Immunotherapy (Allergy Shots) FAQ
1. What are allergy shots?
Allergy shots are also known as allergen immunotherapy. It is a form of treatment to decrease symptoms from allergens, such as pollens, molds, cat, dog, cockroach, dust mites, bees, and fire ants. Individuals are given increasing amounts of allergy vaccine over several months to develop immunity to allergic triggers. It is the only medically proven form of treatment that may permanently reduce allergy symptoms or prevent the development of new allergies and asthma.
2. Who should get allergy shots?
Allergy shots are indicated for individuals with allergic rhinitis (hay fever), allergic conjunctivitis, asthma, stinging insect allergy, and atopic dermatitis (eczema). Individuals should have positive allergy tests by skin tests or blood tests. Allergy shots are normally given to patients whose symptoms are not controlled by medical therapy and allergen avoidance. Allergy shots may also be given to individuals who cannot tolerate allergy medications or who have a personal preference to minimize medication use. For example, children and adults with animal dander or dust mite allergy will likely need to take medications year-round to control symptoms.
3. Can allergy shots treat food allergy?
Allergy shots may help some individuals with pollen-food syndrome, a condition were raw fruits, vegetables and some nuts cause itching of the mouth and tongue. These individuals often have severe pollen sensitivity. However, it is not generally indicated specifically for food allergy and the best option for people with food allergies is to strictly avoid foods that cause symptoms.
4. What are the advantages of allergy shots?
Allergy shots are over 90% effective when given properly. It has been proven to decrease allergy symptoms, medication use, and promote lasting-relief of allergy symptoms even after treatment is stopped. For individuals with asthma, allergy shots may also decrease asthma symptoms and the need to be on daily asthma medications.
5. Can allergies go away on their own?
While it is certainly possible that allergies may improve, most people will continue to have symptoms that worsen over time. Individuals with seasonal allergies may often develop year round symptoms, and individuals with year round allergies may also develop seasonal flare-ups.
6. Are allergy shots effective for children?
Allergy shots are especially effective in children, because treatment has been proven to help prevent the development of new allergies and asthma. As many as 25% of allergic children may develop asthma as they get older if untreated. This observation is sometimes referred to as the "atopic march." Allergy shots are normally given to children 5 years or older, but may occasionally be given earlier.
7. Where can I get allergy shots?
Allergy shots are normally prescribed by a board certified allergist, such as Dr. McEldowney. Allergy shots must be given under the supervision of a physician in a facility equipped and trained to identify and treat adverse reactions to allergy injections. For this reason, allergy injections are not administered at home.
8. Are allergy shots safe?
The most common type of reaction is a local reaction. These vary from a dime-sized itchy spot to a large lemon-sized area of swelling. These often do not require specific treatment and improve as allergy shots are continued. The risk of a serious allergic reaction is rare, but may include serious life-threatening anaphylaxis. Most of the time, a shot of epinephrine will relieve symptoms. Serious allergic reactions normally occur within 30 minutes. As a result, patients are required to remain in the office 30 minutes after their shots are given for observation. Less frequently, patients may have a delayed reaction outside of 30 minutes. We also require and train patients to use an auto-injectable epinephrine pen to carry to and from their shot appointments to cover this rare situation.
9. How does immunotherapy work?
Allergy shots work like vaccines. The body develops stronger immunity and decreased symptoms as the allergy vaccine dose is increased and repeated over time. The body's reaction to allergens is switched from allergy to tolerance.
10. What is the process of allergy shots?
There are two major phases, including build up and maintenance. During the build up phase, the strength of the allergy vaccines is gradually increased by a fixed schedule to reach a target dose referred to as the maintenance dose. Shot are normally given 1 to 2 times per week initially. This duration is normally 3 to 6 months depending on how often shots are received. The maintenance phase is started after the target therapeutic dose is achieved. In our office, most patients are quickly converted to monthly shots.
11. How long will it take to feel better on allergy shots?
Some patients will notice an early improvement of symptoms within several weeks during the build up phase, but it may take as long as 6 to 12 months on the maintenance dose to see a significant improvement. The effectiveness of immunotherapy is related to the strength of allergy vaccines and the length of treatment.
12. How long do I have to take shots?
The standard duration of treatment is 3-5 years to receive maximum benefit. Most patients can be stopped at that time. Many people have lasting remission of allergy symptoms, but others may relapse after stopping allergy shots. The duration of therapy can vary from person to person and some individuals may need to stay on allergy shots longer than the usual duration.
