Allergy Shots: Underused Treatment?

freeing people from daily allergy medications.

When it comes to allergies, the best treatment is obvious to
those who administer it -- and largely avoided by those who need it.

An estimated one in three Americans suffers from seasonal or
year-round allergies caused by pollen, mold, insects, dust mites, and other
common irritants. And allergy shots -- medically known as allergen
immunotherapy -- are considered by most experts to be the most effective way to
bring long-term relief of allergy symptoms.

With each injection, patients are given increasingly higher
doses of the actual allergy trigger until their body becomes resistant to it --
preventing the allergic reaction. By comparison, antihistamines, inhaled
steroids, and other allergy medications -- which usually must be taken daily --
treat the resulting symptoms caused by the allergy trigger, but not the
allergens themselves.

As Good as or Better Than Drugs

"There have been no good head-to-head study comparisons
between immunotherapy and allergy medications," says allergist James Li,
MD, of the Mayo Clinic. "Most physicians recognize that antihistamines have
significant, but a fairly modest benefit. But the degree of benefit with
allergy shots is quite substantial, at least equal to or exceeding many
medications."

But despite their effectiveness, allergy shots are largely
ignored by most patients, whom either suffer through the allergy season in
silence or pop pills to temporarily ease their misery. A survey by the American
College of Allergy, Asthma and Immunology (ACAAI) shows that two in three
people with allergies would never consider getting allergy shots.

Why People Stay Away

First, there's the allergy testing -- multiple scratches into
the skin with different allergy triggers to identify what the person is
allergic to. Then there's the time involved -- weekly injections for three to
five months to gradually build resistance followed by several years of monthly
"maintenance" shots. And there's the pain with each allergy shot.

There's also the time it takes for the allergy shots to show
noticeable results; usually, several months after those weekly
"building" doses are completed. Relief of symptoms can be seen after a
few days of antihistamine pills.

And there's the biggest reason, at least according to most of
the allergy sufferers surveyed by the ACAAI three years ago: The cost. Do the
math and a doctor's visit -- anywhere from $25 to $100 each, repeated 25 times
or so in the first year alone (and then monthly until patients are relatively
symptom-free for two years) -- is a lot more expensive than a bottle of
over-the-counter Claritin, right? And if insurance doesn't pick up the bill,
allergy shots may be all but impossible for some people to afford.

Allergy Shots May Be Cheaper

It's precisely because Claritin has gone over the counter that
these days, taking once-a-day medications may be more expensive than allergy
shots, say experts.

"Many of the standard medications used for common allergies
like hay fever are no longer paid by Medicare, Medicaid, and many private
insurance companies," says Myron Zitt, MD, chief of allergy and immunology
at the Queens Long Island Medical Group in Babylon, N.Y., and clinical
associate professor of medicine at the State University of New York, Stony
Brook, School of Medicine.

"The insurance companies say as long as one effective
medicine is available over the counter, patients should take it -- and not more
expensive prescription drugs," he tells WebMD. "So unlike in years
past, they no longer cover those other drugs. The cost has shifted from the
insurance companies to the patients."

Meanwhile, allergy shots continue to be covered by insurance
companies -- usually in full or with a modest co-pay. But even before Claritin
went over the counter and changed the insurers' rules, allergy shots still
seemed to make good economic sense, at least in the medical community.

In April 2000, Respiratory Reviews published a study
indicating that a patient's out-of-pocket drug costs for treating year-round
allergic rhinitis was $1,200. But researcher Timothy J. Sullivan III, MD, of
Emory University, calculated that the same patient would pay only $800 for the
first year of allergy shots -- the most expensive year. In following years,
when allergy shots are done monthly or even less frequently, those costs drop
to between $290 and $170. Over six years, that amounts to a $1,300 to $2,900
savings with allergy shots, that study shows.

And there's the August 1999 study in TheNew England
Journal of Medicine that shows allergy shots to treat grass pollens can
provide up to three years of additional relief after treatment has
ended. "Once you stop antihistamines and other drugs, you're right back
where you started," says Zitt. Even a couple of missed doses can do
that.

Allergy Shots and the Triggers They Fight

Allergy shots are effective against all sorts of allergy
triggers that float in the air, including:

B

• Tree pollens


• Grass pollens


• Weed pollens


• Mold spores


• Dust mites


• Cat dander


• Insect stings

But when it comes to other types of allergy triggers -- such as
food allergies and skin reactions -- there is not enough research to support
allergy shots, according to the American College of Allergy, Asthma and
Immunology.

Before allergy shots begin, allergists identify the specific
allergen(s) with the skin scratch test, avoiding a common problem; patients who
"self-diagnose" themselves, and may reach for antihistamines under the
assumption they have seasonal hay fever when they could also be allergic to
year-round dust mites, mold, or cat dander.

Allergy shots benefit some patients more than others. Those
with hay fever tend to fare best, with more than 90% getting
"significant" relief, says Li. Allergy shots are also extremely
effective for mild-to-moderate asthma, specifically when attacks are caused by
allergies, or bee sting and other insect sensitivity.

"Allergy shots are also effective for those with cat and
dust mite allergy, but the challenge there is that there continues to be
significant continued exposure -- and avoidance of the allergen is the most
important factor in preventing symptoms," Li tells WebMD. "That's what
makes mold allergies especially difficult. You really need to stop leaky pipes
and other sources causing mold. That's why I personally have less confidence in
mold allergy shots compared to the excellent results seen for pollen, cat, and
dust mites."

Danger, Danger

Although there is a minimal risk of severe allergic reaction
from allergy shots, the injections pose little risk as long as they are
administered with slowly increasing doses. The reason why allergy shots
typically take three to five years is because giving more "hefty" doses
in a shorter time frame could trigger potentially life-threatening anaphylactic
shock -- an intense reaction to an allergy trigger in which the airway can
close.

Who Should Avoid Allergy Shots

Allergy shots are not recommended for those with heart disease
or severe asthma. In addition, allergy shots should not be started during
pregnancy but can be continued during pregnancy if they started before
conception.

By
Reviewed by Brunilda Nazario
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