Allergen Immunotherapy - Health Tips

A parent should look at the safety, efficacy, and commitment required for allergy immunotherapy or SLIT to be successful. Allergy shots are a 3-5 year commitment. During allergy immunotherapy patients are instructed to continue their preventative treatment plan. Allergy immunotherapy is a treatment for both allergic rhinitis and asthma. Patients are instructed that they may experience local reactions which are normal if less than a quarter. If greater than a quarter then parents or patients should notify the office. Anaphylactic reactions are not common but can occur. Therefore, patients are instructed that they must wait in the office for 30 minutes after their injections. SLIT is recommended for patients with isolated allergies who do not have the time to commit to allergy therapy shots. SLIT  is available for dust mites, grass, and ragweed. SLIT  is administered at home but the first dose is given in the office. Patients with EOE are not a candidate SLIT.            

Allergy immunotherapy — or allergy shots — increases your child's resistance to specific allergens, by introducing small doses of each allergen into his or her bloodstream. These doses are increased slowly over time. It is a very effective treatment. Shots must be given in a doctor's office. They are typically administered in to the upper arms at set intervals over a prolonged period of time. These are usually done on a weekly visit. It usually takes regular intervals of immunotherapy over 4-5 years in most cases to see allergic symptoms to decrease or disappear completely.

When medications and avoidance measures do not control allergy symptoms, one should consider allergen immunotherapy--either SCIT (subcutaneous or shots) or SLIT (sublingual).  Allergy "drops" are not FDA approved and insurance will not cover it.  Most "drops" are the extracts designed for subcutaneous use.  One risk of using "drops" is the development of eosinophilic esophagitis and studies for its safely need to be established.

Immunotherapy (allergy shots) consists of a build-up phase and a maintenance phase. The pace of this sequence is determined by patient preference and schedule. The maintenance phase is a 3-5 year period of a monthly dose and regular 6 month follow-up. We offer two methods of completing the build up phase: rapid desensitization ("clusters") or weekly shots ("drop-ins"). Patients are welcome to alternate between the two methods at their convenience. The advantages of allergy shots compared to SLIT are that treatment vials are covered by most insurance companies and this has been the standard of care for many years.

Sublingual immunotherapy (SLIT) is an alternative way to treat allergies without using shots. Small doses of an allergen are given under the tongue to build tolerance to the substance and reduce symptoms. This route offers patients the freedom to treat their allergies conveniently in their own home.

Allergy drops utilize the same allergen extracts with which skin testing and allergy shots are performed. However, while the allergen extracts used in the allergy drops are approved by the Food and Drug Administration (FDA) for allergy testing and allergy shots, they are currently not FDA approved for the use as allergy drops, and are therefore considered an “off­-label” form of treatment. While widely used in Europe and other countries safely and effectively, allergy drops are considered by the FDA to be an “investigational therapy” at the present time.

Although treatment success varies from patient to patient, improvement is anticipated within the first six months of treatment. Maximum benefit usually takes a year or so of regular therapy or longer. Adjustments to dosing may be made as the treatment progresses and the serum vials are renewed.

Allergy shots or immunotherapy are injections given at regular intervals over a long period of time (typically 3-5 years), with the goal of minimizing allergy attacks. Allergy shots are a common treatment for airborne and venom allergies.

The goal of allergy shots is to “desensitize” your body to a very small amount of whatever substance has been triggering your allergies. Over time, you receive gradually increased doses of the same allergen, building up your system’s tolerance to it. With increased tolerance, patients typically respond less strongly to their allergens and thus experience fewer symptoms.

Many people who undergo allergy shots find that they are desensitized to the point where they can reduce or even completely stop taking allergy medications.

Who Are the Best Candidates for Allergy Shots?

If you are able to avoid the trigger of your allergies or if usual doses of medications control your symptoms, then immunotherapy might not be needed. While allergy shots have been proven effective against inhalant allergies and stinging insect allergies, they are not used for food allergies. If any of the following applies to you, then you may be a candidate for allergy shots:

    If the medications to control your symptoms (i.e., antihistamines, decongestants), do not work.
    If the medication used to control your symptoms produces too many side effects.
    If complications (i.e., sinus infections, ear infections) develop.
    If you have asthma triggered by allergies.
    If you are at risk of developing anaphylaxis (a severe reaction that, in some cases, may be fatal) when exposed to an allergen. (As noted above – allergy shots are not used for food allergy.)
    If medications control your symptoms, but your symptoms flare back up every time you try to reduce your medications.
    If you can’t effectively avoid things that trigger your allergies.
    If you would rather take a series of allergy shots than daily medications.
    If you would rather treat the actual problem rather than just use medications to control symptoms.
    If the cost of the medications is a burden, allergy shots are very cost effective compared to the use of daily prescription medications over several years.

