Allergy injection treatment (immunotherapy) involves the injection of gradually increasing doses of the substances to which the patient is allergic, thereby increasing the patient’s tolerance to those substances. Most patients do not experience significant adverse reactions to immunotherapy. However, there are two types of adverse reactions that can occur following an allergy injection.

HOW TO RECOGNIZE A REACTION

The first type of reaction is a localized reaction. It involves swelling, redness and itching limited to the injection site. As long as this is mild and does not last for more than a few hours, no treatment is needed. If the area is uncomfortable, you may apply cold, and—if you have not already done so—take an antihistamine by mouth. If the swelling is larger than two inches in diameter, or such that it is uncomfortable to move the arm, or if it is still present the day after the injection, this constitutes a large localized reaction. A large localized reaction is not dangerous, but it may be a signal that your body is not ready to receive a higher dose. It is therefore important that you tell the nurse about any large localized reactions at the time of your next visit, before you receive the next dose. Advise the nurse of the location and duration of the swelling. This will allow the nurse to adjust the dose appropriately.

The second type of reaction is a generalized reaction. During this type of reaction the patient feels allergic at one or more places in the body separate from the location of the injections. Generalized reactions are much less common than localized reactions, and are therefore not experienced by the majority of patients. However, when they do occur they can be dangerous, and it is therefore essential for you to recognize whether such a reaction is occurring.

Symptoms of such a reaction can include:

• Hives or itching of any part of the body other than the site of the injections (palms, soles, nose, throat, eyes, chest, entire body, etc.)
• Flushing (redness) of the skin, with or without hives
• Swelling of the throat
• Cough, wheeze, or chest tightness or discomfort
• Tearing, sneezing or nasal congestion
• Faintness, or generalized feelings of “not being well”
• Metallic taste
• Cramping of the uterus, stomach, or intestine

Generalized reactions are usually mild or moderate in severity, but on occasion they can be severe or even life threatening. In its worst, full blown form, a severe anaphylactic reaction can result in death!

FOR PATIENT SAFETY, IT IS THEREFORE MANDATORY THAT THE PATIENT (AND PARENT, IF THE PATIENT IS A CHILD) WAIT IN THE WAITING ROOM FOR 30 MINUTES FOLLOWING EACH AND EVERY ALLERGY INJECTION.

This 30 minute waiting period is necessary even for a patient who has received allergy injections for many years without having any adverse reactions.

WHAT TO DO IF A REACTION OCCURS

If any of these symptoms occur during the waiting period, you must notify the receptionist, nurse or doctor immediately. Even if the symptoms are mild, or if you are not certain that they represent a reaction to the injection, you should still bring them to our attention and let the doctor decide whether a reaction is occurring. Treatment of reactions works best if started promptly.

Occasionally, reactions of this type can be delayed, starting after the end of the 30 minute waiting period, or rarely, as late as two hours following the injection(s). If any generalized allergy symptoms occur on the way home, immediately return to the office. If such symptoms occur after returning home, take an antihistamine (if it is not already in your system) and–if wheezing or chest tightness is present–take two puffs of your fast-acting inhaler, and call the office. If it is after office hours, the answering service will contact the doctor. If the reaction is severe, phone 911 for transport to the emergency room.

HOW TO MAKE REACTIONS LESS LIKELY TO OCCUR

Reactions to allergy injections are more likely to occur if allergy symptoms are active prior to receiving the injections. Remember that allergy injections are not medication to make one feel better immediately. Rather, they are injections of allergy-causing materials given in an effort to build-up a tolerance over time. They should be given when the situation is stable. If the patient has had an increase in allergen exposure and has symptoms which are out of control, an allergy injection at that time would be more likely to cause a reaction, and therefore should not be given. Do not come for an allergy injection if wheezing is present or if allergy symptoms are out of control. Do not come for an allergy injection if you have a respiratory infection such as sinusitis, bronchitis, cold or flu. Always inform the nurse if there has been a change in your status, or if you are on new medications prescribed by other doctors.

If you are contemplating pregnancy during your course of immunotherapy, please discuss this with your allergist.