Infomation for patients on shots

Advanced Asthma & Allergy Center
4003 Bellaire Blvd. SuiteG, Houston Tx 77025
Ph: 713-888-0881 Fax 713-888-0891
General Immunotherapy Guidelines

What are Allergy Shots/Allergen Immunotherapy?

Allergen immunotherapy is treatment regimen devised to decrease your sensitivity to what you those allergens that cause your symptoms. Your allergen sensitivities have been determined by your skin testing. The process involves subcutaneous administration off increasing quantities of purified natural allergen extracts. The administration is divided into a Build-up Phase and a Maintenance Phase. During the build up phase injections may be one to two times every 7-10 days. This phase typically lasts between 3-6 months and is determined by the frequency of the injections. The goal of the build up phase is to reach the effective therapeutic dose. This dose may vary from patient to patient and is determined by how sensitive you are to the allergen extract and your immune responses during the build up phase. In the maintenance phase the goal is to increase the time between shots to every 2-4 weeks. This will be determined by your symptoms and in consultation with your physician. When new vials are made the level of antigen is very high and thus you will have a short build up phase before going back to your regular schedule. The recommended time for the maintenance phase is between 3-5 years. Immunotherapy has been shown to prevent the development of new allergies and, in children, it can prevent the progression of the allergic disease from allergic rhinitis to asthma. Allergen immunotherapy can lead to the long-lasting relief of allergy.

How does immunotherapy work?

Mechanistically immunotherapy works like a vaccine to increase your immunity or tolerance to allergens. Patient responses vary depending on the initial severity of their symptoms but most patients show decreased, minimal to no allergy symptoms. Decreased symptoms can be observed during the build up phase but are typically seen a few months after being on the maintenance dose.

What are the possible side effects?

Allergen extracts are completely natural and do not typically have side effects. However there are two types of adverse reactions that can occur with allergen immunotherapy i.e. Local and Systemic reactions. Systemic reactions typically occur within 20 minutes of your shot administration and hence patients are required to wait in the clinic for 20 minutes after their allergy shot.
Local Reactions are common and occur at the site of injection. They include redness, slight swelling and itching. They can be treated with cold packs and topical Benadryl or Hydrocortisone creams along with an antihistamine by mouth. If the local reaction lasts longer than 24 hours and is very bothersome then please inform the staff prior to your next shot as it may require to change your build up regimen to a sensitive protocol

Systemic Reactions are less frequent than local reactions. They are typically mild and include symptoms like sneezing, nasal congestion and hives. They quickly respond to antihistamines.
Anaphylaxis is a serious systemic reaction and possible symptoms include the above plus dizziness, wheezing, throat swelling or chest tightness. This requires rapid treatment with intramuscular epinephrine and the staff is trained to responds to such reactions. If you have any serious systemic reactions after you leave our office then you should call 911 or proceed to the nearest ER. Also notify our office prior as soon as possible and let the staff know again prior to your next shot.

Protocol for immunotherapy at AAAC

1) After you have signed your form authorizing us to make your vials it takes about 1-2 weeks to make up your vials. Your first shot will require a nurse visit to go over the shot process.
2) Immunotherapy begins with the weakest dilution and the concentration increases as the vials go from green to blue to yellow and finally to red.
3) You will be required to wait at least 20 minutes in the office after you receive your shot. No exceptions. If you do leave you are leaving against medical advice and we may not be able to administer your immunotherapy in the future.
4) The recommended time interval during the build up phase is between 3-10 days.
5) During the build up phase if greater than 10 days has passed between shots either the previous dose may have to be repeated, or a lower dose will be given so as to minimize the likelihood of a systemic reaction. After this dose the regular build up will continue.
6) If you are very sensitive to the allergy shots and have very large local reactions then you may be switched to a sensitive build up schedule that requires repeating each dose before advancement to minimize local and or systemic reactions.
7) If you are suffering from severe allergy symptoms, having an upper respiratory infection, fever, or an asthma exacerbation it is important to let the nurse know so that she can inquire with the physician if you can get your immunotherapy that day.
8) It is okay to get your immunotherapy about 48 hours after your fever has resolved.
9) It is crucial to let the doctor know if you become pregnant as this will require adjustment to your immunotherapy
10) If you start any new medications especially beta blockers it is very important to let the nurse know before your shot is administered. Beta blockers interfere with medications used to treat a systemic reaction and you will need to see the doctor before immunotherapy can be initiated or continued.
11) If you choose to receive immunotherapy at another physician’s office then you must sign our release form stating this. You will need a visit with your physician at AAAC prior to starting your red vial. Approximately 2-3 weeks prior to your receiving your last shot from your red vial or if your vials have expired you must contact us to get instructions on proceeding with immunotherapy.