Allergy Shots
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ALLERGY SHOTS (IMMUNOTHERAPY)
Time commitment: When first starting immunotherapy, you will be given a series of 'build-up' shots. These are to be administered once a week, until maintenance is reached:
- Environmental shots: Build-up will take about 20 weeks. Maintenance shots are given every 4 weeks for 3-5 years
- Venom shots: Build-up will take about 8 weeks. Maintenance shots are given every 4 weeks for the first year, every 6 weeks for the second year, and then every 8 weeks for the third, fourth and fifth year
Who Should Get Them?
- Proven to have allergies with collaborative history and positive skin tests or blood tests
- Severe allergic rhinoconjunctivitis (nose/eye symptoms) for 2 or more years not managed by optimal allergen avoidance and medication.
- Some cases of allergic asthma. There must be a clear temporal association between allergen exposure and signs and symptoms of asthma. Symptoms should be occurring during 2 or more allergen seasons during successive years. Regular use of anti-inflammatory medications such as inhaled steroids will suppress symptoms in most patients. Allergen avoidance measures must be properly instituted.
- Allergy to venom (from stinging insects) (see venom allergy information)
Who Should NOT?
- Patients whose history, physical exam, or laboratory studies do not support true allergies despite positive skin tests or blood tests
- Rhinitis (runny, stuffy nose), Asthma or Insect Reactions NOT due to allergies
- For treatment of Food allergies
- For treatment of Eczema or Hives.
- Severe uncontrolled asthma
- Children less than 5 years of age
- Previous properly administered allergy shots that were not successful.
- No reduction of symptoms after 2 years of allergen injections.
- Allergen injections have been given longer than 5 years
- Patients on Beta- blockers (ie. Inderal, Propranolol, Metoprolol, Acebutolol, etc)
How Do Shots Work?
- You are being given increasing amounts of what you are allergic to, in order to build up a “tolerance” to it (desensitization)
How Are The Shots Given?
- Injections are given in the outside upper arm (NOT in the muscle)
- Start with tiny dose of what you are allergic to and then gradually build up weekly until…
- …..a dose called “maintenance dose” is reached (given every 3-4 weeks)
- Storage of allergy shot vials: Keep refrigerated
- Where to get the shots: By doctor or trained nurse in an office where medications to treat reactions are available
· Before Each Injection:
- Avoid vigorous exercise or overheating for 2-3 hours prior to injection. Exercise/heat increases the absorption of the allergen (substance you are allergic to) which can increase the risk of reactions.
- Postpone the injection if ill, fever or flare of asthma symptoms
- Inform doctor if become pregnant (dose should be reduced if on maintenance or stopped if building up)
- Inform nurse or doctor of any reactions that occurred AFTER the LAST injection
- Inform nurse or doctor of any new medications or change in health status
- Identify your name and dose from vial (make sure you get the correct shot)
- After Each Injection:
- You MUST wait at least 30 minutes in the doctor’s office before leaving. This is so you can be treated if you have a reaction.
- Report any unusual reaction to nurse or doctor before leaving the office
- After you leave the office:
- Avoid exercise or overheating for a few hours after injection given
- Carry an antihistamine. To take only if necessary for mild reactions
- If reaction severe, go to the emergency
Side Effects
- Local Reactions (more common): swelling, itchiness, redness around site of injection
- <4cm is normal for most things, with venom shots you can expect lumps<10cm
- If >4 cm (>10cm for venoms) or lasts > 24hrs than inform the doctor’s office before next injection is given
- Can use ice or antihistamines for larger lumps
- Generalized Reactions (less common): shortness of breath, wheezing, cough, tightness of chest or throat, generalized itching, hives, faintness, flushing, perspiration, nausea, vomiting, passing out
***ALL IMMUNOTHERAPY PATIENTS MUST COMMIT TO STAYING THE FULL 30 MINUTES AFTER EACH SHOT, OTHERWISE YOU WILL NOT RECEIVE YOUR SHOT AT THAT APPOINTMENT.
*** Created by Dr. Ellie Tsai MD, FRCPC Kingston Allergy and Asthma 613-546-6673***
Immunotherapy information for health care workers