What if instead of temporarily relieving your allergies with medication, you could train your immune system to stop overreacting to your allergens altogether?
That’s the idea behind allergy immunotherapy, also known as allergy allergy shots. These shots are formulated to aid your body in building long-term tolerance to triggers like pollen, pet dander, mold, grass and even stinging insects.
If you want to know if allergy shots are right for you, read on to learn more about allergy immunotherapy, how allergy shots work and how they impact the immune system.
[Read: How to Treat Seasonal Allergies.]
Understanding Allergy Shots: Core Concepts and Eligibility
Allergy shots, or allergy immunotherapy, work by gradually exposing your immune system to tiny amounts of the allergen causing your symptoms. Over time, the repeated exposure teaches your immune system to become less reactive to the allergen, reducing day-to-day symptoms and the amount of medication needed to treat allergy symptoms. Unlike over-the-counter allergy medications, allergy immunotherapy treats the underlying cause of your allergies.
Why do allergies happen?
Allergies happen when the immune system overreacts to a trigger that is normally harmless, which can be anything from peanuts to pollen. In an allergy sufferer, the body produces antibodies that react to the allergen. These antibodies attach to specific cells, priming them to release inflammatory substances, like histamine, each time the allergen is introduced. This causes those familiar allergy symptoms, such as a runny nose, sneezing, itchy eyes or, in severe cases, anaphylaxis.
What do allergy shots involve?
When receiving immunotherapy for your allergies, trained medical professionals expose you to your allergen in a safe and controlled environment. Allergy shots consist of:
— A buildup phase, which usually lasts three to six months
— A maintenance phase, which lasts about three to five years
With this kind of treatment, you can receive long-term tolerance to your allergens, even after you graduate from your allergy immunotherapy series.
Who should consider allergy shots?
Consider allergy shots if you have persistent and severe allergic reactions that impact your daily life and allergy medications are not providing relief. Before starting allergy immunotherapy, you should also answer these questions, says Dr. Payel Gupta, an allergist and immunologist with Allergy & Asthma Network, a Fairfax, Virginia-based nonprofit outreach, education, advocacy and research organization for people and families living with allergies, asthma and related conditions.
— Am I ready to commit to weekly or biweekly visits for the first several months of the buildup phase and then monthly visits during the maintenance phase for up to three to five years?
— Can I realistically continue treatment monthly for three to five years to get lasting results?
— Are my allergies affecting my quality of life? This could include poor sleep, missing school or work or events because of allergies or poor function due to allergy-related fatigue.
— Have medications stopped giving me the relief I want?
— Do I have time and transportation to keep up with allergy appointments?
— Am I open to potential short-term side effects, such as redness, swelling or mild reactions in the area where I get my shots?
“If patients aren’t quite ready, they can discuss alternative options, like sublingual tablets or ongoing medication management, with their allergist until they’re confident about starting shots,” Gupta says.
Sublingual allergy tablets, or allergy drops, are a type of allergy immunotherapy that exposes your immune system to a controlled dose of a single allergen. The tablet dissolves under your tongue and can be taken at home.
Some individuals may seem like a good candidate for allergy shots but might not be, adds Dr. Christopher Brooks, an allergist and immunologist at the Ohio State University Wexner Medical Center and a clinical assistant professor of otolaryngology at the Ohio State University College of Medicine in Columbus.
Brooks says allergy shots are not the best option if you have:
— Nonallergic causes of nasal symptoms, such as a runny nose or nasal congestion
— Uncontrolled asthma
— Insufficient time for frequent allergy shot appointments
What allergic diseases and symptoms respond best?
Allergy immunotherapy treats reactions to allergens such as:
— Pollen from grass, trees or weeds
— Mold
— Dust mites
— Dander, such as cat dander, dog dander or furry animal dander
— Insect stings, such as bees, wasps, hornets or yellow jackets
| Type of allergic condition | Allergy immunotherapy effectiveness |
| Allergic rhinitis (hay fever) | Allergy shots can reduce the need for medications and improve your hay fever symptoms. |
| Allergic conjunctivitis | With allergy shots, you will see improvement in runny eye symptoms. |
| Allergic asthma | For those who have confirmed allergy triggers, allergy shots can reduce short-term symptoms. |
| Stinging insect allergy | Allergy shots are an effective treatment and can relieve the occurrence and fear of anaphylactic reactions to insect stings. |
| Food allergy, such as peanuts | Allergy shots are not recommended for food allergies, but you can talk to your allergist about oral immunotherapy. Oral immunotherapy involves oral exposure to the allergen rather than a shot. |
[READ: Allergies or Cold: What’s the Difference?]
