Efficacy and Safety of Immunotherapy (‘Allergy Shots’)

Immunotherapy, or “allergy shots,” provided by qualified physicians, is an effective and safe treatment for asthma, allergic rhinitis and insect venom allergy.

Effective Treatment for Asthma

A meta-analysis of 20 published prospective studies showed that allergen immunotherapy is effective in the treatment of asthma.1 The American College of Allergy, Asthma & Immunology (ACAAI) recently compiled an annotated bibliography of 59 articles from the medical literature indicating the value of expert care and immunotherapy for asthma.2 A meta-analysis of 23 published studies involving 935 asthmatic patients with documented allergy indicated that immunotherapy is effective in a selected population of allergic asthmatic patients.3

Effective Treatment for Allergic Rhinitis

An extensive review of immunotherapy for allergic rhinitis in children showed that the only treatment able to affect the natural cause of the disease is immunotherapy, and that immunotherapy may prevent the onset of asthma.4 A meta-analysis of 18 published studies involving 789 patients concluded that immunotherapy is highly effective in the treatment of allergic rhinitis.5

Effective Treatment for Insect Venom Allergy

Immunization with insect venom is an extremely effective treatment for preventing future systemic reactions to insect stings in individuals with previously demonstrated susceptibility.6 A meta-analysis of nine published studies indicated that a course of immunotherapy is highly effective in the management of insect sting hypersensitivity.7

Immunotherapy Safety

There is a small risk of a severe allergic reaction (anaphylaxis) with allergen immunotherapy. These reactions usually start within 30 minutes of injection.

Guidelines for Safe and Effective Immunotherapy

Any immunotherapy fatality, no matter how rare, is unacceptable. To promote immunotherapy safety, the American College of Allergy, Asthma & Immunology offers the following guidelines:

Immunotherapy should be prescribed only by an allergist-immunologist or other physician who is expertly trained in the therapy.

Immunotherapy should be administered under the supervision of an allergist-immunologist or other physician specifically trained in immunotherapy, the early signs and symptoms of anaphylaxis, and appropriate emergency procedures and medications.8

Patients must be suitably selected for immunotherapy.

Immunotherapy should be given only in facilities equipped to treat anaphylaxis.

The health status of the patient should be evaluated prior to every injection. Patients who are acutely ill, especially with asthma or respiratory difficulties, should not receive immunotherapy until their disease is stabilized.

Patients should always be asked about current medications prior to immunotherapy, to avoid interactions with beta blockers and other conflicting medications.

Patients must wait at the health care facility a minimum of 30 minutes after an allergen injection. The time period may be extended for high-risk patients.9, 10

Source: American College of Allergy, Asthma and Immunology

References
  1. Abramson MJ, Puv RM, Weiner JM. Allergen immunotherapy effective in asthma? A meta-analysis of randomized controlled trials. Am J Respir Crit Care Med 1995;151:969-974.
  2. Sullivan TJ, Selner JC, Patterson R, Portnoy J, Seligman M. Expert Care and Immunotherapy for Asthma. A review of published studies with emphasis on patient outcome and cost. ACAAI Monograph, Nov 1996,1-25.
  3. Ross RR. Effectiveness of immunotherapy in the management of asthma: A meta-analysis of the literature. May 1997. Data on file with American Academy of Allergy, Asthma & Immunology (AAAAI) and American College of Allergy, Asthma and Immunology (ACAAI) and submitted for publication.
  4. Bousquet J, Demoly P. Specific immunotherapy for allergic rhinitis in children. Allergy Clin Immunol Inter 1996; 8:145-150.
  5. Ross RR. Effectiveness of immunotherapy in management of allergic rhinitis: A meta-analysis of the literature. May 1997. Data on file with AAAAI and ACAAI and submitted for publication.
  6. Valentine MD. Anaphylaxis and stinging insect hypersensitivity. JAMA 1992; 268:2830-2833.
  7. Ross RR. Effectiveness of immunotherapy in the management of insect venom hypersensitivity: A meta-analysis of the literature. May 1997. Data on file with AAAAI and ACAAI and submitted for publication.
  8. Joint task force on practice parameters representing the American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma & Immunology. Nichlas RA, Bernstein IL, Blessing-Moore J, Fineman S, editors. J Allergy Clin Immunol 1996; 98:1-11.
  9. Executive Committee, American Academy of Allergy, Asthma & Immunology. The waiting period after allergen skin testing and immunotherapy. J Allergy Clin Immunol 1990; 85:526-527.
  10. Board of Directors, American Academy of Allergy, Asthma & Immunology. Position Statement. Guidelines to minimize the risk from systemic reactions caused by immunotherapy with allergenic extracts. J Allergy Clin Immunol 1994; 93:811-812

Photo Credit: Katy Werner