When Allergy Shots Don’t Work

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Claritin, Zyrtec, Xyzal, Allegra, Nasonex, Flonase, Singulair. All treat allergy symptoms, but none actually makes you less allergic. You stop the medicine, it soon stops working. Allergy shots are unique in that if taken at the right dose for at least 3 years, they can continue to provide beneficial immunologic effects after you stop taking them.

Frequently, though, people say allergy shots don’t work. Why is that? Most likely, it’s an inadequate dose. To a point, the higher the dose, the better the protection it gives you. Ask your allergist, “How many micrograms of Der p 1 does my maintenance dose for dust mites contain?” Higher doses are associated with increased side effects, but most reactions are mild—itchy arms, local swelling. Taking antihistamines or applying ice to the site of the shot usually works. Rarely, high effective doses of allergy shots can cause serious reactions—wheezing, hives all over, even anaphylaxis. That’s why we monitor each patient with a digital timer after each shot, and then send each patient out with their own EpiPen to use if they have a late reaction.

Why else don’t allergy shots work? It’s important to split up some components into separate vials. For example, mold extract can digest grass extract. If you are allergic to several things, but your allergy serum is all in just one vial, it is possible that some of its contents are being degraded. There is enormous variability in how allergy shots are formulated, and how they are dosed. Many allergists continue to follow recommendations made 30 or 40 years ago.

At The Allergy Clinic, we base our recipes on guidelines published in 2003 and updated in 2010. Maybe that is why we hear, “these shots have changed my life” more often than “these allergy shots don’t work.”

David B. Engler, MD

Note: Information contained in this article should not be considered a substitute for consultation with a board-certified allergist to address individual medical needs.