The Allergy Shot Treatment Journey: Steps, Timing and What to Expect
Allergy immunotherapy is a long journey. It takes several weeks or more to start treatment, and treatment can last up to a few years.
Here’s what steps to take leading up to your first injection:
1. Allergy testing and verification. Make an appointment with an allergy specialist to test and verify your allergens.
2. Consultation and treatment viability. Discuss your test results with your allergy immunologist, and consider whether allergy shots are a viable treatment for you.
3. Custom mix formulation and preparation. Wait while your allergist formulates and orders your custom allergy mix, and the mix is verified, prepared and sent to the clinic where you will receive your shots. You will also receive an EpiPen prescription if you do not have one already, as allergy shots increase the chance of an anaphylactic reaction during treatment. An EpiPen is a portable, single-dose injection that delivers epinephrine, which can quickly reverse a life-threatening allergic reaction.
4. Allergy intake appointment. Have an allergy intake appointment with an allergy immunotherapy-certified nurse. At this appointment, your allergy nurse will verify your allergy mix and discuss expectations for buildup and maintenance phase, appointment scheduling, post-injection observation and, most importantly, red-flag allergy symptoms to watch out for and how to use your EpiPen.
Appointment logistics and timeline
| Phase | Frequency | Duration | Purpose |
| Buildup | 1-3 times per week | 3-6 months | To build up initial tolerance to the allergen. During this time, your allergy nurse will gradually increase the dose of your allergy mix according to the prescribed plan from your allergist. |
| Maintenance | Every 2-4 weeks | 3-5 years | To sustain long-term tolerance to your allergens. If you miss too many appointments, your nurse may need to lower your dose and build you back up again to maintenance with the oversight of your allergist. |
| Observation | After each appointment, during both buildup and maintenance | 60 minutes or more during the initial appointment and usually 20-30 minutes after every other buildup and maintenance appointment | To monitor you for any local or systemic allergy reaction. For a local reaction, such as redness at the injection site, your nurse may give you an ice pack. For systemic reactions, you may receive an over-the-counter allergy medication, or for severe reactions, your nurse will administer an EpiPen and follow an anaphylaxis protocol. |
At the beginning of each appointment, your allergy nurse will check you in and make sure you have an EpiPen within its expiration date. Then, you will receive your prescribed allergy dose for that day and watch for any signs of a reaction during the observation period. If you have any symptoms, notify your allergy nurse immediately for an assessment.
After your appointment, try to schedule as many future injection appointments as possible to reduce the worry of scheduling and coordination on your own time. Your allergy nurse can help you create a schedule that is both efficient and tailored to your needs.
Anticipate a time commitment to allergy shots
Patients are most likely to complete treatment successfully if they are prepared ahead of time for the commitment that the shots entail.
“Some patients don’t realize that three to five years of treatment is often necessary to see long-term improvement of allergy symptoms, and (they) end treatment early,” Brooks notes.
Many patients experience allergy symptom relief much sooner and stop treatment, thinking they are cured of their allergies. However, it takes completion of the maintenance phase to see long-term relief.
[READ: Everything You Need to Know About Common Food Allergies]
Benefits and Limitations: Balancing Effectiveness, Cost and Safety
Allergy shots, as mentioned above, are highly effective in reducing long-term allergy symptoms.
“It breaks my heart when I see a child who can barely visit a family member because they are highly allergic to pets and any exposure causes their asthma and allergies to flare,” says Dr. Cindy Bauer, the division chief and medical director of allergy and immunology at Phoenix Children’s Hospital. “When these patients receive allergen immunotherapy and can later enjoy family gatherings without sneezing, coughing and itchy eyes, it’s a wonderful moment because it confirms we chose the right treatment.”
Safety in special groups
Allergy shots are generally safe when administered under the guidance of an allergy immunotherapy provider and a nurse certified in allergy immunotherapy. Children, for instance, can safely receive allergy shots under the direction of an allergist.
Those who have uncontrolled asthma or who are pregnant, however, should not receive allergy shots, says Dr. Yesim Demirdag, a board-certified allergist and immunologist at University of California Irvine Health.
