Allergy Immunotherapy

Q. WHAT DO ALLERGY SHOTS CONSIST OF AND HOW DO THEY WORK?
A. Allergy shots consist of the unavoidable airborne allergens to which the patient has been found sensitive, in a purified and sterilized form. Injecting these substances stimulate the body's protective mechanisms to produce immunity to the allergens that the patient is sensitive to. This protective immunity will counteract the effects of the allergic antibodies which are the cause of allergic symptoms.

Q. DOES IT MATTER HOW MUCH ALLERGEN IS GIVEN IN THE INJECTION?
A. Yes. It is absolutely crucial that an adequate dosage of each allergen be given in order for the treatment with allergy shots to be effective. If the dosage is too low, the immune system will not be adequately stimulated to produce protective antibody.

Q. WHY DO ALLERGENS NEED TO BE GIVEN BY INJECTION?
A. It is not possible with available materials for an effective amount of allergens to be absorbed into the body by any other route.

Q. HOW SOON DO ALLERGY SHOTS TAKE EFFECT?
A. Usually it takes at least one year for allergy shots to produce a beneficial effect. In the first few months of allergy immunotherapy each dose is greater than the one before. Protection against the effects of allergen exposure occurs only after the higher dosages are reached. If the dose was to be started too high or increased too rapidly, unpleasant reactions may occur. The principle in allergy immunotherapy is that immunity is built-up in a stepwise manner, so that the protective response produced by the first injection permits a higher dose to be given on the second injection, and so forth, until the full dose is reached. Usually the final or maintenance dose is 1000 to 10,000 times higher than the starting dose.

Q. HOW OFTEN ARE ALLERGY INJECTIONS ADMINISTERED?
A. Injections are given weekly or twice a week at the beginning of treatment. Once the maintenance dose is reached, the interval between injections is changed to every two weeks and subsequently every three weeks.

Q. WHY MUST ALLERGY INJECTIONS BE GIVEN REGULARLY?
A. During the time in which the dose of allergy immunotherapy is being increased, the dose administered cannot safely be increased if more than one week has elapsed between injections. Therefore, if injections are not given regularly during the build-up period, an effective dosage cannot be reached. The body may lose immunity after a short period of time between allergy injections, and allergic reactions to the injections may occur if the dose is not reduced when too much time has elapsed between shots.

Q. HOW LONG DOES A PATIENT CONTINUE TO TAKE ALLERGY INJECTIONS?
A. The majority of patients require 5 years of injection treatment in order to have long term improvement after injection treatment is discontinued. If the injections are stopped prematurely, recurrent symptoms usually develop in a few months. After several years of continuous treatment, however, the improvement that has been attained usually will persist for several years after injections have been stopped.

Q. WHAT ARE THE SIDE EFFECTS OF ALLERGY SHOTS?
A. The most common side effect is mild soreness, redness, and swelling at the site of the injection. This is a very common reaction and it is usually gone by the next day. The reaction should be treated with local application of an ice pack. If such local reaction persists more than 24 hours or if the reaction size is greater than the size of a quarter, the dosage of the allergy injection will not be increased. A potentially more serious effect of allergy immunotherapy is a systemic reaction.

Q. WHAT IS A SYSTEMIC REACTION AND IS THIS REACTION COMMON?
A. A systemic reaction to allergy immunotherapy is uncommon. Signs and symptoms of a systemic reaction include hives, itching all over the body, flushing of the skin, coughing, wheezing, racing heart, weakness, a fall in the blood pressure and swelling of the face, tongue or throat. These reactions will typically begin within the first twenty minutes after the injection.

Q. WHAT IS DONE IF A SYSTEMIC REACTION OCCURS?
A. Systemic reactions are treated with an injection of epinephrine (adrenaline), which normally acts promptly to reverse the reaction. Severe reactions may require the administration of additional medications.

Q. WHAT CAN I DO TO LESSEN THE CHANCE OF A SYSTEMIC REACTION?
A. The incidence and severity of systemic reactions is lessened by meticulous attention to the doses of allergen administered and the recording of the reactions to previous injections. You should notify the individual administering your allergy injection of any adverse reaction to the previous shot, including the size of the local reaction and the amount of time the reaction lasted. In addition, if you are having increased asthmatic symptoms, an upper respiratory infection with fever or significant allergy symptoms, your medical problems should be treated before continuing with your next allergy injection. Also, you should avoid exercise and alcohol consumption immediately before and after allergy injections.

Q. ARE THERE ANY MEDICATIONS THAT I NEED TO AVOID WHILE I AM ON ALLERGY IMMUNOTHERAPY?
A. There are a group of medications called BETA-BLOCKERS that should not be prescribed while you are on allergy immunotherapy. These medications may increase the possibility of a systemic reaction and will interfere with the doctor's ability to reverse this reaction. Some commonly described beta-blockers include: Inderal, Inderide, Lopressor, Normodyne, Normozide, Tenormin, Tenoretic, Corgard, Corzide, Sectral, Blockadren, Timolide and Visken. There may be other beta-blockers or beta-blockers known by other names than those on this list. If you are not sure if the medications you may be taking are beta-blockers, please ask.

Q. WHAT HAPPENS IF I BECOME PREGNANT WHILE ON ALLERGY IMMUNOTHERAPY?
A. Allergy immunotherapy can safely be administered during pregnancy without any adverse effect to the fetus or mother. The dose of the injection is not increased during pregnancy.

Q. CAN I TAKE ANTIHISTAMINES WHILE ON IMMUNOTHERAPY?
A. Yes. It is important, however, to notify whoever is giving you your allergy injections if you are taking antihistamines. If you are regularly on such medication and then discontinue the antihistamine, the nurse and doctor must be notified as this can alter a response to the allergy injection.


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If you have any other questions concerning allergy immunotherapy, feel free to discuss these issues with me.

Ellen Epstein, M.D.
Advanced Allergy and Asthma, PLLC.
165 N. Village Ave.
Suite 141
Rockville Centre, NY 11570

 

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