Allergy and Asthma Specialists of Kansas City  
     
     

Allergy and Asthma Specialists of Kansas City

               Charles J. Siegel, M.D.                    6000 N. Oak Trfwy                   Phone     816 453-7771 

               Louis H. Stekoll, M.D.                    Suite 102                                     Fax         816 452-7980 

                                                                           Gladstone, MO 64118               

                    

Allergy Immunotherapy Risks and Benefits

 

Allergy immunotherapy is an effective treatment for allergic conditions such as perennial and seasonal allergic rhinitis or hay fever, asthma and stinging insect allergy. Immunotherapy should generally modify your allergic sensitivity and thereby reduce symptoms and the need for medication.  Immunotherapy will not cure but will usually improve many of the symptoms and complications of allergic disease.

 

Traditional allergy immunotherapy or allergy shots is a medical treatment involving a series of injections with gradually increasing doses of a vaccine or extract made from the allergens to which you are allergic. This will have a specific effect on your allergy immune system increasing your immunity by stimulating the production of blocking antibodies.  The allergy extract is specifically designed for you based on the results of an evaluation of your symptoms, medical history, physical findings and allergy testing.  Allergy shots are given to patients of all ages depending on health status and indications.     


Patients who are receiving high dose maintenance immunotherapy for a pollen, such as ragweed, will achieve approximately 80 to 90% reduction in their allergic symptoms, as well as, a possible reduction in the need for additional medication. For dust mites and pets a 60 to 70% reduction in symptoms may be realized. For mold the percentages are approximately 50 to 70%. Allergy immunotherapy is an alternative form of therapy used in conjunction with avoidance measures and medical therapy. Candidates for allergy immunotherapy are those who fail to do well on a medical regimen, have side effects to the medications or cannot completely avoid their allergens. Other criteria include those patients experiencing complications of their allergies out of control such as recurring infections.

 

Allergy injections are believed to be safe during pregnancy. Possible harm to your baby could occur if you have a major reaction to the injection with a drop in blood pressure and the need for oxygen and other treatment. We encourage conservative treatment during pregnancy and not advancing your dose above the maximum dose given prior to your pregnancy. The allergy injections will not cause or prevent allergies in your baby.  Please arrange a follow-up visit if you become pregnant so that your allergy treatment program including medications can be reviewed. One of the benefits of continuing allergy immunotherapy during pregnancy is that you may need less of other medicines.

 

There are several medications particularly some blood pressure or headache medications known as beta blockers that should not be taken while on allergy immunotherapy.  In addition to beta blockers, ACE inhibitors or antagonists, another type of blood pressure medication, should not be taken while on shots for stinging insects.  Please notify our staff promptly of any new medications that have been prescribed for you since your last visit or allergy shot. Generally, there is no interference between allergy medications and allergy injections. As you begin your immunotherapy you should continue your prescribed medications, because immunotherapy will take time to become effective. As you reach the maintenance dose, you may find your need for allergy medications will decrease and you will be able to gradually reduce or discontinue some of your medications. However, you should always take an oral antihistamine on the day of the shot.  Always talk with your physician before reducing any asthma medication.

 

Allergy shots are injected subcutaneously in the upper arm and are usually started at a very low dose. The dose is gradually increased on a regular basis through a series of four vials of increasing concentration until a therapeutic dose or maintenance dose is reached.  An optimal maintenance dose is 0.3cc to 0.5cc of a 1:100 concentration but may differ from person to person.  Although some patients may have to be maintained at a lower dose due to reactions, they may still realize benefit.  Injections are typically given once or twice a week while the allergen dose is being increased. This frequency minimizes the chances of a reaction and the maintenance dose is reached within six to eight months.   An alternative protocol for a quicker buildup is cluster immunotherapy.  Three injections are given in the office over a two hour period once or twice a week for 4-5 visits.   These patients will reach maintenance sooner but there is a slightly

increased risk of a reaction to the shots.  Occasionally, the buildup process is slowed or reduced due to shot reactions, large local reactions, increased symptoms, or missed shots. 

