Allergy Shots


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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
Usually occurs within 30 minutes which is why you must wait that long in a doctor’s office after each shot, so that you can be treated if any of the above occur


*** Created by Dr. Ellie Tsai MD, FRCPC Kingston Allergy and Asthma 613-546-6673***

Immunotherapy information for health care workers

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