to the injection, please contact us before your next injection so that we may adjust the dosage.
Allergy injections should be given under the direct supervision of a physician, so that the physician can monitor potential problems and treat any reactions. If your injections are to be given somewhere other than in our office or clinic, we must have the name, address and telephone number of the physician who will assume the responsibility for administering your injections. We will provide you with a form to complete that will allow us to forward your extracts to another physician or medical facility. Allergenic extracts will be released only to a licensed physician. After completing the initial series of injections, immunotherapy patients should have a follow-up visit. At that time, if your allergic symptoms are not clearly improving, the allergist-immunologist may make changes in your prescription to make it more effective for you. It is important for patients who are experiencing persistent allergic problems to have regular re-evaluations, usually at six- to 12-month intervals. Patients who are doing well, who are having no problems with their injections, and who have not developed any new medical problems should plan on a review of their treatment program with the doctor once a year.
You or a family member may be starting immunotherapy, sometimes called allergy shots. Patients frequently have questions about the injections. Many of the most common questions are addressed below. Please feel free to speak with one of our staff members if your questions are not satisfactorily answered, or if you have questions other than these. By working together, we will have the best opportunity for good results and improvement in your allergy symptoms.
Immunotherapy or allergy shots is a medical treatment involving a series of injections with gradually increasing doses of a vaccine or "extract" made from the allergens to which you are allergic.
No. The allergy extract prescription is specifically designed for you, based on the results of an evaluation of your symptoms, medical history, physical findings and allergy testing. It is highly unlikely that two allergy patients will be on precisely the same extract prescription.
Immunotherapy is a preventive treatment for allergic respiratory conditions such as perennial and seasonal allergic rhinitis ("hay fever"), asthma ("wheezing"), and insect sting allergy.
The primary goal of immunotherapy is to relieve the symptoms caused by allergies. Immunotherapy should generally reduce your allergic sensitivities, thereby reducing symptoms and reducing the need for medications. Immunotherapy is not a cure for the condition, but it usually will improve many of the symptoms and complications of allergic disease.
Generally, 85% to 90% of patients who are receiving high-dose maintenance immunotherapy will have a significant reduction in their allergic symptoms, as well as a reduction in their need for additional medications.
Allergy problems are generally attacked from three directions: (1) avoidance of recognized allergens; (2) medications; and (3) immunotherapy. Avoidance of the offending allergen is the ideal solution and is usually recommended for allergens such as foods, drugs and animals. However, avoidance may be difficult when the allergen is airborne pollen or mold. Medications also may be beneficial, but only work with regular use and are most helpful when symptoms are mild. Immunotherapy is a "long-term" preventive treatment that can alter the causes of allergic symptoms. It stimulates the patient's immune defenses and is a natural response. A patient often will require a combination of avoidance measures, medications and immunotherapy for the most effective control.
It always is wise to avoid known allergens, particularly easily avoided ones such as animals. However, many allergens such as pollen and mold are in the atmosphere and cannot be totally avoided. Allergy injections are especially useful for reducing reactions to these allergens. Very heavy exposure to an allergen may produce symptoms despite allergy injections. Common sense is the rule, and heavy exposures should be avoided whenever possible.
There is no interference between allergy medications and allergy injections. As you begin your immunotherapy, you should continue your prescribed medications because immunotherapy will take time to become effective. As you proceed toward "maintenance" immunotherapy, you may find that your need for allergy medications will decrease, and you will be able to gradually reduce or discontinue some of your medications. However, always talk with your physician before reducing an asthma medication.
The "advancement phase" of your immunotherapy may take several months. The schedule of injections that your physician decides is best for you will determine when you reach maintenance levels. You should expect to begin seeing benefits from your immunotherapy as you reach maintenance levels, although some patients will require six to 12 months on high doses before seeing maximum benefit. Your dose should never be advanced if a significant reaction occurred after your last injection. Exceeding the optimal dose can lead to worsening of symptoms.
Allergy injections contain potent doses of allergens to which you are allergic. No matter how long you have been on allergy injections, the potential always exists for you to have a serious (and possibly even life-threatening) allergic reaction to the shot. Therefore, you must receive your injections in a physician's office where emergency treatment is immediately available. You may receive your injections in our office or in the office of another physician.
Allergy shots usually cause no immediate problem. The only common side effect is localized swelling at the site of the injection, usually no larger than a quarter. Ice applied to the site of the swelling will help relieve some of the discomfort. There also are medications that may help avoid this side effect. Do not scratch or massage the injection site. Scratching may worsen the local reaction. You should not expect to have a major flare-up of your allergy symptoms after a shot. Notify us or the physician administering the injection immediately if you think you are having a reaction to an injection. Symptoms suggesting a reaction include:
These "anaphylactic" reactions must be treated promptly by the physician and staff. Most serious reactions begin within 20 to 30 minutes, while you are still under observation. However, please do not ignore these generalized symptoms even if they begin several hours after an injection. Return to our office or go to the nearest emergency room for treatment.
As noted above, there is always a slight risk that you could have a serious reaction to your allergy injection, no matter how long you have been on injections. Since serious reactions can be life-threatening, a physician should be readily available. If you do not have the time to wait after your injection, please do not come for your shot that day. It is better to come another day when you have the time to stay, so that we may administer your injection safely.
Call us before the immunotherapy appointment if you are ill or not feeling well - for example, a fever or wheezing within the past 12 hours. We may want to postpone your shot.
The answer varies from patient to patient. You should check with your physician on how often you need to be seen.
There is no need for allergy testing every year. The general recommendation is that you consider re-testing every three to five years, or as new problems seem to develop. The doctor can discuss possible re-testing at your annual visits.
Yes! There are several medications, particularly some blood pressure medications known as "beta blockers" and ACE inhibitors, that usually are not given along with immunotherapy. Please notify the nurse of any new mediations that have been prescribed for you since your last visit with the physician.
Allergy injections are believed to be safe during pregnancy. The only possible harm to your baby could occur if you have a major reaction with a drop in blood pressure and a need for oxygen. We encourage conservative treatment during your pregnancy and not advancing your dose above the maximum dose given prior to pregnancy. The allergy injections will not cause or prevent allergies in your baby. Please arrange a follow-up visit if you become pregnant so your allergy treatment program can be reviewed. One of the benefits of continuing immunotherapy during pregnancy is that you may need less of other medications.
You can skip injections while on vacation if you will be gone less than three weeks. Missing a week or two will not have a serious impact on the overall immunotherapy program. If you plan an extended trip, notify the office staff, and we will arrange for transfer of your extract to a local physician at your destination.
No. As you reach "maintenance," you may find that you can space your injections farther apart. If you have been receiving injections twice a week, your physician may suggest reducing them to once a week and observe for control of symptoms over the next month or two. If you continue to be well controlled, injections can be spaced every other week or up to four weeks apart. During peak pollen or mold seasons, you may notice that you are having more local reactions to your injections due to the increased allergen exposure in your surroundings. (This is called "co-seasonal" exposure). If this occurs, the maintenance volume will be temporarily reduced.