 

The shot dose will be reduced if one misses more than 3-4 weeks of shots. If one misses more than 8 weeks of shots, the buildup process may have to be restarted from the beginning. After the maintenance dose is reached, injections may be given every one to four weeks depending on symptom improvement.  Your progress is reassessed generally every 6 months with follow-up appointments. Improvement in your symptoms may not be immediate. Some patients may see improvement in symptoms as they reach maintenance, but it may take 6 to 18 months at maintenance before the full benefit of allergy immunotherapy is realized.  If an individual shows no significant improvement after one and a half to two years of allergy immunotherapy, the shots will generally be discontinued or a reassessment may be undertaken. Patients who are doing well on immunotherapy will continue the treatment for three to five years, after which the need for continuation is reassessed.  

 

There are risks associated with allergy injections. The risk is present because a substance to which you are known to be allergic is being injected into you. Some adverse reactions to allergy injections are potentially life-threatening and may require immediate medical attention. For this reason, immunotherapy should be given under the supervision of a physician in a facility equipped with the proper staff and equipment to identify and treat adverse or allergic reactions to allergy injections. You may receive your injections in our office or an outside facility under the supervision of a physician.

 

There are two types of adverse reactions that occur with immunotherapy, local and systemic/anaphylactic reactions. Local reactions are fairly common occurring at a rate of 3 to 5% and presents as redness and swelling at the injection site. This can happen immediately or several hours after the injection. These reactions are more likely to occur as you reach the higher concentrations and higher volume injections. You should notify the nurse if your local reaction is severe with significant swelling exceeding 2 inches in diameter or lasting until the following day. Also, occasionally a bruise may occur at the site of injection.

 

The second type of reaction is a systemic/anaphylactic reaction. These are much less common than local reactions occurring approximately one in 2500 injections.  Systemic reactions are often mild and usually respond rapidly to medical therapy. Symptoms can include increased allergy symptoms such as sneezing, nasal congestion, coughing, hives, or itchy eyes, nose or skin.  Rarely, a severe systemic reaction called anaphylaxis can develop after an immunotherapy injection. In addition to the symptoms associated with a mild systemic reaction, symptoms of an anaphylactic reaction can include swelling in the throat, respiratory difficulties, nausea, dizziness, abdominal cramping or a decrease in the blood pressure. Most reactions develop within 20 minutes of the allergy injection but may be delayed up to 2 hours.  Most patients will be required to wait in the office 20 minutes for observation of any potential reaction.  Occasionally, you may be required to stay longer for observation or treatment of a reaction.  Patients with a higher risk of a reaction will be required to wait 30 minutes or longer and will be required to carry injectable epinephrine on shot days due potentially more serious systemic/anaphylactic reactions after leaving the office.  These patients include those with previous systemic/anaphylactic reaction, some asthmatics and highly allergic individuals.  Although not mandatory, all patients are advised to carry injectable epinephrine on shot days to treat systemic/anaphylactic reactions that may occur after leaving the office.   A few deaths, perhaps two to three, are reported in the United States each year from allergy injections. This is a small percentage and most systemic reactions are not life threatening if treated promptly.  You will always check with the nurse before leaving.  If you do not have the time to wait after an injection, please do not come for your shot that day. It is better to come another day when you have the time to stay so that we may administer your injection safely. Also, we will postpone your shot if you are not feeling well.  For example, if you have a fever, significantly increased allergy symptoms or have had wheezing associated with asthma recently.  No strenuous exercise within four hours after an allergy shot is allowed due to potential increased allergen absorption.  If you have any problems or questions, please discuss your options with our staff before your shot. 

 

In summary, the goal of immunotherapy is to reduce allergic sensitivity with improvement in your quality of life at home, work or school. If you have any questions or have had a change in your medications which could conflict with allergy shots please notify our staff.

 

I have read the above and understand the risks and benefits of allergy immunotherapy.

 

Print Name:___________________________________________

 

Signature (Patient or Guardian):_____________________________________           Date: _____________

 

 

 


 


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