Allergy Shots

Introduction

Allergy shots are a proven effective treatment for allergic rhinitis and allergic asthma. Relief of allergy symptoms can last long after completion of treatment. It can also help prevent the development of new allergies and may even prevent the progression of allergic rhinitis to asthma. The American Academy of Allergy, Asthma, and Immunology (AAAAI) says people should see a doctor about immunotherapy if they:

• Have a clear relationship between asthma, rhinitis, conjunctivitis, and exposure to an allergen,
• Have a poor response to allergy medication or avoidance measures,
• Have a long duration of allergy symptoms (most of the year),
• Are a child with rhinitis, because of the potential role of allergen immunotherapy in modifying the progression of allergic disease.

What are allergy shots?

Allergy shots may also be known as Allergen Immunotherapy, Allergy Injection Therapy, or Allergen Desensitization Shots. Allergy shots are a treatment used to decrease your sensitivity to substances called allergens, such as pollen, dust mites, mold, animal dander, and stinging insect venom. These allergens are identified by allergy skin testing, and are the triggers for your allergy symptoms when you are exposed to them.

Allergy shots involve injections of increasing amounts of allergens over several months, followed by up to five years of routine maintenance injections. Improvement in allergy symptoms can often be seen in the first few months of treatment. Allergy shots are continued year-round, even if you are feeling better. They can lead to long-lasting relief of allergy symptoms even after treatment has stopped.

What conditions can be treated with allergy shots?

Allergy symptoms that may improve with allergy shots include runny nose and nasal congestion, watery or itchy eyes, sneezing, cough, and itching of the nose, roof of mouth, or throat. Symptoms of allergic asthma may also improve.

Allergy shots are also used to treat stinging insect hypersensitivity, or bee-sting allergies. For more information regarding allergy shots for bee sting allergy, click here. (link to another section specifically about bee sting shots)

Allergy shots do not treat food allergies, hives (urticaria), rashes, eczema (atopic dermatitis), contact dermatitis, or other skin allergies.

How do allergy shots work?

Allergy shots work like a vaccine, training your body’s immune system not to respond in an allergic manner when you are exposed to allergens. As you receive gradually increasing amounts of the substances in your shots, you develop a resistance and tolerance to them.

Allergy shots can lead to decreased, minimal, or no allergy symptoms when you are exposed to the allergen(s) in your shot mixture.

Your allergy specialist will formulate a “recipe” for your allergy treatment extract (also known as allergy vaccine) based on the results of your allergy tests. This vaccine will be mixed by the trained nurses at Spokane Allergy & Asthma Clinic.

You will have a scheduled “first shot” appointment during which you will sign an informed consent and discuss any additional questions you may have. You will have a prick test applied to your forearm for each of the dilutions of your allergy extract(s). The reactions are measured after 15 minutes and are used to determine the starting dose.

What is cluster immunotherapy?

Conventional allergy shots require at least 27 doses (1-2 times/ week) during the build up phase. On the other hand cluster immunotherapy offers a more rapid buildup. During the first 3 visits, 4 injections are given from each treatment set so the patient is in the office for 2.5-3 hours. A lot of allergy medications are given in order to allow the dose to be advanced more rapidly. The patient then continues conventional buildup for 8 more visits.

If you are interested in cluster immunotherapy, you should contact Stacy Stern in our billing department, (509) 747-1624 ext. 125 to discuss the cost. Billing for cluster build up is different than conventional immunotherapy. Out of pocket cost for the patient depends on their insurance coverage.

What is my time commitment if I start allergy shots?

During the build-up phase, you will receive your allergy shots once or twice weekly (every 3 to 10 days) until you have reached your target therapeutic dose, known as the maintenance dose. Once you have reached your maintenance dose, the time interval between your shots will gradually be increased to every 2 to 4 weeks.

During the build-up phase (and any time your dose has been reduced below your maintenance dose) you must receive your injections every 3 to 10 days until the maintenance dose is reached. If you wait longer than 10 days, the dose will be repeated or reduced, which will cause a delay in your treatment.

You will be required to have a yearly “extract check” visit with your allergy specialist. This will generally occur when your extract is gone or about to expire. Allergy extracts expire one year after they are mixed.

You will have a “first shot” appointment for each refill of your allergy extract lasting approximately 45 minutes to an hour. For your safety, the first dose of a new extract is customarily reduced by at least 50% and must be administered in our clinic. You will then need to receive injections at the 3- to 10-day interval until you return to maintenance. After that, you may return to your previous maintenance interval.

Are there any reactions I might experience while on allergy shots?

Although allergy shots have been proven to be highly effective in treating the cause of allergy symptoms, you may experience some adverse effects. Local reactions may include itching, redness, swelling, warmth, and soreness at the injection site lasting up to a few days. They may begin within minutes of receiving your injection, or they may develop several hours later. Local reactions can be uncomfortable, but have not been shown to increase the risk of having a systemic reaction.

There is a small risk of having a serious systemic reaction to allergy shots. Symptoms may include sudden generalized itching, flushing, hives, vomiting, diarrhea, coughing, wheezing, difficulty breathing, or lightheadedness. If left untreated, systemic reactions can lead to shock, or anaphylaxis. For this reason we require that your allergy shots be administered only in a medical facility that is prepared to treat anaphylactic shock. Most serious reactions occur within 30 minutes of the injection(s). Immediate treatment is vital, therefore you must stay in the doctor’s office for at least 30 minutes after receiving your injection(s).

Do I stop taking my regular allergy medications when I start allergy shots?

NO. It may take up to a year on allergy shots to notice significant improvement in allergy symptoms. While on shots, your symptoms may become decreased, minimal, or nonexistent. Some people may need to continue using over-the-counter or prescription antihistamines, nasal sprays, and/or eye drops indefinitely.

Can I receive my injections anywhere besides Spokane Allergy & Asthma Clinic?

Due to the risk of a serious reaction, allergy shots must be given in a medical facility or doctor’s office. There must be adequate equipment and trained personnel immediately available to treat systemic reactions under the supervision of a physician, nurse practitioner or physician assistant.

Can I receive allergy shots if I’m pregnant?

It is safe if you are at or near maintenance to continue with your allergy shots after becoming pregnant. Advancing to higher doses while pregnant is considered to be more risky, so allergy shots are not begun on pregnant women. If you become pregnant while on allergy shots, you must notify the shot nurse immediately and they can help you determine whether or not to continue the shots during your pregnancy.

How much do allergy shots cost?

There are multiple factors that determine how much allergy shots cost. These factors include the number and type of allergens to be included in your extract(s), how often you receive your injections, and your insurance coverage. It is impossible to estimate your specific costs until allergy testing has been completed.

It is the patient’s responsibility to check with their insurance company for coverage and deductible information. Discounts are available for private pay patients.

What else do I need to know about allergy shots?

You cannot be on allergy injection therapy if you are taking beta-blocker medications. These drugs may be used for problems such as high blood pressure, heart disease and migraine headaches. They may also be used in an eye drop form for treating the eye disease glaucoma. Systemic reactions to allergy vaccines may occur with greater frequency and be more difficult to treat in patients receiving beta-blocking agents. Click here for a list of beta-blockers. (link here to list or pop-up a list)

If you have asthma, you should not get your shot(s) on days when you are symptomatic. Systemic reactions, which are rare, could be more severe and more difficult to treat if you are already having asthma symptoms. A peak flow or FEV1 measurement may be used to determine if it is safe to administer your shots on a given day.