Immunotherapy can provide lasting relief

Immunotherapy treatment (allergy shots) is based on a century-old concept that the immune system can be desensitized to specific allergens that trigger allergy symptoms. These symptoms may be caused by allergic respiratory conditions such as allergic rhinitis (hay fever) and asthma

While common allergy medications often control symptoms (but not always); if you stop taking the medication(s), your allergy symptoms return shortly afterward. 

Allergy shots can potentially lead to lasting remission of allergy symptoms, and it may play a preventive role in terms of development of asthma and new allergies.

The Process

Treatment involves injecting the allergen(s), causing the allergy symptoms. These allergens are identified by a combination of a medical evaluation performed by a board-certified allergist/immunologist and allergy skin or allergy blood tests.

The treatment begins with a build-up phase. Injections containing increasing amounts of the allergens are given 1 to 2 times a week until the target dose is reached. This target dose varies from person to person. The target dose may be reached in 3 to 6 months with a conventional schedule (one dose increase per visit) but may be achieved in shorter period of time with less visits with accelerated schedules such as rush immunotherapy.

The maintenance phase begins when the target dose is reached. Once the maintenance dose is reached, the time between the allergy injections can be increased and generally ranges from every three to four weeks. Maintenance immunotherapy treatment is generally continued for three to five years.

Some people have lasting remission of their allergy symptoms but others may relapse after discontinuing immunotherapy, so the duration of allergen immunotherapy varies from person to person.

Risks involved with the immunotherapy approach are rare, but may include serious life-threatening anaphylaxis. For that reason, immunotherapy should only be given under the supervision of a physician or qualified physician extender (nurse practitioner or physician assistant) in a facility equipped with proper staff and equipment to identify and treat allergic reactions.

The decision to begin immunotherapy will be based on several factors:

  • Length of allergy season and severity of symptoms
  • How well medications and avoiding allergens control allergy symptoms
  • Desire to avoid long-term medication use
  • Time. Immunotherapy will require a significant time commitment during the build-up phase, and a less frequent commitment during the maintenance phase

Out-of-pocket costs vary depending on insurance coverage. Yet, allergy shots can be a cost-effective approach to managing allergy symptoms and save patients money in the long run.  Click here for more information on this.

Rush Immunotherapy

By performing rush immunotherapy, a patient can reach maintenance dosing much quicker.  The process is accomplished over one day.  The patient takes medications to help prevent allergic reactions for the three days prior to the procedure.  At the end of the day, the patient is where they would be if they had received 15 injections in the conventional build-up schedule (about halfway to maintenance).  The patient will still need to complete the last half of the build-up conventionally.  Allergic reactions are more common in rush patients, and it is not for everyone, but many patients appreciate the ability to reach maintenance more quickly because that is typically when allergic symptoms begin to improve.

Sublingual Immunotherapy

Sublingual immunotherapy (SLIT) is placing drops of the allergen under the tongue everyday in order to build immune tolerance.  It is not FDA-approved or covered by insurance at this time, but has robust data that supports its use when using the proper protocols and dosing.  Allergy shots are probably more effective, but because of the time commitment involved with the injections some people prefer a sublingual alternative that can be done at home.  We only offer sublingual immunotherapy for allergens with the best data behind them (such as timothy grass or ragweed and a few others), keeping in line with the best available evidence.  Generally, we use no more than two allergens for SLIT.  There are pros and cons to sublingual immunotherapy and whether it is right for you.  Dr. Jacobs tackles the topic in this blog post.