Dr. Shradha Agarwal is an assistant professor of medicine and clinical immunology at Mount Sinai. She treats patients for problems ranging from environmental and food allergies to asthma and sinusitis.
An assistant professor of medicine and clinical immunology at Mount Sinai, Dr. Shradha Agarwal treats patients for problems ranging from environmental and food allergies to asthma and sinusitis. In the summer, the majority of her patients visit for seasonal allergies.
WHO’S AT RISK
As much as 30% of the American population suffers from seasonal allergies alone, and for many of them, allergy shots can bring relief where other therapies fail. “Immunotherapy is the technical term for allergy shots, which generally consist of a series of injections that contain allergens that provoke the patient’s symptoms,” says Agarwal. “Allergy shots can be particularly beneficial to anyone who has a life-threatening stinging insect allergy, so now that picnic season is here and insects are everywhere, it’s a good time for allergy sufferers to talk to their doctor about immunotherapy.” Allergy shots are available for allergens ranging from pollen and dust mites to animals as well as stinging insects.
Who can benefit from allergy shots? “Anyone whose allergies aren’t controlled well by medication, or who experiences unacceptable side effects from medication, or who can’t avoid a specific allergen like dust mites, pollen, or animal dander is a potential candidate for allergy shots,” says Agarwal.
Most allergy shots follow a regimen that involves a build-up phase that increases the dosage of the shot over the span of weeks and months until the body develops a tolerance. “During the build-up phase, patients usually visit the doctor one to two times a week — once they reach the maintenance dose, patients continue to receive shots on a monthly basis,” says Agarwal. “After three to five years, the question becomes whether to continue with the shots — some patients can have sustained remission of symptoms, but others may relapse.”
Another treatment option accelerates the build-up process over several days. “Rush immunotherapy is a rapid desensitization process that delivers one dose every 60 minutes,” says Agarwal. “You might want to investigate this option if you have a busy work or travel schedule, or if you are a woman who is planning pregnancy and want to avoid daily medication. The plus side is that the patient achieves benefits more rapidly, but there is an increased risk of localized and systemic reaction, which we actually treat preemptively.”
Rush immunotherapy can be a particularly good option for people with insect allergy. “Rapid desensitization is an ideal strategy for these patients because you can’t always avoid exposure, you never know when you’ll have a reaction, and insect-related allergic reactions can be life-threatening,” says Agarwal. “If you’ve ever had a severe reaction to an insect, you should be tested to see if you’re allergic, and talk to your doctor about a treatment plan.”
Patients of any age are potential candidates for immunotherapy. “There’s no real age cut off-allergy shots can be offered for adults and children, men and women,” says Agarwal. “The main thing is to get your allergies diagnosed correctly and discuss your various treatment options with your doctor.”
SIGNS AND SYMPTOMS
The vast majority of patients experience no side effects as a result of allergy shots. “Redness and swelling at the injection site is all that happens to most people,” says Agarwal. “Although complications are quite rare, the reason we do allergy shots at the allergist’s office is so we can monitor and treat any side effects quickly.”
A small number of patients can develop an anaphylactic response to the shots. “These patients can develop swelling in the throat, wheezing, and tightness in the chest, usually within 30 minutes of the injection,” says Agarwal. “These kinds of serious reaction don’t happen often, but require immediate treatment with epinephrine, also known as an epi pen. The key thing is to have the patient monitored by a medical professional who can recognize the symptoms and provide treatment quickly.”
Getting a proper diagnosis is the first step toward allergy relief-and that entails a trip to the allergist to get tested. “The diagnosis is made according to the patient’s history and skin prick test,” says Agarwal. “We get the results within 10-15 minutes, and then we can discuss whether you’d be better off getting allergy shots or taking antihistamine.”
Multiple factors go into making the best treatment decision for each individual patient. “The decision is made based on factors like the length of the patient’s allergy season, the severity of the patient’s symptoms, and how well medications are controlling the patient’s symptoms,” says Agarwal. “Taking antihistamines could be the right choice for you if your symptoms are well-controlled by it, if it’s only necessary for a few days out of the year, and if you don’t mind taking medications.”
Other patients are better served by allergy shots. “If you’re someone who is taking medications year round, or if they aren’t being completely effective, I would really encourage you to do immunotherapy,” says Agarwal. “Another good reason to get shots would be if you have a constant exposure, like a pet you’re allergic to.”
Allergy shots can be particularly beneficial to anyone who has a life-threatening stinging insect allergy.
Allergy and immunology are booming research fields. “We’re always looking for ways to improve the efficacy and tolerability of allergy injections,” says Agarwal. “Right now there is a lot of focus on sublingual immunotherapy, including a new therapy for grass and ragweed that patients can take daily by mouth.”
QUESTIONS FOR YOUR DOCTOR
The first question to ask off the bat has two parts, “What am I allergic to?” and “How can I avoid the allergen?” Once you have been correctly diagnosed, ask about your treatment options. “What medications are most suitable for me?” and “Am I a candidate for immunotherapy?” “If allergies are detracting from your quality of life, the most practical thing is to minimize exposure to them and discuss an individualized treatment plan with your doctor,” says Agarwal. “Your course of treatment should depend on the severity of your symptoms, how well medication works for you, and your preferences and priorities. There’s no reason to assume that you have to suffer through another allergy season.”
WHAT YOU CAN DO
Two websites chockablock with patient-friendly information are the American Academy of Allergy Asthma and Immunology (aaaai.org) and Mount Sinai (mountsinai.org/patient-care/service-areas/allergy-and-immunology).
Discuss allergy shots with your doctor.
If your allergies are interfering with the way you want to live your life, talk to your doctor about whether immunotherapy might help.
Take precautions against insects.
If you’re picnicking, avoid trash cans and other places where bees swarm. Other avoidance strategies: remove any insect nests near the house, avoid wearing brightly colored clothes or strong scents that may attract insects, avoid walking barefoot outside, and wear long pants and sleeves when doing outdoor work near bushes.
Take allergic reactions seriously.
If you see someone having a severe allergic reaction to bees or something else, don’t hesitate to call 911 right away. “If you’re at a picnic and a child has a severe allergic reaction to a bee, use their epipen and call 911 right away,” says Agarwal.
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