Hives (Urticaria) | Causes, Symptoms & Treatment

Are Allergy Shots Worth It?

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.

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."

Should You Get Allergy Shots?

You probably take something to ease your seasonal allergy symptoms. Maybe you're using more and more medicine over time, or it's not working that well. You may be thinking about switching to immunotherapy to see if that helps more.

Immunotherapy for allergies, such as allergy shots, aren't a quick fix but in time, they can make a big difference.

Immunotherapy for allergies exposes you to a tiny amount of your allergy trigger so that over time, your body learns to handle it better. This can make a big difference in your allergy symptoms. 

"A lot of patients now are looking for more natural treatment options and minimizing the amount of medications they're needing," says Kara Wada, MD, an assistant professor of allergy and immunology at the Ohio State University Wexner Medical Center.

If you've got asthma, it must be under good control before you start this type of treatment because exposure to your allergy trigger has the potential to cause a flare-up.

Allergy shots are one form of immunotherapy for allergies. You get the shots in a doctor's office. They can make a big difference and may even get rid of your symptoms. But it may take years for them to take full effect.

Sublingual immunotherapy is another form. It uses tablets. ("Sublingual" means that the medicine goes under your tongue.) Sublingual treatments haven't been studied as much as allergy shots. They haven't been shown to work as well as allergy shots. But if you're up for the commitment of taking the medicine day in, day out, as prescribed, it might be an option to explore for the specific allergies it targets.

If you're interested in allergy shots or sublingual immunotherapy, you first need to visit your allergist and get tested to pinpoint exactly what you're allergic to, if you haven't done this already.

With allergy shots, your allergist creates a shot formulation that's based on your test results. You'll need to get a shot from your allergist once or twice a week for 3-6 months. You'll get the shot in your upper arm. It'll contain a tiny amount of the thing you're allergic to -- pollen, pet dander, mold, dust mites, or bee venom, for example.

Each week, your doctor will raise the amount of allergens in the shot until you reach a maintenance dose. Your doctor might recommend that you take an antihistamine before you get each treatment.

Once you reach the maintenance dose, you can usually cut back on your visits (and shots) to every 2-4 weeks, a schedule you keep for 3-5 years or until your symptoms improve. "There seems to be some point within that window when the immune response changes," Wada says.

You'll need to wait in your allergist's office for about half an hour after each allergy shot to make sure you don't have a serious reaction.

With sublingual immunotherapy, your treatment will probably start 12-16 weeks before pollen season begins and last through pollen season. You take the first dose in the allergist's office and the rest at home.

The most obvious drawback for allergy shots is the time commitment. You must stick to a weekly schedule of allergist visits for months, and it could be years of monthly follow-ups before you see significant improvement.

That said, symptoms generally start to improve within the first year of treatment and often continue to get better during the second year. By the third to fifth year, most people are free of allergy symptoms and may be able to stop getting shots.

If your symptoms don't improve after a year of shots, talk with your doctor about other treatment options.

Aside from time, there's the potential for a reaction to the treatment, since it has small amounts of the things you're allergic to. For instance, you may have redness or swelling around the injection site if you get a shot, or you may have other symptoms.

"Sometimes, patients report an increase in nose or eye symptoms, such as stuffy nose, runny nose, or itchy eyes," says allergy immunologist Kathleen Dass, MD, of the Michigan Allergy, Asthma & Immunology Center. 

It's rare, but it's also possible to have anaphylaxis, which is a severe allergic reaction involving hives, swelling, trouble breathing, dizziness, and loss of consciousness. That's why you need to get the treatment in your allergist's office and wait there for a while after each shot, Dass says.

Sublingual immunotherapy treatments often cause mouth and throat irritation, Wada says. But they're less likely to lead to anaphylaxis, research shows. 

Allergy shots can be expensive, but they're generally covered by insurance. Check your plan. If you have a high-deductible health plan, you may have to pay out of pocket until you hit your deductible each year.

If you're thinking about sublingual treatment, you can get it only for allergies to ragweed, certain grasses, and dust mites. So if you're having reactions to a different type of allergen, it's not an option.

