Allergy shots (also called immunotherapy) are a series ofinjections containing small amounts of the substances youare allergic to. They are meant to desensitize or downregulate your immune system to the specific allergens thattrigger an allergic response in you. Immunotherapy is not asubstitute for avoidance of allergens or for the use of allergymedications or surgery, but rather a supplement to thosetreatment measures. Allergy injections may permit you totolerate exposure to the allergen with fewer allergysymptoms.

EfficacyAllergy symptoms will not improve overnight. It is a gradualprocess that can take 6 months or more before you startfeeling better. It may take 12-24 months for full benefits tobe evident. You will most likely still need allergymedications during this time to control your symptoms.About 80% of allergic patients on immunotherapy notesignificant improvement of symptoms and become lessdependent on medications. The goal of allergy shots is todecrease your allergy symptoms and thus your need forallergy and /or asthma medications.

ProcedureAllergy shots are started at a low dose and graduallyincreased every injection and vial until maintenance isreached. Allergy shots are given twice weekly with at least2 days between shots until you reach “maintenance.” Onceyou are on maintenance, shots are given once weekly for afull year going through every season. As your symptomsbecome controlled and you are not allergy medicationdependent, shots are reduced to once every 2 weeks and thenevery 3 weeks. After the first injection from each new vial,you will need to wait in our office for 20 minutes to makesure no adverse reactions occur. This is for your safety!

DurationIt usually takes 2-6 months to reach the maintenance dose.The time may be longer depending on local reactions or ifinjections are not received on a regular basis. It is veryimportant that you keep on schedule to achieve the bestresults. If you are unable to receive regular injections,immunotherapy should not be started. Immunotherapy maybe discontinued at the discretion of your physician if shotsare not given on a regular basis, as there is an increased risk

of reactions under these circumstances. Depending on yoursymptom control, allergy shots may take 3-5 years to achievemaximum benefit.

New MedicationsPlease notify the allergy department if you start ANY newmedication, particularly medications for high blood pressure,migraine headaches, and glaucoma. “Beta blocker”medications are contraindicated while on immunotherapyand your injections will need to be discontinued while youare taking a beta blocker. Beta blockers come in severalforms such as pills or eye drops. If you are not sure if themedication is a beta blocker, please ask us.

Adverse ReactionsImmunotherapy is associated with some widely recognizedrisks. Risk is present because a substance to which you areknown to be allergic is being injected into you. Someadverse reactions can be life threatening and may requireimmediate medical attention.

LOCAL REACTIONSThese are common and are usually restricted to a smallarea around the injection site. These reactions aremore likely to occur as you reach the maintenancedose. Redness, itching and bruising at the injectionsite are all normal. These symptoms should go awaywithin 4-8 hours after receiving the shot. Red raisedwheals larger than a 50 cent piece occurring within30 - 60 minutes should be reported to our office so wecan adjust the dose accordingly. If the wheal occursover an hour after injection, you may proceed to nextscheduled dose.

SYSTEMIC REACTIONSIn rare cases, a severe allergic reaction (anaphylacticshock) can occur after an allergy shot, usually withinthe first 20 minutes. Every patient is prescribed anEpiPen® which would be used to reverse symptoms ofan allergic reaction very rapidly. It is very importantthat you have your EpiPen at every allergy shot forthis reason. Symptoms of anaphylaxis are acuteshortness of breath, low blood pressure, throattightening, wheezing, flushed skin, nausea, coughing,restlessness, heaviness in chest or chest tightness,

STARTING ALLERGY SHOTS(Immunotherapy)

increased secretions, rapid pulse and sense ofimpending doom. All allergy patients should alsohave antihistamines on hand, particularly liquidBenadryl® to counter act these reactions. If you have asevere allergic reaction, you should seek medicalattention immediately at the nearest emergencyfacility. Also notify us the next day so we can adjustyour vial accordingly. You should not receive anotherallergy shot until you speak with our office. Thesesystemic reactions can occur at any time whetherbuilding or at maintenance without previous warning.Urticarial reactions (hives) includes various degrees ofrash, swelling and/or itching of more than one part ofthe body. There may be mild to moderate discomfort,primarily from the itching. This rare reaction mayoccur within minutes to hours after an injection.If you should have an exaggeration of your allergysymptoms (such as nasal congestion, runny nose orwheezing) in the afternoon or night of your allergyinjection, take your antihistamine. Report this to theperson giving you your next shot.

PregnancyFor females of childbearing potential: If you becomepregnant while on immunotherapy, notify our officeimmediately so that your doctor can determine an appropriatedosage schedule for the injections during pregnancy.Immunotherapy doses will not be advanced duringpregnancy, but may be maintained at a constant level.

When you should NOT get an allergy shot:If you have a fever greater than 100 degrees Fahrenheit.Please wait 48 hours after you are fever free before getting anallergy shot.If you received an immunization or vaccination such as flu,MMR, tetanus etc. You should not do an allergy shot thesame day, as it would be difficult to distinguish which onecaused a reaction if one were to occur.If you are having any breathing difficulties such as asthmaexacerbation or an illness such as influenza or pneumonia.If you have a cold or sinus infection you may get a shot ifyou don’t have a fever or breathing difficulties which maybe wheezing or chest tightness. If you are unsure if you canhave an allergy shot please call our office.Patients who are in respiratory distress (wheezing, coughing,chest tightness, or shortness of breath) should NOT receiveallergy injections. If you are experiencing any problems withbreathing, you should call our office for an appointment witha physician.If swelling remains from previous injection. Postpone thenext injection until the swelling has subsided.

ExerciseThere should be NO strenuous exercise or over heating for 2hours before and 2 hours after your allergy injection.Increased blood flow can promote faster release of allergensfrom the shot into the blood stream.

AsthmaAsthma patients will be required to do peak flows prior toeach allergy shot to increase safety while doingimmunotherapy. Asthma patients will also be followedclosely with pulmonary function testing if they do not havea pulmonologist they see regularly. This is to ensure safetyas we increase the immunotherapy. Please notify our officeof any increase in asthma symptoms such as wheezing,shortness of breath or nighttime coughing.

Key PointsYou need to have your EpiPen with you at all allergyinjections.You must fax, mail or bring to your appointment yourCOMPLETED injection log after receiving 0.50 dose fromyour treatment vials so we can mix your next vial.You may start taking medications you were advised to stopsuch as antihistamines. Use these as a supplement until yourallergy shots control your allergy symptoms. Please let the person giving your allergy injections know ofany reactions you had from the previous injection.You may apply ice and/or hydrocortisone cream to theinjection site to help reduce local reactions of itching, rednessand swelling. You can also take an antihistamine such asZyrtec®, Claritin®, Bcnadryl® or Allegra® on the day you get your shot to prevent reactions.Please make sure to call our office to set up your next vialappointment at least two weeks prior to needing a newvial. If you can make an appointment at least two weeks inadvance, you will be more likely to get the time and day youwant. You MUST reach 0.50 dose before coming in for new vials.If you do not reach 0.50 you will not be able to start yournew vials.Do not hesitate to call with any questions or concernsregarding your immunotherapy. We are more than happy tohelp you.