As per the Joint Task Force, allergy shots (Immunotherapy) can be recommended to persons suffering from allergic rhinitis (“hay fever”), allergic conjunctivitis (eye allergy), allergic asthma, and severe allergy to insect stings.  Allergy shots for allergic disorders should be considered only for patients who have clinical histories compatible with their objective diagnostic findings (typically, a positive skin test). For example, patients with systemic allergic reactions to fire ant stings have been successfully treated with allergy shots however; Allergists do not recommend fire ant allergy shots for patients who do not have a clinical history suggestive of severe fire ant allergy, even if the skin test or blood test shows the presence of allergic antibody to fire ants.  In addition, due to safety concerns, allergy shots are never used to treat food allergy. As per the JTF guidelines, the allergy shot used to treat an allergic disorder should contain only “clinically relevant allergens” and “the physician prescribing immunotherapy should be trained and experienced with its appropriate use”. Only the physician performing the patient interview and physical exam can accurately determine the role “allergic sensitivity” is playing in the patient’s illness. It is the “Standard of Care” among Allergists to recommend Immunotherapy only after carefully considering the patients clinical history; including their previous response to medications and their environmental exposures. On average nationwide, Allergists use allergy shots to treat less that 25% of their allergic patients.

If the allergic patient is selected correctly by the physician, scientific studies have shown that “allergy shots”, formulated in accordance with the guidelines advocated by the JTF, are effective for the treatment of nasal and eye allergy symptoms, can improve asthma control and can prevent serious allergic symptoms (anaphylaxis) after insect stings.  The patient should always ask their physician if they follow the JTF practice parameter recommendations when they are formulating their allergy shots. 
According to the JTF, allergy shots have been proven to be optimally effective if administered in the dosing range of 5-20 micrograms per maintenance injection. If full dose "conventional" shots are used, effectiveness can typically be achieved in the majority of patients with a shot frequency of twice per month. If a physician prescribes an allergy shot below this range, a true estimation of the likelihood for clinical improvement cannot be made, however, sub-optimal dosing would be expected to yield sub-optimal effectiveness. Some non-Allergist Physicians prescribe allergy shots using doses that are much below those recommended by the JCAAI in an attempt to make these shots "safe enough for home use". Even if administered at very low dose, the risk for systemic reactions cannot be reduced to zero. For this reason, Allergists do not recommend the self-administration of allergy shots.

Who makes the decision as to what goes into my allergy shot? 

Allergists make their own decisions concerning the contents of an immunotherapy treatment and never rely on the judgment of a third party; even if the third party is another physician. The practice of sending the results of a skin test or blood test to an allergy extract company to prepare an allergy shot, often referred to as the “remote” practice of allergy, increases the risk for providing the patient with suboptimal or inappropriate therapy.  The Allergists of San Antonio Texas have reached a consensus opinion that effective immunotherapy for nasal allergies can typically be formulated after skin testing to 62 or less aeroallergens. The decisions as to which allergens are to be included in an allergy shot requires an understanding of allergen cross-reactivity and local aerobiology. Each allergen to which a patient is allergic may not need to be included in an allergy shot to achieve a beneficial outcome. It is also the consensus opinion of the Allergists in San Antonio, that all allergens necessary to treat a person with nasal allergies can be included in three or less treatment sets (Allergists most commonly use one or two sets). 

Allergy shots are usually recommended to be continued for a period of at least three years. Discontinuing treatment following a shorter duration of time will often result in the return of the allergy symptoms. A 5 year period has been advocated by the JTF before considering discontinuation. The frequency of allergy shot administration during this time period is variable. When the highest recommended dose of the allergy shot has been reached, called the “maintenance dose”, shots are typically administered once to twice per month. If allergic symptoms are poorly controlled, allergy shots may be given more frequently, if they are well controlled, they may be administered less frequently. After discontinuing allergy shots, some patients may experience long term remission of symptoms however; the recommended duration of allergy shots is highly individualized.                                    

Due to patient safety concerns, “Home” immunotherapy has not been practiced by any Allergist in San Antonio Texas since 1995 when this prohibition was first recommended by the JTF. Surveys have shown that as many as 1 out of every 30 patients who receive allergy shots will experience a systemic allergic reaction. Although most of these reactions are mild and non-progressing, the JTF feels that safest place for managing any allergic reaction to an allergy shot is in the office of a trained physician. Because approximately 70% of the allergic reactions to allergy shots occur within the first 30 minutes, the JTF has also recommended an in-office waiting period of 30 minutes following any immunotherapy injection. Clinical studies have shown that achieving the optimally effectiveness of an allergy shot requires “full strength” dosing; designed to reach a target maintenance injection dose containing  5-20 micrograms of the major allergens for each extract. Clinical studies have clearly shown that “Low dose” allergy shots are not as effective as “full dose” injections  and “low dose” allergy shots have never been proven in any reliable study to be safer that “full dose” allergy shots. 

 

The most accurate answer to this question is “possibly”. Research is currently being conducted to determine the safety and effectiveness of this method. At this time, large reliable studies examining the use of oral or sublingual (under the tongue) immunotherapy have not been conducted in the United States. Consequently, there is no USFDA approved formulation for these forms of immunotherapy, and therefore the JTF has deemed these treatments “investigational”.