FAQ: Allergy Immunotherapy

Allergen Immunotherapy is a safe and effective way of treating many inhaled allergic symptoms. The decision to employ this therapy is based on your particular symptoms and allergic sensitivities. Immunotherapy is generally a good long term investment in managing your allergic problems. The objective is to maintain patients as free of symptoms as possible, on as little medication as possible, and with few or no reactions to injections.

This method of treatment, combined with avoidance of environmental offenders, serves an important long-term role in the management of allergy symptoms. The following information is provided to answer commonly asked questions about Immunotherapy.

  • What is Immunotherapy?
  • How does Immunotherapy work?
  • What are the side effects of Immunotherapy?
  • What about pregnancy and Immunotherapy?
  • What are the patient’s obligations while on Immunotherapy?
  • How do you know what to put in my treatment mixture?
  • Do I continue allergy medication while I am on Immunotherapy?
  • How effective is Immunotherapy?
  • Can I receive my injections other than at the office?
  • Are there any contraindications to allergy Immunotherapy?

What is Immunotherapy?

Immunotherapy, or allergen hyposensitization, is a treatment program designed to reduce allergic sensitivity to environmental substances (allergens) including pollen, dust mites, mold spores, insect venoms, animal dander, etc. The process consists of receiving injections from treatment mixtures containing extracts of the above agents. Injections begin once or twice weekly with weak solutions, advancing to shots of progressively stronger solutions. Most patients reach “maintenance”, or the most concentrated solutions at 5 – 6 months, at which time the injection frequency reduces to every two to four weeks, depending on how the patient is responding. Total duration of treatment varies, but most patients are treated for three to five years.

How does Immunotherapy work?

The vaccine “teaches” the body’s immune system not to respond in an allergic manner to allergens. As the immune system is regularly exposed to the allergens through these injections, the body, in a sense, begins to ignore them. Scientific studies have proven that these vaccines stimulate the production of “blocking” antibodies by your immune system, but there are other, perhaps more important, effects of these injections on the immune system.

What are the side effects of Immunotherapy?

Some individuals who are on Immunotherapy report “immediate local reactions” at the site of the injection. These consist of local itching, redness and possibly a small hive. These usually begin within ten minutes and resolve in one to two hours. A few patients report “late reactions”, consisting of local swelling and soreness eight to twelve hours after injections.

Neither of these immediate or late reactions is serious but may produce some discomfort. As you return for shots each visit, the nurse will inquire how you are tolerating the injections, and you should inform her fully before your shots.

On rare occasions, patients may experience a “systemic” reaction, wherein they develop symptoms, such as sneezing, eye itching or tearing, hives, asthma, itching of throat, hands, feet, or potentially more serious problems, including shock. These serious reactions are fortunately extremely rare and are much less likely when the proper precautions are taken.

Because nearly all of these systemic reactions occur within twenty minutes after the injection, patients are required to wait twenty minutes after each shot before leaving the office. Other than local or rare systemic reactions there are no other known adverse reactions to Immunotherapy.

What about pregnancy and Immunotherapy?

It is not known whether it is safe to advance the dose of Immunotherapy during pregnancy. However, women on maintenance therapy can very safely be continued on injections.

What are the patient’s obligations while on Immunotherapy?

It is important for patients to be regular in their injection schedule and report all adverse reactions. Irregular attendance for allergy shots often means reducing the dose, or at times, restarting the entire process. These are very important in your overall medication management as well as your injection therapy.

It is also very important to notify the staff of any change in your medical condition in terms of your allergic symptoms or, especially, if you have been prescribed any new medications by another doctor.

How do you know what to put in my treatment mixture?

Your treatment mixture will be prepared based on your allergy skin test results. Common offenders include trees, grasses, ragweed, weeds, dust mite, venoms, animal dander and mold spores. Immunotherapy for foods is not currently recommended, as safety and effectiveness have not been shown in scientific studies.

Do I continue allergy medication while I am on Immunotherapy?

YES. It often takes 3 to 12 months before one notes improvement of allergy symptoms on Immunotherapy, and use of over-the-counter or prescription allergy medications are often needed.

How effective is Immunotherapy?

Many scientific studies, published in medical journals such as the New England Journal of Medicine, have proven the effectiveness of Immunotherapy for allergic rhinitis (hay fever) with approximately 80 – 90% of patients improving, often to the point of needing little or no medication. Response rates in asthma cases generally are lower, probably due to the fact that both non-allergic and allergic triggers for asthma are common.

Can I receive my injections other than at the office?

Allergy Immunotherapy must be administered under direct supervision of trained medical personnel who can make proper judgments regarding dosage and be prepared to treat potentially serious reactions. Arrangements can be made for medical personnel closer to home to administer the injections that are trained and willing to do so.

Are there any contraindications to allergy Immunotherapy?

If you are using beta-blocker medications caution must be employed when giving allergy shots, even though there is no strict contraindication. Beta-blockers are medications commonly used to control high blood pressure, heart rhythm problems (cardiac dysrhythmia) and migraine headaches. Common names include: Betagen, Blocadren, Corgard, Inderal, Lopressor, Nordyne, Sectral, Tenoretic, Tenormin, Timpotic, Propranolol, and Visken. (This is not a complete list, so ask your doctor or nurse.) Also, patients with severe asthma are often not good candidates for this therapy.