IMMUNOTHERAPY (ALLERGY SHOTS)

Immunotherapy (IT), also known as allergy shots, is a treatment protocol used to make one less sensitive to things to which one is allergic. IT works by slowly making your body less responsive to inhaled allergens over the course of several months to years. Allergy is an overreaction by your immune system to things like pollen, animal dander, dust, mold, etc. The mechanism by which IT works is felt to be related to a desensitization process where your immune system is made more familiar to allergens you come in contact with and prevents this overreaction. The exact mechanism is unclear, but is felt to be related to an immune switch, mediated through certain enzymes your body produces to create your symptoms (such as sneezing, cough, or runny nose).

After going through the course of IT prescribed by your physician, your symptoms should lessen and you should require less medicine (essentially turning this immune switch off). A course of IT will vary amongst each individual, but the usual course can last up to 3 to 5 years, at which time you will be reassessed to see if continuation is required.

WHY WE DO IMMUNOTHERAPY

Immunotherapy (allergy injections) is prescribed to decrease your sensitivity to substances (pollen, mold, dust mites, animal dander, stinging insects, etc.) which upon contact cause allergy symptoms. Immunotherapy is not a substitute for avoidance of known allergens. Immunotherapy is a more holistic/natural approach to treat allergies since the injections do not contain any medications. Immunotherapy often supplements the treatment of allergies with medications and avoidance, but after treatment one may experience a decreased need for the use of allergy medications.

HOW WELL DOES IMMUNOTHERAPY WORK

Roughly 85-90% of allergic patients who obtain immunotherapy will experience significant improvement of their symptoms. This improvement may not be immediate. It may require 3 to 6 months before any relief of allergy symptoms is experienced. To realize a proper decrease in your symptom complex it may take even up to 12-24 months. To maximize this benefit you may need to be treated for a minimum of 3-5 years, or longer depending on the individual.

HOW IS IMMUNOTHERAPY GIVEN

Immunotherapy is usually begun at a very low dose, gradually increasing the dose on a regular basis (usually 1-3 times per week, each dose separated by 48 hours). This dosing frequency will reduce the chances of a reaction permitting the maintenance dose to be reached prior to the expiration of your prescription. Once a therapeutic dose (often called the “maintenance dose”) is reached we begin to separate the dosing frequency up to every 3 to 4 weeks. This separation of the maintenance dose differs from person to person.

POSSIBLE REACTIONS

Reactions to Immunotherapy may occur. There are some widely recognized risks. Risk is present because known allergens that cause symptoms when you are exposed to them are being injected into you. Rarely these reactions may be life-threatening and may require immediate medical attention. These reactions are listed in increasing order of severity:

1. Local Reactions
   The most common reactions are called local reactions, these are often limited to a small area around the site of the injection, but occasionally may spread to a larger area on the same arm. These reactions consist of varying degrees of redness, swelling, pain, and itching. These reactions are more likely to occur as you increase the dose. The reactions may occur at any time after the injection is given, even several hours after the injection, but the overwhelming majority occur within the first 20 minutes after the injection. These are easily managed with topical corticosteroid creams, NSAIDS, and/ or ice compresses placed for ten minute intervals to decrease swelling.
2. Systemic (Generalized) Reactions
   Systemic (involving more than one organ system) occur rarely. Generalized reactions need to be addressed quickly because of the potential danger of progression to shortness of breath, vascular collapse (extremely low blood pressure) and possible death if not treated. These reactions may involve:
3. Skin hives (urticaria) may occur within minutes to hours after the injection. Hives are described as varying degrees of a flushing (like when you blush) rash, swelling, and/or itching of more than one part of the body. People most commonly complain of a sensation of warmth and itching.
4. Angioedema (swelling of the blood vessel) is rarer and can also occur within minutes to hours after the injection, and is characterized by a progression of the swelling of any part of the body one may experience after one develops hives, or even without hives. Any organ may be involved but most commonly the ears, tongue, lips, throat, intestine, hands, or feet, alone or in combination can be affected. Asthma like symptoms may accompany these reactions and can lead to a worsening reaction further involving airway closure.
5. Anaphylactic Shock is the rarest complication and also can occur within minutes to hours of the injection. Anaphylaxis is defined as a widespread and very serious allergic reaction. Symptoms include dizziness, loss of consciousness, labored breathing, swelling of the tongue and breathing tubes, blueness of the skin, low blood pressure, heart failure, and death. Immediate emergency treatment is required for this type of shock.

This is why we make you wait. The reactions previously described are rare. Despite this rarity we take precautions with each patient because they are unpredictable and can occur at any stage of treatment. The more severe reactions will require immediate attention by the provider. There may be minimal treatment involved to emergency treatment, depending on the type of reaction. If any of the above reactions occur, and you choose to continue treatment, the provider will adjust the dosage for subsequent injections. With the more significant reactions, a visit with your provider may be required to discuss your options and receive advice.

THE IMMUNOTHERAPY PRESCRIPTION

After full evaluation of your allergies, the provider will order a specific prescription catered to your individual allergy profile. This will include all vaccine dilutions that are required to reach your treatment dose, also known as the “maintenance” dose. There is a “buildup phase” in which we start at the lowest dilution and gradually increase the dose (concentration) of your prescription. The vaccines will have a 6 month expiration date so one must get at least 1 injection per week to prevent the vials from expiring at their due date. If you miss a dose that is fine, but too many missed will result in not achieving your maintenance dose in a timely fashion. You can always come in for injections up to 3 times per week with a 48 hour separation between injections to build up faster, however 1 time per week will allow you to achieve the goal of reaching maintenance without your vials expiring.

IMMUNOTHERAPY AND PREGNANCY

If you become pregnant or are attempting to conceive please let one of the staff or your provider know immediately, so that we can manage your prescription appropriately. Most can continue on their allergy shots, but the dosage may require adjustment. This adjustment will depend on where in your prescription you are. There will be no advancement in your dose while you are pregnant, but maintenance at a constant level can be achieved.

MEDICATION CHANGES

There are certain circumstances where a prescription change may affect your immunotherapy. Some medications need to be monitored so as not to cause any problems in your allergy management. If other physicians are going to add any new medications please notify the staff immediately. “Beta blockers” are medications that are used to treat various conditions such as hypertension (high blood pressure), migraine headaches, and in glaucoma in the form of eye drops. “Beta blocker” medications are contraindicated while on immunotherapy, because these medications may interfere with emergency treatment measures used to manage an allergic reaction.

THE SHOT OFFICE

Our immunotherapy shot clinic is located at our Lakeway location (401 Ranch Road 620, Suite 200, Lakeway, TX).  Hours are as follows:

• Monday:   8:30am-12:30pm, 1:30pm-4:30pm
• Tuesday:   9:30am-11:30am, 1:30pm-6:00pm
• Wednesday:   8:30am-11:30am, 1:30pm-4:30pm
• Thursday: 7:30am-11:30am, 1:00pm-3:30pm
• Friday:   Closed

These visits are done on a “walk in” basis and do not require an appointment. Minors must be accompanied by a parent or legal guardian in order to receive an injection. A maximum of 3 injection days per week with a 48 hour window separating injection visits is allowed. Please be aware that we will have you wait for 20 minutes following each injection, so please be prepared to stay for that waiting period.