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Allergy Consultants, P.A.
Specialists in Pediatric and Adult Allergy, Asthma, and Sinus Disease Arthur F. Fost, M.D. David A. Fost, M.D. Antonio A. de la Cruz, M.D. Mark E. Weinstein, M.D.
IMMUNOTHERAPY (ALLERGY SHOTS)

This information is about Allergy Immunotherapy, or Allergy Shots
Allergy shots are a means of reducing the symptoms of allergic rhinitis (hayfever, sinusitis) and asthma, and in some
cases reversing an allergic process. If started on a timely basis, they may also be effective in preventing asthma.
Most patients choose to treat their allergic symptoms by avoiding allergy triggers and/or with medications (nose
sprays, pills, ect.) but some find this too difficult, costly, and tedious over many years. Some patients simply do not
like to take medications or become frustrated because the medications do not alter the course of allergies over time.
The allergy injections are then the preferred alternative. It is a method that has been used for 80 years and, it in
recent years, improvements in the science of allergy have made this technique even more effective.
Who Might Consider Immunotherapy?
Immunotherapy is appropriate for patients who have allergy symptoms lasting longer than six (6) to eighty (8)
weeks each year. It is also helpful for asthma, insect allergy and chronic sinusitis. Immunotherapy is not
recommended for food allergies. It is not proven useful for less well-defined areas such as intestinal and emotional
problems, arthritis, headaches unrelated to sinus problems or hives.

How Does It Work?
Who Immunotherapy is a process in which an allergic patient can become desensitized to those pollens and inhalants
that trigger allergic rhinitis (nasal congestion,) allergic conjunctivitis, asthma and insect reactions. Small doses of
the actual allergic substance are injected weekly. Each week the dose is increased. Patients usually stay on a
weekly schedule for approximately 9 months, and then is every for weeks once a maintenance dose is reached.
Gradually a protective antibody known as Immunoglobulin G (IgG) is formed to block the allergic reaction. When
someone has an allergy, they have high levels of the allergic antibody Immunoglobulin E (IgE), in their blood. This
IgE is activated by the allergen (dust mites, ragweed, cat, ect.), and it attaches itself to the “mast” cells that release
histamine. The histamine causes swelling and congestion. It causes a tightening of the airways to create asthma.
The change induced by immunotherapy is gradual. Many patients notice an improvement within six()6) months at
which time the patient should schedule a 6-month evaluation appointment. Progress is evaluated every six (6)
months to one (1) year. Immunotherapy does not work in about 5% of patients who were correctly diagnosed to
have significant allergies.
How Long Should Someone Receive Immunotherapy?
A two (2) year period is usually adequate to assess the success of treatment. If high doses of treatment have been
achieved, one should notice a significant improvement in symptoms. Usually patients continue on a maintenance or
top dose of immunotherapy for three to five years on a monthly basis.
At year 4 or 5, a trial of discontinuing treatment is often attempted. After immunotherapy is stopped symptoms may
return at a rate of %5 in the first (1st) year, and 10% in the second (2nd) year and up to 35% in the third (3rd) to fifth
(5th) years.
Immunotherapy and Pregnancy
Allergy shots are not started for women during pregnancy, though there is no medical reason not to do so. The
beginning of immunotherapy has a greater chance of allergic reactions to the shots (see reactions to shots). If an
woman has been receiving immunotherapy and becomes pregnant, she may safely continue the shots during
pregnancy. Immunotherapy has been used for eighty (80) years and does not harm the baby.

Allergy Consultants, P.A.
Specialists in Pediatric and Adult Allergy, Asthma, and Sinus Disease Arthur F. Fost, M.D. David A. Fost, M.D. Antonio A. de la Cruz, M.D. Mark E. Weinstein, M.D.

Reactions to Allergy Shots
There are two (2) kings of reactions to the allergy shot: Local and Generalized (Systemic)

Local: Reactions occur at the site of the injection on the arms (where the shots was given). Redness and
itching are frequent and are not a reason to hold or decrease the dose. Swelling or a lump that are irritating
are reasons to hold or decrease the dose. This might occur in the office during the 30 minute waiting
period, or at home over the next 24 hours. Patients are asked to tell the doctor or nurse before the next
injection about any swelling. We want to know how large it is…is it the size of a dime, nickel, quarter,
half-dollar or larger? We can adjust the dose of further injections. An ice pack and antihistamine, such
as Benadryl, can be used to reduce for any swelling. Patients are asked to call the office during office
hours to report these reactions.
Generalized (Systemic): reactions occur when there is any chest tightness, breathing difficulty, throat or
lip swelling, hives, dizziness, nausea, vomiting, diarrhea, stomach cramps or an overall feeling of warmth
to the face and body. This usually occurs in the first 10 minutes after the injection but can occur over the
first hour. This is a strong reaction, not a minor feeling, which sometimes starts with a general feeling of
itchiness. Other times it starts with a tickle or tingling in the throat. One should return to the office
during office hours or go directly to the emergency room for evaluation and treatment of this
reaction.
If someone else can drive you, this would be best. Patients are requested to have Epinephrine
Auto injector and an antihistamine with them. Vigorous exercise should be avoided for a few hours after
shots.

***We must be informed or any medication changes while on Immunotherapy.

Drugs Not To Be Taken While On Immunotherapy
If any other physician wants to put you on any of the following medications which all contain a family of drugs
called Beta-blockers, its is important to notify him/her that you are on immunotherapy and have been told you are
not supposed to take them.
• If you are currently taking a Beta-Blocker, please notify your doctor or nurse. There is some evidence that patients who are taking these medications are moiré likely to experience reactions or more severe allergy symptoms. Also Beta-Blockers can interfere with epinephrine (Adrenaline) which is the most important drug used to treat severe reactions to Immunotherapy.
The following is a list of some Beta-Blockers used to treat high blood pressure, glaucoma, migraine, headache or
irregular heartbeat:
Generic Names Brand Names
Acebutolol (Sectrol)
Nebivolol (Bystolic)
Atenolol (Tenoretic, Tenormin)
Penbutolol (Levatol)
Betaxolol (Kerlone)
Pindolol (Visken)
Bisoprolol (Zebeta, Ziac)
Propanolol (Inderal, Inderal LA, Inderide, InnoPran XL)
Carteolol (Cartrol)
Sotalol (Betapace, Sorine)
Carvedilol (Coreg, Coreg SR)
Timolol (Blocadren, Timolide)
Esmolol (Brevibloc)
Betaxolol (Betopic, Betopic S) for the eyes
Labetalol (Normadyne, Trandate)
Levobunolol (Batagan) for the eyes
Metoprolol (Lopressor, Toprol, Toprol XL)
Metipranolol (OptiPranolol) for the eyes
Nadolol (Corgard, Corzide)
Timolol (Betimol, Istalol, Timoptic, Timoptic XE for the eyes)

Source: http://sneezedoctors.com/sites/default/files/Immunotherapy%20Handout.pdf

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