13. What happens if I don't get better on shots?
As stated previously, allergy shots are over 90% effective in reducing allergy symptoms. Most patients will improve clinically and decrease the need to take medication, however, not everybody will be able to stop taking all allergy medications. The effectiveness of immunotherapy should be evident after 1 year on maintenance dosing. If a patient has not seen improvement after this time, the individual's specific treatment should be reviewed to discuss possible reasons why the treatment failed and explore other treatment options.
14. What are the reasons that allergy shots don't work?
There are multiple reasons that allergy shots may not be as effective as they should. First, it is important to identify and treat all clinically relevant allergens the patient is exposed to. Second, it is necessary to use allergy vaccines in levels high enough to improve symptoms. Clinical studies provide us with specific dosing recommendations to be effective. Third, allergy vaccines have very specific mixing recommendations. If incompatible allergens are treated in the same vial, they can decrease the effective strength of the vaccine. Not following recommended guidelines for dosing and mixing will decrease the effect of treatment. Finally, allergy shots must be given long enough at therapeutic doses to be effective. As mentioned previously, it may take as long as 1 year on maintenance therapy to notice significant improvement in symptoms and medication use.
15. How are specific allergens selected for allergy vaccines?
Allergy shots should be completely individualized based on clinical history, allergen exposure, and allergy test results. A unique treatment mixture is then created for every individual. Allergy vaccines should be prescribed by a board certified allergist with specific training in formulating allergy vaccines.
16. What is a board certified allergist?
An allergist should be certified by the American Board of Allergy and Immunology which is the only allergy subspecialty board recognized by the American Board of Medical Specialties. This ensures that your physician has had at least 2-3 years of subspecialty fellowship training in an ACGME-accredited training program and has passed the board exam in Allergy and Immunology. Dr. McEldowney is board certified by both the American Board of Allergy & Immunology and the American Board of Internal Medicine.
17. How do I check if an allergist is certified by the American Board of Allergy and Immunology?
You may verify that a doctor is board certified at http://www.certificationmatters.org/is-your-doctor-board-certified.aspx or call toll-free 1-866-ASK-ABMS (275-2267). A short registration and log-on may be required for the website. You should verify specific certification from the American Board of Allergy & Immunology. Note, physicians may be board certified in other specialties (for example, pediatrics and internal medicine) and be considered "board certified"; however, this does not assure proper subspecialty certification specifically for Allergy and Immunology.
18. How much do allergy shots cost?
Most insurance plans cover both the cost of vaccine preparation and administration of shots. Some insurance plans may cover 100% of costs, however some insurance plans may require a co-pay or deductible. This will be dependent on your individual insurance plan. Allergy shots in our office do not involve a specific office visit level co-pay, but there is a charge for administration of the allergy shot. I would recommend contacting your individual insurance plan to determine your benefits. As a service to our patients, we will contact the insurance company on behalf of the patient to determine any potential out-of-pocket expenses before committing to treatment. In general, allergy shots have been shown to be cost effective in reducing long-term total health care expenses on medical visits and medications.
19. Why should I get allergy shots at Allergy and Asthma Care of Blakeney?
Allergy and Asthma Care of Blakeney is an independent solo allergy practice founded by Dr. McEldowney. His goal is to provide the best practices in allergy and asthma care, including allergen immunotherapy. As a small office, we personalize care and spend more time with our patients. We completely individualize testing and treatment recommendations. For immunotherapy, we use the highest quality allergy extracts in recommended doses proven to be clinically effective. Our build-up schedule is shorter so that most patients improve and achieve monthly dosing faster. We also schedule allergy shot visits to minimize wait times and maximize efficiency. We have a high level of clinical success and are constantly striving to improve all aspects of treatment.
20. Do you offer sublingual immunotherapy (allergy drops)?
Sublingual immunotherapy is the practice of placing drops of allergy extracts under the tongue instead of by injections. Sublingual immunotherapy is not FDA approved and is not covered by insurance companies. As such, these allergy drops are usually paid out-of-pocket to providers using it off-label. Although it has been used more extensively in Europe than the United States, there are important differences in extracts and patient characteristics that need to be determined. Clinical studies are underway and it may be an important treatment option in the future. At this time, we do not offer this form of treatment.