Weighing the Pros and Cons of Allergy Shots

Around a third of adults in America suffer from allergies. If you’re among them, you’re likely looking for a way to alleviate your symptoms.

Allergy shots can provide lasting relief from certain allergies (excluding food allergies), but they do have some drawbacks. The question is, are the time, discomfort, and expense involved justified?

To assist you in making this decision, here’s a look at the current scientific understanding of allergy immunotherapy, how long the effects of the shots last, and what the future may hold for allergy shots.

How do allergy shots work?

Allergy shots have been used in various forms since the 1910s. The aim is to reduce sensitivity to a specific allergen, such as pollen or pet dander.

Your allergist will pinpoint your specific allergens and then create a personalized allergen mixture, according to Dr. David Morris, chief of allergy and immunology at Dayton Children’s Hospital. This mixture contains very diluted, small amounts of those allergens, which are injected under the skin.

This process encourages the immune system to recognize these substances as normal rather than foreign, explains allergist Dr. J. Allen Meadows, executive director of advocacy and governmental affairs at the American College of Allergy, Asthma & Immunology (ACAAI) and a pediatric allergist at the University of Alabama at Birmingham.

You’ll be monitored for about 30 minutes after your shot. According to Morris, this is because there’s a possibility of a reaction, as you’re receiving an injectable substance that you’re allergic to. The (AAAAI) notes that while serious reactions are rare, they can be life-threatening.

Over the next several months, you’ll receive weekly injections containing a gradually increasing dose of allergens. Meadows says this helps you develop a tolerance to these allergens.

After approximately seven months, your doctor may reduce the frequency of shots to once every two weeks. Eventually, you’ll reach the maintenance dose, which involves monthly shots containing a high dose of the allergen you’re allergic to, according to otolaryngologist Dr. Marc Dubin, chief medical officer at ENT Speciality Partners.

You’ll likely continue with these monthly shots for three to five years. It may take up to a year on the maintenance dose before you notice a significant reduction in your symptoms. In essence, allergy shots require a considerable time investment.

However, if you can commit the time, the reward is substantial: Meadows states that it brings about a long-term change in your immune system. You can discontinue the shots and experience freedom from allergy symptoms, often for decades. While some allergists might suggest the results are permanent, he prefers to be cautious about such a long-term claim.

Who gets the best results?

The AAAAI suggests that anyone over the age of 5 can benefit from allergy shots. According to Morris, people with pollen allergies tend to see particularly good results. He notes that the improvement in quality of life is most noticeable for pollen allergies, as individuals often feel significantly better during pollen season.

However, Dubin notes that if your symptoms are initially severe, you might not experience as much relief. Allergy shots are not recommended if you have severe asthma symptoms or are taking certain medications, including beta-blockers for high blood pressure and certain antidepressants.

Allergy shots can also treat insect sting allergies, but Dubin says this process usually takes longer and has more risks.

If your symptoms return after a course of allergy shots, you can undergo another round of treatment. Morris mentions that this is common in his practice, as he treats children who might repeat the process in their 30s after completing it in childhood.

How much do allergy shots cost?

Insurance coverage varies, but Morris estimates that most people will have out-of-pocket expenses ranging from $1,000 to $4,000 for office visit co-pays and the treatment itself.

Morris points out that some insurers charge a co-pay for each shot. With weekly shots for six months (28 shots) and a $25 co-pay per shot, the costs can quickly add up, making allergy shots unaffordable for some.

What advancements are in the pipeline?

Some healthcare providers are using quicker schedules for administering allergy shots, sometimes called rapid desensitization, cluster immunotherapy, or rush immunotherapy.

Instead of weekly shots during the build-up phase, you might receive multiple shots per week, or even more than one shot per day, according to Morris. This speeds up the process of reaching the maintenance phase to a few weeks or months. However, he also notes that this faster schedule typically carries a higher risk of reaction.

There’s also a tablet form of allergen immunotherapy available for people with allergies to ragweed, certain grasses, and dust. The tablet is placed under the tongue to dissolve at least three days a week. While sublingual tablets and drops have been popular in Europe for some time, Meadows notes that this method hasn’t gained much traction in the U.S., where most insurance companies require prior authorization for coverage.

While the tablets might cause an itchy mouth, the side effects are generally mild. Dubin adds that another advantage of this technique is that it can be done at home without medical supervision.

Morris is intrigued by intralymphatic immunotherapy, a new technique in early research phases that involves injecting allergens into a lymph node, where immune cells reside, instead of under the skin.

This approach is fast-acting, requiring only three injections over two months. However, it requires an ultrasound to guide the shot, which demands technical skill and the right equipment. While early results are promising, the U.S. Food and Drug Administration hasn’t yet approved it.

Morris emphasizes that not all treatments are suitable for every patient, but he’s encouraged by the potential for improved quality of life. He advises individuals to consult with a board-certified allergist to discuss the available treatments, their risks and benefits, and determine the best option for them.