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.
Allergy shots are one form. There’s also sublingual immunotherapy, which uses tablets. (“Sublingual” means that the medicine goes under your tongue.)
Both forms work the same way: They expose 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.
What to Expect
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 at least once a week for 3-6 months. 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 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.
What Are the Downsides?
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.
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. While it’s rare, it’s also possible to have anaphylaxis, which is a severe allergic reaction involving hives, swelling, trouble breathing, dizziness, and/or 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.
Also, allergy shots can be expensive. While they’re generally covered by insurance, 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, keep in mind that 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.
Sublingual immunotherapy treatments often cause mouth and throat irritation, Wada says. But they’re less likely to lead to anaphylaxis, research shows.
How Well Do the Treatments Work?
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.”
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.