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Frequently Asked Questions and their Answers:
- How many people have “allergic rhinitis” (allergic nose disease)?
- What are the symptoms?
- Are there other ways that allergic rhinitis affects quality-of-life?
- How do you know what I am allergic to?
- How do you treat allergic rhinitis?
- What are in allergy shots?
- Why do allergy shots take so long to work?
- What if I cannot wait six months for shots to work?
- At what age can someone start shots?
- Is immunotherapy dangerous?
- Can I give allergy shots at home?
- I heard allergy shots do not work, is that true?
- Are they expensive?
- Do symptoms return after stopping shots?
ANSWERS:
How many people have “allergic rhinitis” (allergic nose disease)?
Surveys suggest anywhere from 40 million to 100 million Americans suffer from allergic rhinitis.
What are the symptoms?
Common symptoms include post nasal drip, sneezing, and itchy stuffy runny nose. Patients often have sinus pressure headaches, especially if mold allergic. A less commonly recognized symptom is fatigue. We see patients who sleep 12 hours per day and still require an afternoon nap! A major cause of fatigue is severe nasal congestion causing fragmented sleep.
Are there other ways that allergic rhinitis affects quality-of-life?
Patients with allergic rhinitis can have less energy, and difficulty concentrating, sleeping, singing or exercising. Other symptoms include irritability, restlessness, or depression. Allergy medicines can cause sedation.
How do you know what I am allergic to?
First, we perform a thorough history and physical examination. We then use a device with 8 plastic prongs to perform relatively painless punctures on the arms or back. A “wheal” or hive suggests allergies. If this testing is negative but we still suspect allergies, we might perform additional testing. In this second type of testing, we make small “bubbles” under the skin with tiny needles. To minimize discomfort, topical anesthesia can be used before testing.
How do you treat allergic rhinitis?
There are three approaches to allergy treatment:
- Avoidance – If people could avoid things which cause allergies, they would have no symptoms. Unfortunately, this is nearly impossible in our society. Pollen allergic patients could not go outside, and patients with indoor allergies to pets, molds, or dust mites could not completely eliminate indoor irritants.
- Medications – Patients with mild allergies usually respond well to antihistamines or nasal steroids, but these medicines are not strong enough for severely allergic patients.
- Allergy shots (“immunotherapy”) – This is the most effective treatment, but requires four to five years to successfully complete.
What are in allergy shots?
The allergens to which one is allergic. We use the skin tests results above to determine which allergens to place in your “vaccine.”
Why do allergy shots take so long to work?
Immunotherapy requires 2 phases:
- “Build-up" – Doses are gradually increased to a level which controls symptoms. It normally requires 20-25 visits to reach this dose.
- “Maintenance" – We give shots weekly to maintain this control. After about 1 year of shots, we increase the frequency to 2 weeks, and eventually to 4-week intervals. Reaching this 4-week interval usually takes 3 years. After 1-2 years at this frequency, shots are stopped, normally with excellent long-term control of symptoms.
What if I cannot wait six months for shots to work?
A procedure called “rush immunotherapy” often allows one to reach a fully protective dose in one day! Then the patient continues weekly shots for several months, then increases to 2-week intervals. This saves approximately six to nine months of weekly shots. This procedure is just as effective as traditional allergy shots, but saves lots of time, and often money. Most insurance covers this procedure.
At what age can someone start shots?
I usually recommend 3-1/2 or 4 years of age, because allergy shots can stress younger children. Also, pollen allergies rarely begin until this age. Starting immunotherapy this early decreases the chance of developing additional allergies, and can prevent the development of asthma.
Is immunotherapy dangerous?
The death rate averages four persons per year in this country, or about one in two million shots. Most reactions are mild. A few percent of patients have a serious reaction, which we can easily reverse in our office. Patients with heart disease, severe asthma, or who take “beta-blockers” for high blood pressure, are at higher risk.
Can I give allergy shots at home?
Unfortunately, no. Due to the possibility of a life-threatening reaction, a national task force in 2003 recommends that allergy shots be given only in the presence of a physician. I strictly adhere to the expert panel’s recommendation: “Immunotherapy injections should not be administered at home because of the risk of inadequate recognition and treatment of systemic reactions.” Some allergists disregard this advice and give patients epinephrine to reverse an allergic reaction. There are several problems with this approach: the epinephrine could be expired, misplaced, or otherwise not available when a reaction occurs; the patient could pass out before injecting the epinephrine; the device could malfunction; the patient could forget how to use it, or might not recognize a severe reaction until it is too late.
I heard allergy shots do not work, is that true?
Like most treatments, allergy shots do not work for everyone. However, in my experience, immunotherapy is almost always effective. Mold, pollen, and dust mite shots are extremely effective. Cat shots usually work, but dog shots rarely do.
Are they expensive?
Most insurance pays all or part of the cost of allergy shots. I believe that is because insurance companies recognize the proven effectiveness of the shots and that patients require significantly fewer medicines after shots begin working.
Do symptoms return after stopping shots?
Infrequently. After completing a 4-5 year course of allergy shots, most patients have minimal to no symptoms years after stopping. Some patients will occasionally require an antihistamine to control symptoms, but very rarely do all symptoms return.