Have you considered allergy shots? They may help you feel better. And for children, shots may help prevent their allergies leading to asthma. Here, you can learn about shots from Ira Finegold, M.D., chief of allergy at St. Luke’s Roosevelt Hospital and chairman of the immunotherapy committee for the American College of Allergy, Asthma and Immunology.
Who should consider getting allergy shots?
Ira Finegold: Immunotherapy is appropriate for patients who have antibodies after being exposed to triggers such as pollens, molds, dust mites, pet dander, cockroaches or bee stings, whose symptoms are not well-controlled by medications and for people who don’t want to be on medications for a long time. Also, children should be on it.
Allergy shots haven’t always worked for some people. How have doctors improved them?
Finegold: We used to treat patients who are allergic to more than one substance with one shot of different substances that a patient was allergic to. But we know that certain allergen vaccines react when mixed with other allergens, a factor that must be considered because it can reduce the treatment’s effectiveness. Certain vaccines should not be mixed, such as grass, tree or weed pollens with dust mites or molds. Injections must be given separately instead of in one injection.
If you were allergic to pollen and also to dust mites and grass, you would get it in one shot. But now we split it up. The enzymes of the dust mites destroy the ragweed extract. We make the vaccines work more effectively by giving them separately.
Has the strength of the dose changed at all?
Finegold: Years ago, we would have had someone get the fullest dose you could give to keep allergies under control, as strong as you could take it. That’s not necessary. Now we start by injecting a small amount of a purified allergen extract, which is the substance to which an individual is allergic to, such as pet dander of plant pollens. And then we gradually increase the quantity until the patient eventually becomes immune or desensitized to the allergen.
Does a doctor have to be the one to do the shot?
Finegold: It should be administered in a safe environment. You need to have the equipment in case there is a severe reaction. Have it done in a doctor’s office or hospital as opposed to home. If you do it at home and a bad reaction happens, you are up a creek without a paddle.
What about children? Should they get shots?
Finegold: You want to keep allergies controlled in children because they could develop into asthma. Roughly 20 percent of children with severe to moderate allergies develop asthma. We don’t know why there is this connection or why it develops into asthma for some kids.
In the Prevent Asthma Treatment study, the kids in that study didn’t progress to develop asthma and have even less allergies when treated with allergy shots. It was done for seven years and was published in the Journal of Allergy and Clinical Immunology.
What is the most common form of asthma in children?
Finegold: The most common form of asthma among children is allergic asthma. In this form, otherwise harmless allergens, such as dust mites, cat and dog dander or other environmental allergens can trigger an asthma attack. In addition to allergy symptoms brought on by exposure to these allergens such as watery eyes, sneezing and itching, children with asthma can experience severe airway constriction. If left untreated, the disease escalates to dangerous proportions, even resulting in trips to the emergency room.
Do allergy shots work?
Finegold: Allergy immunotheraphy not only makes symptoms go away, it can truly help prevent the amplification of the disease into asthma and decreases the number of allergies.
What about side effects or bad reactions?
Finegold: Bad reactions are extremely rare, but we do want patients to stay in the doctor’s office for at least 30 minutes to make sure there isn’t a bad reaction. Most people will have a mild reaction, a little soreness, swelling.
Are there any precautions I should take before getting an allergy shot?
Finegold: Beta-blockers should be avoided because they can interfere with epinephrine. But antidepressants are not a problem.
How much of an improvement will I see?
Finegold: If doctors choose these people correctly and administer it correctly, 90 to 95 percent improve. Probably most people – about one-third of allergy sufferers – don’t get shots. Allergists only see the tip of the iceberg. Some people may not realize that allergy shots are effective, safe and economical. Some people think shots are painful, that the tests are terrible. But they really aren’t. Actually, skin tests aren’t bad.
How often do I have to get shots?
Finegold: Sometimes shots can take months. You will need to get them once a week for 14 weeks. But some people can’t make that kind of time commitment. If they can’t, we do a Rush Treatment. I’ve done that in my office. The doctor gives multiple shots in a prolonged office sitting – three hours. I prescribe medications to be taken prior to the treatment so reactions are significantly diminished.
Why should I get allergy shots?
Finegold: At least, 5,000 people die from asthma attacks each year. And taking medication is expensive and inconvenient. It’s $1 to $2 a pill.
When your allergies lasts a week or so, you don’t need to. But if it is prolonged for six months, you should probably consider allergy shots.
There are some basic rules. The first thing you do is avoidance. Also, people have to be educated as to why they get sick so they can be empowered.
What’s the first step I should take in getting help for my allergies?
Finegold: You should see a board-certified allergist and get a skin test. It’s much more effective than a blood test.
While you wait for the results, you need some kind of drug relief.
It’s not automatic. We don’t give it to everyone right away because not everyone needs it. Sometimes medications are enough, like antihistamines, nasal steroids.
How long will I need to get shots?
Finegold: You could be getting it for three years, and then we re-evaluate. We usually have the patients come back every week for 14 weeks to get shots. And then, they need to come back every four weeks for three years to get shots.
Some people are on immunotherapy for longer periods. If they get sick, it may not be until three, four, five years later after stopping. Sometimes the immune system is swung over to a more normal pattern to a nonallergic pattern. Sometimes it’s permanent. We don’t have an answer for why this happens.