Author: Miriam K. Anand, M.D., FACAAI, FAAAAI
Sneezing, itchy eyes, stuffy nose and you need tissues on hand at all times. You’d almost forgotten how bad things were last year and this year they seem even worse. You can’t wait for it to be over, right? But what about next year…and the year after that? If there were something you could start doing now that could help in the future, would you do it? Medicines can give relief from allergy symptoms, but they can’t change how allergic to things you are. Did you know that there is a treatment available that can do that? There is, it’s called immunotherapy and it’s been used to decrease allergies for almost 100 hundred years.
What is immunotherapy?
Immunotherapy is a way to change how your immune system views the things that you are allergic to. When we have allergies, our immune system overreacts to substances in our environment that shouldn’t normally cause problems. Immunotherapy retrains the immune system over time so that we are not bothered as much by those triggers. In other words, it desensitizes us to the triggers.
Is immunotherapy a cure for allergies?
No, immunotherapy is not a cure for allergies. There is no cure for allergies, but immunotherapy can increase our tolerance to allergic triggers, which can allow us to enjoy life more with less bothersome allergy issues. It is what we refer to in medicine as “disease modifying”, because it doesn’t only control symptoms, like medicines do, it actually changes the body’s response to allergens. While one may not be able to go without medicines altogether, the number of medicines or length of use may be decreased. For those with severe allergies, they may find that medicines work better to control their symptoms after undergoing immunotherapy.
Will immunotherapy help me with my pet allergies?
Yes. In addition to helping treat allergies to pollens, such as grasses, weeds and trees, immunotherapy can also be used to treat pet allergies and allergies to dust mite, cockroach and others.
How Does Immunotherapy Work?
Immunotherapy works by administering very small amounts of allergens to the patient and gradually increasing the dose until the highest dose or “maintenance dose” is reached. The most common and effective method is through weekly allergy injections or allergy shots. Once the maintenance dose is reached, then the patient can start coming once monthly for c. 3 to 5 years. Most patients will have lasting benefits after completing this cycle unless they move to a climate with new allergens. Others may find that they do best continuing the monthly maintenance dose. These shots are not the same as steroid shots. To find out more about those, click here: https://allergyassocaz.wordpress.com/2019/02/15/is-that-springtime-allergy-shot-safe-find-out-here/
What are the risks of allergy shots?
The biggest risk is having an allergic reaction, since the patient is being injected with substance that he or she is allergic to. Most often, this can present as itching or swelling where the injection was given. The bigger risk, however, is a more severe allergic reaction, also known as anaphylaxis. In rare cases, these types of reactions can be potentially fatal. For this reason, patients should get their injections in a medically supervised setting and should wait there for at least 20 to 30 minutes. If they experience any symptoms after leaving, they should notify their allergist right away. Many patients may be instructed to carry autoinjectible epinephrine with them on injection days.
Shots? Is there any other way than shots?
You may have heard of sublingual immunotherapy. There is evidence based and FDA approved sublingual immunotherapy available in the United States, but the oft touted sublingual allergy drops are neither evidence based nor FDA approved. Furthermore, insurance does not cover them, while some insurances may cover the tablets.
Regarding FDA approved sublingual immunotherapy (a.k.a., SLIT), this consists of a tablet that is placed under the tongue until it dissolves. Sublingual immunotherapy has been shown to be helpful for treatment against one allergen, but if more than one allergen is used, the efficacy goes down to the same rate as placebo. Thus far, there are only tablets for a few allergens. For this reason and others, the tablets have not been very successful for many patients in Arizona.
Sublingual tablets are used daily and can be given at home after the first dose, but studies thus far have shown that allergy shots provide stronger relief than sublingual immunotherapy, especially since many in Arizona and the United States are allergic to more than one pollen or allergen.
Where is the best place to find out about allergy shots?
The best place to find out about allergy shots is through talking to an allergy specialist, such as an allergist/immunologist. They have the most expertise in diagnosing and treating allergies and you can click here to learn more: https://allergyassocaz.wordpress.com/2019/01/20/what-is-an-allergist-immunologist-and-how-are-they-different/
There are some companies that market skin testing and allergy shots in non-specialist offices, such as primary care settings. The testing is often done by a technician with little to no allergy training and there is no trained allergist/immunologist on site. These companies often provide extracts that are to be given at home. This can be very dangerous for someone with strong allergies, so the extracts may be made weaker to reduce the risk of a bad reaction. This means that the effectiveness will also be reduced. A trained allergist/immunologist has the most expertise in determining the allergen extracts that are right for you or your child and how they should be administered so that you can get safe and effective results.
But what about the copay or out of pocket cost?
While many insurances cover much or all of the cost for allergy injections,
some patients may still have a copay, coinsurance or deductible. To learn
more about these terms, click here: https://allergyassocaz.wordpress.com/2019/01/20/its-january-new-insurance-plan-or-terms-what-does-it-mean/
When weighing these potential costs, there are a number of questions to
How much are you currently spending on allergy medicines or visits to your
doctor or urgent care? What about time missed from work or the effect on
your child’s education of missing school? If you add that up and consider
that this could continue to be an annual cost, how much will you spend on
that? Contrast that to the up front out of pocket cost for injections and
the savings down the road when you’re not needing to use paid time off for sick
days due to allergies and needing less medicine in general to control your
symptoms. In addition, better control of allergies and asthma will lead
to fewer urgent care and sick visits to a doctor.
In our practice, when asked if they feel allergy injections are working,
many of our patients make comments such as, “absolutely” or “definitely”.
Others even go so far as to say, “I never want to go back to the way things
This is why allergy injections should be considered an investment. Not
only will they save you money in the future, but they will improve your quality
of life, allowing you to live your life with less of a burden from your
Tabatabaian F, Casale TB. Selection of patients for sublingual immunotherapy (SLIT) versus subcutaneous immunotherapy (SCIT). Allergy Asthma Proc.
2015 Mar-Apr;36(2):100-4. doi: 10.2500/aap.2015.36.3830.
Nelson HS, Makatsori M, Calderon MA. Subcutaneous Immunotherapy and Sublingual Immunotherapy: Comparative Efficacy, Current and Potential Indications, and Warnings–United States Versus Europe. Immunol Allergy Clin North Am. 2016 Feb;36(1):13-24. doi: 10.1016/j.iac.2015.08.005.