What are allergy shots?
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 allergies.
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.
How Do Allergy Shots Work?
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. After initiation of allergy shots, most patients find they have decreasing allergy symptoms and gradually require less allergy medications. Allergy shots are the only long-term way to bring symptoms under control in patients who have significant allergic disease.
Allergy shots work by slowly “teaching” the body to no longer recognize certain proteins (pollens, animal dander, etc.) as allergens.
For the first year, shots are administered once weekly in our office for about a year. Once the maintenance dose is achieved, this is spaced out to monthly. 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 offer lunch time, evening, and weekend shot clinics to accommodate our patients. No appointment is necessary to come in and get your allergy shot administered.
Who Are the Best Candidates for Allergy Shots?
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 fully work.
• If medications control your symptoms, but your symptoms flare back up every time you try to reduce your medications, so you are dependent on your medications.
• If the medication used to control your symptoms produces too many side effects (such as sleepiness, nosebleeds).
• If you have asthma triggered by allergies (i.e. if you have to use inhalers during the allergy season due to shortness of breath symptoms etc).
• If complications (i.e., sinus infections, ear infections) develop.
• If you can’t effectively avoid things that trigger your allergies (pets, pollen).
• If you would rather treat the actual problem rather than just use medications to control symptoms.
• If you would rather not use medications daily.
• 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.
Alternatives To Allergy Shots
Sublingual Immunotherapy is often referred to as allergy drops. The antigens used in allergy drops are the same ones that are used in allergy shots, they are just taken orally versus having them injected into the arm. Research has shown allergy drops to be less effective than allergy shots in the treatment of allergies and drops pose some additional challenges to patients who are allergic to multiple items.
Currently, allergy drops are not approved by the FDA, though their usage is fairly common and completely legal. The lack of FDA approval does mean that insurance will not cover allergy drops and patients will be responsible for the cost. Even so, for some patients, allergy drops will still make sense and may be reasonable from a cost standpoint. We are glad to discuss the pros and cons of allergy drops vs shots so you can make an informed decision.
Getting the Most Out of Treatment
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 place 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 “generic 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.
Hedberg Allergy & Asthma offers a variety of treatment options for our patients, including allergy medications, allergy shots and drops. We recommend you schedule an appointment with one of our allergists to find out what you’re allergic to and to review which treatment option makes the most sense for you.
Call or click here to make an appointment today and get on the road to defeating your allergies, once and for all!