Allergy & Asthma-Kent H. DeYarman, MD

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Immunotherapy (Allergy Shots) For Stinging Insect Allergy-General Info:

Immunotherapy (allergy shots) may be a treatment option for your (or your child's) allergy to stinging insect venoms. It is important for you to understand the purpose and expectations of immunotherapy, the general program (schedule), the risks, and alternate treatment options before making a decision about starting allergy shots.

 

The purpose of immunotherapy is to make the patient less sensitive to stinging insect venoms. If you have had a systemic reaction to a sting (hives, breathing problems, etc.) and you have allergy antibody to venom (positive skin test or blood test to venom) then you have a 55-65% chance of a systemic reaction with each future sting. Immunotherapy will reduce the risk of reaction to each sting to less than 1-2 %. Allergy shots for bee sting allergies are usually continued for 5 years and then stopped. The benefit from allergy shots typically continues for many years if the injections have been given for a 5 year period.

 

The schedule of allergy shots for stinging insect venoms is slightly different than for inhalant allergens and is outlined below:

 

***The first 3 weeks you come to the office weekly and receive 3 injections of venom each visit starting with very dilute amounts and gradually increasing the strength. You receive the first injection, wait 30 minutes, receive the second injection, wait 30 minutes, then receive the third injection and wait 30 minutes before leaving.

 

***Weeks 4-8 you still come weekly for injections but receive only 2 injections each time with a 30 minute wait after each injection.

 

***Weeks 9-12 you continue to come weekly for injections but receive only one injection each visit.

 

***Then you begin to lengthen the time between injections and by 16 weeks are receiving a single injection monthly.

 

***After 1 year the injections may be lengthened to every 6 weeks.

 

The disadvantages of allergy shots include the involved schedule especially in the first few months, the cost, and the possibility of an allergic reaction to the allergy shot. We try hard to minimize difficulties of receiving allergy shots. Our office is open many hours during the week (see below). You do not need an appointment to come in for your shot and you do not need to come on the same day or at the same time. You will have a bar-coded ID card you slip in front of a scanner that immediately "checks you in,” and notifies the nurse you are here. The average time between scanning your card and receiving the shot is 2-3 minutes (our computer tracks this). You then need to wait in the office for 30 minutes for the nurse to check the injection site and to monitor for shot reactions.

 

It is possible to have a SYSTEMIC REACTION to allergy shots. These usually occur within minutes after an injection (but may rarely occur up to several hours later) and are easily treated but require immediate attention. The reactions may involve itching, rash or swelling in places other than the injection site, hay fever symptoms, trouble breathing, and faintness due to dropping blood pressure. These reactions are very rare and usually reverse quickly if treated but have the potential of being serious and even fatal. You should immediately notify the nurse if you have symptoms of a reaction. Immediate treatment is most effective in stopping the reaction. Serious reactions are almost unheard of except for patients with the following risk factors:

 

1. Patients on beta blockers and ACE inhibitors-these are medications used for heart and blood pressure problems, for migraine headaches and in eye drops for glaucoma. Other physicians may not be aware of problems with beta blockers and allergy shots. NOTIFY OUR OFFICE OF ALL CHANGES IN MEDICATIONS FROM ALL DRS.

 

2. Leaving the office too early. Shot reactions are easy to treat here, much harder if you are not in the office.

 

Because of this we do not allow allergy shots to be given outside of a physician’s office and do not give them here unless Dr. DeYarman is in the office.

 

In addition to these precautions we recommend:

 

*You do not receive your shot if you have a fever.

 

*Avoid strenuous exercise for 2 hours after a shot.

 

*Carry your EpiPen with you. The EpiPen is injectable adrenalin that is prescribed for all patients with stinging insect allergies. Although your risk of reaction to stinging insects is very low after you are on allergy shots you may wish to continue to carry the EpiPen as the risk does not quite drop to zero.

Despite these concerns, shot reactions are rare and nearly always simple to treat.

LOCAL REACTIONS are common after allergy shots and consist of redness, swelling and itching at the injection site. These may be immediate or delayed in onset and may last for hours to a day or more. If local reactions are excessive, report the reaction to the nurse before your next injection. You may treat the local reactions with ice applied to the injection site, a strong (prescription) cortisone cream or ibuprofen by mouth if you are not aspirin sensitive..

Allergy shots may be given during PREGNANCY. Please notify us if you are pregnant as minor changes in your shot program may be needed and we should review your overall allergy management program.

Please notify us if any questions or concerns arise during the course of your immunotherapy program.

PRACTICAL POINTS TO REMEMBER:

1. Allergy shots are given in our office in Medford during the following hours:

Mon: 8:30 AM - 11:30 AM & 1:30 PM - 4:30 PM
Tue: 8:30 AM - 11:30 AM & 1:30 PM - 5:30 PM
Wed: 8:00 AM - 11:30 AM & 1:30 PM - 4:30 PM
Thu: 8:30 AM - 11:30 AM & 1:30 PM - 4:30 PM

At times our office is closed on the usual shot days. These closures are posted on the outside front door to the office and at the check in computer. We make every attempt to post these notices at least a month ahead.

In addition our schedule for allergy shots and any changes in our schedule may be found on our website (http://oregonallergy.com). Just bookmark the schedule page (
Contact & Schedules) and you can check in an instant to make sure we will be in the office when you arrive. You are also welcome to call to make sure we are open before you come for your allergy shot. Patients who live far away can receive injections in other physicians offices.

2. You do not need an appointment for your allergy shot. When you come for your first allergy shot let our staff know it is your first injection. They will show you how to check in for your shots. For all subsequent injections you just place your bar-coded ID card under the scanner at the shot check in computer and all of your information will appear on the computer, the computer will tell you how many people are ahead of you and the nurse will call you within a few minutes. You then need to wait for 30 minutes and check with the nurse before leaving the office. During the 30 minute waiting time you may rescan your ID card and the computer will tell you how long you have waited.

3. Wear short sleeves for easy access to the arm for allergy shots.

4. Antihistamines the day of the allergy shots are encouraged to reduce local reactions.

5. You should not be taking BETA BLOCKERS OR ACE INHIBITORS while on venom shots. These medications are used for blood pressure, heart problems, migraine headaches, and in eye drops for glaucoma. Other physicians may not know you should not be on these medications while you are on allergy shots. NOTIFY OUR NURSES OF ALL NEW MEDICATIONS PRESCRIBED BY ANY OFFICE.

6. Asthma that is unstable is a risk factor for allergy shot reactions. If your asthma has not been well controlled, please notify our nurses and we will restabilize your asthma and adjust your shot dose. Severe flare-ups of hay fever may also be a risk factor and you should notify us of this before receiving an allergy shot.

7. You should not exercise for 2 hours after an allergy shot.

8. Large or uncomfortable local reactions may be treated with ice applied to the shot area, application of a strong (prescription) cortisone cream, or oral ibuprofen if you are not sensitive to aspirin or ibuprofen.