Nearly a third of American adults have some kind of allergy. If you’re one of them, you’re probably eager to find a solution.
Allergy shots can provide long-lasting relief for certain non-food allergies, but there are some downsides. Is the time commitment, discomfort, and cost worth it?
To help make that decision, here’s the latest science behind allergy immunotherapy, how long the effects of the shots last, and what the future of allergy shots may hold.
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How do allergy shots work?
Allergy shots have been around in one form or another since the 1910s. The idea is to desensitize an allergic person to a specific allergen, like pollen or cat dander.
Your allergist will determine exactly what you’re allergic to and then “they make a specialized cocktail of allergens for that person,” says Dr. David Morris, chief of allergy and immunology at Dayton Children’s Hospital. This cocktail contains very small, diluted amounts of those allergens and is then injected under your skin.
“This stimulates the immune system to feel like these things are normal and not foreign,” says 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.
After your shot, you’ll be observed for about 30 minutes. “This is because you do have the potential to have a reaction; we’re giving you something injectable that you’re allergic to,” Morris says. Serious reactions are rare but can be life-threatening, according to the American Academy of Allergy, Asthma, and Immunology (AAAAI).
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For the next several months, you’ll get one or two shots a week containing increasing amounts of your allergens. This process helps you slowly build a tolerance to those allergens, Meadows says.
After about seven months, your doctor will be able to space out your doses to every two weeks. Eventually, you get to what’s considered a maintenance dose, which is when you can move to “a shot a month at a high dose of what you’re allergic to,” says otolaryngologist Dr. Marc Dubin, chief medical officer at ENT Speciality Partners.
You’ll likely stick to that once-a-month shot for three to five years. It can take as long as 12 months on your maintenance dose before you notice your symptoms are improving. In other words, allergy shots are definitely a time commitment.
If you can make the time, however, then comes the payoff: “It changes your immune system on a long-term basis,” Meadows says. You don’t have to take any more shots, and you’re free of your allergy symptoms—often for decades, he says. “Some allergists will say the results last ‘forever,’ but forever is a long time, so I’m not as comfortable with that.”
Who gets the best results?
Anyone older than 5 can benefit from allergy shots, according to the AAAAI. People with pollen allergies tend to really appreciate the treatment effects, Morris says. “For a patient’s quality of life, pollen is the [most] noticeable one, because people are miserable during pollen season, and they notice they’re no longer miserable,” he says.
But if your symptoms are severe to start with, you might not see as much relief, Dubin says. You shouldn’t get allergy shots if you currently have severe asthma symptoms, or if you’re taking certain medications, including beta-blockers for high blood pressure and certain antidepressants, he adds.
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Allergy shots can also be used for people who are allergic to insect stings, but the process often takes longer and comes with more risks, Dubin says.
If your symptoms start to come back after a course of allergy shots, you can go for another round. In fact, that’s quite common in Morris’ practice, considering he treats children: They might complete allergy shots in childhood and repeat the process in their 30s, he says.
How much do allergy shots cost?
Insurance coverage varies from person to person, but most people can expect to have some out-of-pocket costs for allergy shots—anywhere from $1,000 to $4,000 for office-visit copays and the treatment itself, Morris says.
“I have seen some of the insurers charge a copay for every shot,” Morris says. “So if you’re getting 28 shots—one a week for six months—and you’ve got a $25 copay, you start to do the math.” The cost alone can make allergy shots unrealistic for some people.
What advancements are in the pipeline?
Some health care providers are using shorter timelines for administering allergy shots, sometimes referred to as rapid desensitization or cluster or rush immunotherapy.
Instead of getting one shot a week during your build-up phase, you might get several shots a week—even more than one shot in a day, Morris says. This expedites the time it takes to reach the maintenance phase to a few weeks or months. However, people generally have a higher risk of having a reaction on a faster allergy shot schedule, he adds.
There is also a tablet form of allergen immunotherapy that works for people who are allergic to ragweed, some grasses, and dust. You let the tablet dissolve under your tongue at least three days a week. While under-the-tongue tablets and drops have been popular in Europe for some time, this method hasn’t really caught on in the U.S., where most insurance providers don’t cover it without prior authorization, Meadows says.
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While the tablets can make your mouth itchy, the risk of serious side effects is low. So another plus of this technique is you can do it yourself at home without needing to be monitored by your doctor, Dubin says.
Although it’s still in early research phases, Morris is intrigued by a new technique involving injecting allergens into a lymph node, where immune cells live, rather than under the skin, called intralymphatic immunotherapy.
This approach kicks in quickly: It takes just three injections over two months. However, it requires an ultrasound to deliver the shot, so it takes some technical skill and the right equipment, he says. It’s currently available at a limited number of health care facilities, but it’s not yet approved by the U.S. Food and Drug Administration.
“Not all these are going to be right for every patient, [but] I’m excited for patients to get some quality-of-life improvements,” Morris says. “I recommend people see a board-certified allergist and discuss these treatments and the risks and benefits and decide what’s right for them.”
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