Children can also receive allergy shots.  The age in which shots may be recommended to young children is done on a case-by-case basis. Research has also shown that allergy shots can prevent children who have allergic rhinitis from getting asthma.

Allergy vaccine therapy is a process in which an allergic patient can become desensitized to those pollens and other inhalant allergens that trigger allergic rhinitis (nasal congestion), allergic conjunctivitis (itchy, teary eyes), asthma and bee sting reactions. Small doses of the actual allergic substance are injected weekly. Each week the dose is increased. Gradually a protective antibody, also known as Immunoglobulin G, is formed to block the allergic reaction. Also allergy shots desensitize or tame the immune system so that it stops over reacting to the allergens.

The improvement induced by allergy vaccine therapy is gradual. Many patients notice an improvement within the first six (6) months. 90-95% of patients report significant improvement once at full dose therapy which usually takes about 1 year.

Commonly known as “allergy shots”, these are a series of injections designed to control your allergies; they are not a medication. Medicines treat the symptoms of allergies, while allergy shots treat the cause.

People who should consider getting injections include:

• Those with moderate to severe allergies, including those allergic to cats, dogs, and stinging insects (bees, wasps, etc.)
• Those with sinus problems or asthma due to allergies
• Those who don’t respond to allergy medications or would like to avoid long-term use of those medicines
• Those who are able to commit to a regularly scheduled treatment plan

What Are the Benefits?

• Patients treated with allergy shots are expected to have a marked decrease in allergy symptoms as well as a marked decrease in the use of allergy medications.
• Symptoms like fatigue, poor concentration, headaches, ear and sinus infections can also be improved.
• Children treated with allergy shots are less likely to develop asthma or new allergies.
• Asthma and sinusitis episodes will usually be decreased.

Allergy shots is the most commonly used form of immunotherapy.  It is very effective in reducing allergy symptoms and therefore the need for medication.  It is the only treatment that allows us to make positive changes to the immune system, and can reduce the chances of developing new allergies and asthma.

Your allergy shots will include a combination of the allergens you are sensitive to, which can include pollens, molds, pets, insects and dust mites.  Initially the shots are given once to multiple times a week.  Once a maintenance dose is achieved, we continue shots on a monthly basis.  This is done for anywhere between 3 to 5 years, sometimes longer.

Shots are given in office under physician-supervision, because there is a small chance of having an allergic reaction to the treatment.

Will I need allergy shots?

Not everyone who is allergic will need allergy shots. Some can improve with avoiding the cause of the reaction and others can improve with only medications. However, if symptoms remain refractory to medications or a patient doesn't want to consistently take medications, then allergen immunotherapy or "allergy shots" may be recommended for long-term control of allergy and asthma.

How do allergy shots work?

Allergy shots slowly change the immune system- making you significantly less reactive to future allergy exposure.

If I need shots, how long will I have to take them?

Regardless of the type of build-up schedule for your allergy shots, literature shows that allergen immunotherapy for 3 to 5 years provides the best results for long-term improvement. In other words, just 3 to 5 years of allergy shots may prevent allergy symptoms for years afterwards!

How do I start shots?

Standard Allergen Immunotherapy- Injections are given weekly for the first 6 months, moved up to every 2 weeks (3 times), every 3 weeks (3 times), finally to everyone 4 weeks (or about once a month) and continued.

"RUSH" Immunotherapy- Advance your allergy shots rapidly, moving you approximately 3 months ahead (or half way) vs. standard allergy shots. This requires pretreatment with additional medication and is done over the course of 6-8 hours in our office.

"Cluster" Immunotherapy- A series of 2-3 injections are given in the office over one and a half to two hours. You can come in once a week for a total of 6 weeks to reach your maintenance dose.

What is your office procedure for giving shots?

You may come during normal shot hours but an appointment is preferable to make your visit more efficient. To monitor your safety, we ask you to wait 30 minutes in our office after your injections(s).