Education Articles

Immunotherapy Instructions

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Allergen immunotherapy is an effective form of treatment for many patients with allergic disease. In addition to helping symptoms of seasonal and perennial allergic rhinitis, it is possible that immunotherapy can reduce the incidence of secondary infections such as sinusitis. Symptoms of reactive airway disease or asthma may be reduced if allergic disease is kept under control with immunotherapy. There is no guarantee of results as each individual responds differently to treatment and some patients do not respond at all.

Treatment Course

Immunotherapy consists of injections of tiny amounts of antigens that were found positive during your skin testing and also match your symptom history. Starting with a small dose with your first injection, each subsequent injection will have an increased volume of antigen in it. The progression of doses will follow a weekly schedule and an assessment of how you tolerated that last dose will be made before you receive your next dose. You will see the doctor every 4-6 months to assess progress.

Length of Immunotherapy

The total treatment period for immunotherapy usually last 3-4 years. After the first 6 months to one year, the interval between your injections may be lengthened to once every two weeks. The interval between your injections is lengthened gradually as your symptoms are better controlled. Usually in the third year of treatment, you will have progressed to a 28 day interval between injections. Your doctor and you will decide when the time is right for your treatment to end.

Immune Response

Symptoms will not be relieved immediately because it takes time to build up blocking antibodies to the antigens we introduce in your injections. Continuing symptoms will require use of antihistamines and whatever your doctor has prescribed to relieve your allergy symptoms right along with immunotherapy for a period of time until allergy symptoms are under better control. It is difficult to predict each patient‚’ response to immunotherapy, but typically, relief of symptoms may begin to be noticed after 6 months of immunotherapy.

Risks of Immunotherapy

The risk for adverse reactions to immunotherapy is low, but does exist. It may manifest itself in different forms. Some patients may see local reaction at the injection site consisting of swelling, redness and warmth. If this occurs apply a cold compress to the site and take a dose of Benadryl or other antihistamine such as Zyrtec, Clarinex, or Allegra. You may also apply a cortisone cream such as Cortaid to decrease inflammation and swelling. Benadryl cream may also be applied to decrease itching. Please note the size of the local reaction and report this to the allergy nurse. If your local reaction lasts longer than 24 hours and continues to increase in redness and warmth, please call the office and do not wait until your next visit to inform us of this.


Other reactions may mimic your allergy symptoms. These include, but are not limited to: shortness of breath; increased itchy, watery eyes; runny nose; increased nasal congestion; wheezing; cough, increased throat clearing. Most severe reactions occur within 20-30 minutes after your allergy injection is given and this is the reason you are asked to wait in the office and be observed for 20-30 minutes following your allergy injection. This waiting period is MANDATORY. If your schedule will not allow the full waiting time, please reschedule.

Delayed Reactions

Occasionally, a less common reaction known as a delayed reaction can occur. The onset of this can occur 1-4 hours after your allergy injection and may include symptoms such as hives, shortness of breath, wheezing and cough. Please call the office and report these symptoms. If they appear life threatening call 911.

Changes in Medications and Medical History

If there are changes in your medications or general medical condition, please inform the allergy staff of this prior to your next allergy injection. It is very important to advise any provider you see that you are receiving immunotherapy.


As discussed prior to your allergy testing, beta-blockers are not to be used while you are on immunotherapy. If your physician discusses treatment of conditions such as high blood pressure, migraine headaches, or glaucoma with a Beta-Blocker and feels it is necessary to treat you with this medication, allergy treatment will need to be discontinued. Please keep us informed of this development.

Sick Days

If you are ill with fever, infection or are experiencing severe allergy symptoms or if your asthma is out of control, do not come for your allergy injections. Please re-schedule for a day when you feel better.


In general, vaccinations make your immune system work harder; therefore, influenza immunization or vaccination and booster shots should be staggered with your allergy shot. Give yourself 3-4 days between these treatments. There is no interaction. Should you have a reaction to one of these injections it would be easier to identify which one may have caused the reaction.


Avoid exercise and workouts for 4 hours before and after your allergy injections. Large amounts of histamine may be released during sustained, vigorous exercise and can increase your allergic response if spaced too closely to your injection.

Allergen Exposure

If you were found highly positive to a pet and are being treated for this, avoid grooming or handling the pet on the day of your allergy injection. If you were found grass positive and have increased symptoms in season, no not mow the lawn on the day of your injection.

Safety Measures

You will be asked to identify your allergy vials prior to getting your injection to verify that they have your name and date of birth on them. You will wait 20 minutes after your allergy injection and have your arms checked by a nurse before you leave the office. Please discuss any concerns or questions prior to receiving your allergy injections.

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