If you began allergy shots prior to becoming pregnant, notify your allergist as soon as possible if you do become pregnant. Some allergists may allow the continuation of maintenance shots during pregnancy, but this depends on the individual case.
“Elderly patients and those with comorbidities may be better suited for sublingual immunotherapy,” Demirdag adds.
Common side effects
Because allergy shots introduce the allergen, often in larger quantities than a normal environmental exposure, reactions may occur. This is why the post-injection 30-minute observation period is in place. Many reactions occur within this time period, but you’ll be able to receive guidance and treatment in a medical setting.
Localized reaction symptoms include:
— Redness at the injection site
— Swelling at the injection site
— Hives
— Itching
If you have a local reaction during the observation period, your nurse may direct you to use your inhaler, provide you with an ice pack or give you an allergy medication. Your allergist will also provide guidelines on how to safely treat a localized reaction at home and what symptoms would prompt you to return to the clinic or seek emergency care.
Systemic or anaphylactic symptoms can also occur, especially during the buildup phase while your allergist is evaluating how your body reacts to allergen exposure. These symptoms include:
— Difficulty breathing or swallowing
— Dizziness
— Swelling of the lips, throat or mouth
— Rapid heartbeat
— Gastrointestinal symptoms, such as cramping, diarrhea or vomiting
If you have a systemic reaction during the observation period, your nurse will administer your EpiPen, follow an anaphylaxis protocol, notify your allergist and safely transfer you into emergency care. If you have a systemic reaction at home, follow your allergist’s instructions to administer your EpiPen and seek emergency medical attention.
Cost factors and insurance
Allergy shots are often covered by insurance, but the exact cost depends on your plan.
Coverage includes two parts:
— The allergen mixture itself, which includes the vial preparation and the customized allergy immunotherapy mix based on your testing results
— The injection visits, which include each time you receive an allergy shot
Be sure to ask your insurance:
— Are allergy shots covered in my plan?
— Will I owe a copay or deductible at each injection visit?
— Are both the extract vials and the injection fees covered?
— Is prior authorization required before I start allergy shots?
— Is my allergist in-network?
Gupta also recommends asking your allergist what CPT (Current Procedural Terminology) codes they use for allergy testing and injections, so you can inquire about those codes specifically with your insurance.
Realistic Expectations: Allergy Shots Compared to Other Treatments
Allergy shots aren’t a one-size-fits-all, and they aren’t right for everyone.
| Allergy shot pros | Allergy shot cons |
| Long-term symptom relief | Requires frequent office visits that last 30 minutes or longer |
| Modifies the immune system to tolerate allergens, fixing the underlying cause of allergies | Risk of severe allergic reaction |
| Reduces daily reliance on allergy medications | Time, cost and travel can be burdensome |
Types of allergy treatments
There are various types of allergy treatments that are best used for certain cases:
| Treatment type | Ideal for |
| Allergy shots | Multiple environmental allergies that cause severe symptoms |
| Sublingual immunotherapy (SLIT) | Single, well-defined allergies and people who prefer home treatment |
| Oral immunotherapy | Added protection from accidental exposure to food allergies. Oral immunotherapy is not disease-modifying in the same way as allergy shots or sublingual tablets for respiratory allergies. |
| Medications | Mild symptoms and first-line management |
“I discuss these options with every patient and include their availability and long-term goals during the decision-making process,” Demirdag says. “For example, if the patient is highly allergic to pets and would like to move in with a partner who has a pet they are allergic to, I recommend allergy shots. On the other hand, for a high school student who has mild nasal allergy symptoms to tree pollens only, I may only recommend standard medications. Then, for a busy professor who is only allergic to ragweed pollens and develops severe nasal symptoms during ragweed season, I recommend sublingual immunotherapy for ragweed.”
Pollen and dust mite allergies have the most substantial evidence of successful treatment from allergy shots because these allergens are common, exposures are unavoidable, and they are well-studied in large clinical trials.
Demirdag recommends considering the following when weighing allergy treatment:
— How much allergies impact your daily life
— What you have already tried to relieve your allergies
— How much time and commitment you can give to treatment
— Whether trying oral and intranasal antihistamines or intranasal corticosteroids could be safe and effective for you
“All these treatment modalities require long-term commitment and have advantages and disadvantages. Allergists help patients using shared decision-making, weighing factors like efficacy, safety, adherence and patient goals,” Demirdag says.
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What to Know About Allergy Shots and Allergy Immunotherapy originally appeared on usnews.com
