Pollen season came early this year, bringing with it an early start to the sneezing, sniffling, itchy-eyes season for many kids. If your child’s discomfort lasts for weeks or months on end or is so severe that it interferes with school, other activities or sleep, you may wonder if allergy shots are the answer.
At Nemours, only a small proportion of our allergy patients receive allergy shots. In fact, allergy shots were more common 30-40 years ago than they are today for a variety of reasons. Now medication does the trick for most kids.
There are basically three treatments for allergies:
- Avoid the allergen. Environmental controls such as keeping windows shut on high-pollen days and keeping pets out of a child’s bedroom; if he or she is allergic to pet dander.
- Medication to relieve symptoms. These include antihistamines and decongestants (ask your doctor about the best types and dosage for your child) and prescription drugs such as inhaled nasal steroids and leukotriene antagonists.
- Allergy shots. To treat allergies that are not effectively relieved by medications, allergy shots are a viable option for children. For some kids, allergy shots may temporarily alter their immune systems and allow them to develop tolerance to allergens. Shots don’t work for everyone or every allergen; for example they haven’t been effectively studied in the treatment of mold and certain animal allergies (horses, rabbits, etc). However, they do work well for dust mite, some common household pet allergies (dog and cat), grass and other pollen allergies.
How allergy shots work: The allergy shot contains purified extracts of the components to which the patient is allergic. We administer shots by giving them on a scheduled basis for three to five years. Typically, we start off with a shot once or twice a week at a very low dose and gradually build up the dosage. We are basically training the immune system to regard the allergen as harmless. This is called the incremental (or build-up) phase. Once we get to the desired maximum dose, the patient enters the maintenance phase and remains on the same dose. Shortly after that, we will taper down the frequency of the shots, so we go from giving shots once a week to twice a month to once a month. Usually, the patient will be on a monthly schedule for three years or so. There may be variations to this schedule. Most people who’ve had shots in this fashion will be able to come off the shots after three to five years and sustain the tolerance to the allergen for several years after that.
What parents should know: Allergy shots must be done in a setting where the staff is familiar with giving shots and there is resuscitative equipment on hand. The reason for this is that there is a very, very small risk of anaphylaxis, a potentially serious, even fatal reaction. It is extremely rare for this to happen, but this is why we monitor patients closely after their shot. When we administer an allergy shot at Nemours, we wait 30 minutes for any sign of reaction. After 30 minutes, the likelihood of an anaphylactic reaction is minimal.
Who is a good candidate for allergy shots? That is where the art of medicine comes in. It could be the patient’s preference, or if they do not have complete control over their allergies on medication. For parents, the inconvenience of the bringing the child in for shots on a regular basis can pose a logistical barrier. We most definitely do not recommend anyone receiving shots at home, even if they have medical training, due to the risk of reaction I mentioned earlier. Every child who gets allergy shots is prescribed an epi-pen (epinephrine) as a precaution in case of an extreme reaction.
Christopher C. Chang, M.D., Ph.D., is division chief of the division of pediatric allergy/immunology at Nemours/Alfred I. duPont Hospital for Children.