If you stick with allergy shots long enough, there's a good chance you'll see improvement or even an end to your allergy symptoms. About 85% of people with hay fever who get this type of treatment say their allergy symptoms get better.

"That's one of the things I find pretty neat as an allergist," Wada says. "Typically, a lot of the treatments we have are geared toward treating the symptoms. This is one of the few things we have toward the root of the problem."

You may want to avoid exercise or doing anything strenuous for 2 hours before and after your appointment. Exercise boosts blood flow to the tissues and may cause the allergens to spread throughout your body faster. It's not likely to cause a serious problem, but it's best to be safe.

Tell your doctor about any other medicines or herbs and supplements you take. Some medications interfere with the treatment or raise the risk of side effects. You may need to stop allergy shots if you take these medications.

If you're pregnant or planning to get pregnant, ask your doctor whether you should continue to get allergy shots.

Usually, you'll stay at the doctor's office for about 30 minutes after you get an allergy shot. That's to make sure you don't get side effects like itchy eyes, shortness of breath, a runny nose, or a tight throat. If you get these symptoms after you leave, go back to your doctor's office or to the nearest emergency room.

Redness, swelling, or irritation right around the site of the injection is normal. These symptoms should go away in 4 to 8 hours.

Get on the phone and go to the nearest emergency room if you have shortness of breath, a tight throat, or any other symptoms that worry you after getting your shot.

They may be more risky for people with heart or lung disease, or who take certain medications. Tell your allergist about your health and any medicines you take, so you can decide if allergy shots are a good option for you.

Allergy Shots For Asthma

Allergy shots are one type of treatment for asthma that may benefit those with allergies and asthma that is triggered by allergies, called allergic asthma. Also called immunotherapy, allergy shots are not an asthma cure like an injection of antibiotics might cure an infection. Instead, allergy shots work a bit more like a vaccine.

Allergy shots for asthma actually contain a very small amount of an allergen (something you're allergic to). Over time, the dose is increased. By exposing you to greater and greater amounts of the allergen, your body is likely to develop a tolerance to it. If the treatment goes well, your allergic reaction will become much less severe.

Allergy shots can reduce the symptoms of allergies and prevent the development of asthma. Allergy shots also appear to help people who already have asthma, although there is some debate about this. One study found that allergy shots for asthma were as effective as inhaled steroids in reducing asthma symptoms.

Before you get allergy shots for asthma, your doctor will want to do allergy testing. This is a way of finding out which allergens affect you. It will probably involve skin testing, in which a small amount of the allergen is scraped onto or injected under your skin. Allergy shots aren't available for every kind of allergy.

Allergy shots for asthma include shots for:

Once you and your doctor have discovered which allergens affect you, the next step is to get the shots. The frequency of the injections varies, but you might get them once or twice a week for the first three to six months -- or until you reach the maximum dose. After that, you might only need maintenance injections every two to four weeks. This might continue for three to five years.

Although some people feel asthma symptom relief from their allergy injections quickly, it may take up to a year for others. In some people, allergy shots have no effect. 

Allergy shots are not right for everyone. It may not be safe for people who have uncontrolled asthma or other health conditions, such as heart disease. It may also not be a good idea for people taking certain medications, such as beta-blockers. Allergy shots for asthma are not used in children who are under age 5.

Allergy shots for asthma might be considered for people who:

Allergy shots for asthma do have risks. The most common side effects are redness and swelling at the site of the injection.

More severe reactions are less common. Very rarely, allergy injections can even lead to anaphylactic shock, which can be fatal. This is why you should always get these shots in the presence of experts who can control any adverse reactions in the event of an asthma emergency. Your asthma doctor might want to keep you under observation for about 30 minutes after the injection to watch for any ill effects.

There is an new alternative to shots called Sublingual Immunotherapy or "SLIT" that is promising and now available. Instead of a shot, the medication is dissolved under your tongue. Ask your doctor if you are a candidate for SLIT.

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