One of the cornerstones of the field of allergy is allergen immunotherapy, or allergy shots. This is also one of the areas that we get the most questions about. We hear patients say all the time, “I remember my dad used to get an allergy shot every spring and fall!”. Oftentimes, this meant an injection of steroids to help patients “get through” a particular time of year. While treatments of this nature can be beneficial, they serve to treat the symptoms of a problem while the problem itself remains.
When we as allergists discuss “allergy shots” we are specifically referring to a treatment that is also known as “allergen immunotherapy”. This is a course of treatment lasting for 4-5 years that specifically addresses the underlying problem – the fact that the body is incorrectly recognizing airborne organic proteins (pollens, mold spores, animal dander) as harmful and is forming proteins called IgE antibodies to attempt to eradicate them. Each person who suffers from allergies has a unique set of airborne proteins to which they react. Here at Hedberg Allergy & Asthma Center, we can identify which airborne proteins each patient is reacting to (based on history and allergy testing) and formulate an individual treatment plan specifically for that patient. Our board-certified allergists receive years of extensive training in formulating allergen immunotherapy shots, which is necessary to provide safe, but effective treatment of alleriges. Knowledge of which allergens can be safely mixed together, which allergens cross react, and the appropriate doses of each allergen extracts to meet efficacy guidelines is paramount in ensuring that the 4-5 years you spend completing a course of allergen immunotherapy is worthwhile. Many different types of providers are now offering allergy shots and it is important to make sure that the provider you trust with this process has the knowledge and training necessary to allow you to get the maximum benefit from your allergy shots, while doing so in the safest manner possible.
Allergy shots work by slowly “teaching” the body to no longer recognize certain proteins (pollens, animal dander, etc.) as allergens. We start with an extremely low dose of allergen and slowly build up over the course of approximately one year. Once you reach a specified “maintenance” dose, we continue this for 3-4 additional years, occasionally longer. At the end of that time, most patients find that they no longer struggle with allergies and many no longer require any allergy medications.
For the first year, shots are administered one to two times weekly in our office. Once the maintenance dose is achieved, this is spaced out to once every 2-4 weeks. Some clinics allow patients to administer allergy shots at home. Based on published guidelines set forth by our international allergy societies, we feel that this practice is unsafe due to the potential for allergic reaction due to allergy shots (which is low, but present). Therefore, we require that shots be given in our office or in the office of a licensed physician who has agreed to abide by our safety guidelines.
We do have a number of patients who come to our clinic either actively receiving shots from another physician or having been on allergy shots in the past who remain symptomatic. Some have even been on shots for 20-30 years or longer! This is usually explained by the fact that the amount of allergen extract in the shot is insufficient or by the fact that their tests were incorrectly interpreted in the first and they were never really allergic at all! Patients should ask their shot provider if the contents of their shots and the schedules by which they are administered meet current AAAAI/ACAAI guidelines (found here). Also, patients should be aware of what is actually contained in their allergy shots. The use of “stock mixes” of allergens is (unfortunately) very popular, and can be potentially harmful if the patient is not allergic to each component of the mix. Shot providers should be able and willing to discuss the contents of the shot, the amounts of each allergen, the schedule by which the shots will be administered, and how this plan follows the guidelines for allergen immunotherapy.
If there are questions about allergy shots, we are always available. Our providers are all fellowship-trained and well versed in the proper, evidence- and guidelines-based practices for administering allergy shots and can walk patients step by step through the allergy shot process. Call and make an appointment today and get on the road to defeating your allergies, once and for all!