Should you try allergy shots?

By Mark Pruitt, MSN, FNP, and Steven Olsen, M.D, ear, nose and throat physician, Providence Hood River Memorial Hospital

We're both big believers in allergy shots – also known as immunotherapy, because the shots retrain the immune system to stop overreacting to allergens. Mark's personal experience with immunotherapy is a testament to the difference it can make in a person's life. A sickly child growing up in rural Virginia, Mark was plagued by asthma attacks triggered by allergies. At 14, he weighed a scrawny 86 pounds, stood only 5 feet 2 inches tall, and missed upwards of 30 school days a year due to his allergic asthma. When his parents heard that a pediatrician in their small town had been trained in allergy testing and immunotherapy, they took Mark to see him. The doctor gave Mark an allergy test to identify the specific allergens that were provoking his attacks, and started giving Mark shots to desensitize him to those allergens. Within a matter of months, Mark grew several inches, gained 40 pounds, and felt so much better that he started running track and playing basketball. It completely turned his life around, and it's why he is so passionate about allergy and asthma care today.

Not everyone has the dramatic turnaround that Mark experienced, but many do. In fact, several studies have shown that if you start immunotherapy early enough in kids with allergies, you can prevent them from developing asthma entirely. The American Academy of Allergy, Asthma and Immunology claims that allergy shots can improve nasal symptoms in about 90 percent of people with allergies. It's a great alternative for people who can't get relief from nasal sprays and antihistamines. And unlike those treatments, which only target allergy symptoms, immunotherapy goes after the root of the problem.

We get a lot of questions from patients who are considering allergy shots. Here are the answers to some of the most common ones.

I tried allergy shots years ago and they didn't help. Are they better today?
Yes – immunotherapy is much more effective now than it was 15 or 20 years ago. With today's standardized dosing, we see far more successes and far fewer reactions. If it's been more than 15 years since you tried it, and you're not getting results from medication, it might be well worth another try.

How long does it take the shots to take effect?
This is another area of great improvement in recent years. The old belief was that we should build tolerance to allergens very slowly, so it often took five or six months of weekly or twice-weekly shots before people saw any results. Now we have what we call cluster immunotherapy, or rush immunotherapy, which builds tolerance much more quickly and relieves symptoms in as little as four to seven weeks. Besides feeling better sooner, people find it much more convenient: They can jump from getting their shots weekly to every other week, and then every three or four weeks, much more quickly on this accelerated program. We've had great success with it.

How much relief do people get from the shots?
We can't always eliminate symptoms entirely, but if we were to take a rough straw poll of our current patients, we'd say that more than 75 percent of them, and probably closer to 80 percent, get major relief from their allergy symptoms. We've had several who were able to go off all of their allergy medications after just six weeks of shots.

Do some people have to keep taking medication?
Some do, but usually the amount of medication they need is greatly reduced. Is it worth getting the shots if you still have to take some meds? A recent retrospective study of kids in Florida who went through immunotherapy found that it reduced their health care costs by about one-third over time. Even for children who started the therapy but stopped it before completing the full course of shots, there were still long-term benefits. The study concluded that far more people should be getting immunotherapy.

How long is a full course of shots? What happens if symptoms return after you stop the shots?
A full course of allergy shots usually continues for three to five years, with the frequency of the shots gradually tapering off. An older study found that once the shots were stopped after a full course, about half of people never had any more problems with their nasal symptoms. For the other half, symptoms began to creep back sometime after six to 24 months later. If symptoms return, you can simply start taking the shots again. With today's dosing, most people can very quickly return to their optimal level of immune resistance after they restart the shots.

If symptoms start creeping back before it's time for your next shot, can you get the shot earlier?
Absolutely. We tell our patients that we go by their nose, not by the calendar. If you notice symptoms returning, it's fine to come in sooner for your next shot. The same goes for seasonal allergies that hit harder in the spring and early summer – at those times, many people choose to come in for shots more frequently to keep symptoms well under control.

Are there any risks?
Because the shots are delivering something that you are allergic to, there is a small risk of a severe allergic reaction. That's why we give the shots in a medical office, where we have the expertise and medications to treat any potential reactions. Since the dosing has become so standardized, adverse reactions have become quite rare.

So should you get the shots?
There are a lot of factors to weigh when deciding whether allergy shots are right for you. The shots can be costly and time consuming, they do come with some risks, and they don't work for everyone. On the other hand, some people have a great response and never have to take allergy medications again. Weigh the pros and cons carefully with this decision tool: Should I take allergy shots? Then talk over all of your questions with your doctor. We're very enthusiastic about the great results we've seen, but it's a big decision that each individual should make very carefully with a doctor's guidance.

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For more information on allergy treatments, read our article:
Ask an expert: My allergy meds aren't working.