Safety First

Immunotherapy should be administered in a setting that permits the prompt recognition and management of adverse reactions. The preferred location for such administration is the prescribing physician’s office. However, patients can receive immunotherapy injections at another health care facility if the physician and staff at that location are trained and equipped to recognize and manage immunotherapy reactions, particularly anaphylaxis. – Allergen Immunotherapy: A Practice Parameter 3rd update - Joint Task Force on Practice Parameters, AAAAI and ACAAI

Allergy shots are the most effective therapy for treating nasal allergies and their attendant complications. My patients often call them life changing. Despite their effectiveness, many patients who would benefit from them choose not to utilize this therapy. The most common reason they choose not to do so is not money, since insurance coverage is generally very good, or fear of needles, since the injections are relatively painless. The biggest reason is time. Allergy shots must be administered in a medically supervised setting where the provider and staff are familiar with the shot process and have the means to diagnose and manage acute allergic reactions. This means coming to the doctor’s office to receive injections. Given the busy modern lifestyle, this can be a significant time commitment. So why does it have to be this way? The answer is safety.

So why does it have to be this way? The answer is safety.

Allergy shots are generally a safe procedure, but, like all medical procedures, there is risk involved. Overall, systemic allergic reactions happen in about 1 out of every 500 injections. From 1980-1990, about 5% of patients experienced a systemic reaction. From 1990-2000, this rate fell to about 1% of patients. The tremendous drop in reaction rates is attributable in part to better standardization of allergen extracts and to the widespread implementation of computerized immunotherapy monitoring systems, which drastically reduced dosing errors. Indeed, the most recent data suggests that only 25% of systemic reactions are due to dosing errors, while almost half are due to receiving injections during a severe allergy flare. Fortunately, most reactions to allergy shots are mild to moderate, but severe reactions, even fatalities, do occur. Fatality rates have remained fairly constant at 1:2.5 million injections, about the same risk as being in a commercial airline crash, 1:2.5 million flights.

Those numbers should be reassuring to patients but also might lead some to conclude that allergy shots are indeed safe enough for home administration. They’re not, and here’s why: Allergy shots are as safe as they are because the vast majority are given in a medically supervised setting. All of the above data looking at safety come from patients who received shots at the office of their allergist or another physician. We don’t know what the reaction rates or safety outcomes would have been if the same patient population had been allowed to receive injections at home, but I can’t imagine that they would be better.

Allergen immunotherapy is a complex process that requires careful monitoring of doses, frequent dose adjustment, and clinical training to evaluate if patients are well enough to receive their shots. Allergists have years of training and experience in this regard as well as in the diagnosis and management of acute allergic reactions. We have dedicated staff whose sole job is to administer injections and computer managed protocols designed to reduce error. All of this helps the allergist deliver the most effective therapies with the highest degree of safety. You should accept no less.

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