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Allergen immunotherapy (also called vaccine therapy or desensitization) has been available for approximately 100 years. The process involves the administration of gradually increasing quantities of specific allergens to persons with allergies until a dose is reached that is effective in reducing disease severity from natural exposure. The goal of treatment is to reduce responses to allergic triggers in the short-term and to decrease inflammatory response and prevent development of persistent disease in the long-term.

Allergen immunotherapy should be considered for people who:

• Experience moderate to severe allergy symptoms
• Require systemic corticosteroids
• Have inadequate response to nasal corticosteroids
• Have co-existing conditions such as asthma or sinusitis

Allergen immunotherapy should also be considered for those patients for whom the cost of immunotherapy will be less than the cost of long-term medications.

The allergens for which immunotherapy is known to be effective include:

• Hymenoptera venom (sawflies, wasps, bees, ants)
• Pollens
• Cat dander
• Dust mites
• Cockroaches
• Fungi

Allergy immunotherapy is not effective for atopic dermatitis or urticaria (hives) and cannot be used for food allergies because the risk of a severe allergic reaction (anaphylaxis) is too great.

"Allergy shots" are administered subcutaneously (injection under the skin) on a weekly basis in the medical provider's office. An observation period of 20-30 minutes after injection is mandatory to monitor for adverse reactions. The dose is gradually increased by the allergist to an optimal maintenance dose, which is then administered at intervals of 2 to 6 weeks. Typically, the maintenance concentration is achieved in 6 months however, people with a higher degree of allergen sensitivity may require a longer build-up phase. Within 6-12 months of treatment, hay fever symptoms usually begin to decrease. It is usually possible to discontinue treatment after about five years of injections. Approximately 33% of people treated with allergen immunotherapy are cured after treatment, another 33% experience a partial relapse, and the remainder will relapse completely. Those not cured may be helped by resuming the shots. It is important to follow up with your allergist regularly during treatment.

Another approach to allergy shots is called "rush immunotherapy." Patients spend several days receiving repeated shots to desensitize them against allergens, followed by earlier transition to the maintenance schedule. Studies have suggested that rush immunotherapy can be at least somewhat effective under certain circumstances, however, more studies are needed to demonstrate its safety and effectiveness. Currently, no allergen extracts are approved by the FDA for this approach.

Sublingual Immunotherapy

Allergen immunotherapy can also been given via sublingual (under the tongue) administration. This method is called sublingual immunotherapy (SLIT) or "allergy drops". This approach has been found to be easier for children, severe asthmatics, the elderly, and anyone who cannot tolerate allergy shots. SLIT has been available in Europe for decades - it is thought that as many as 50%-75% of allergy patients in Europe utilize this method for allergy immunotherapy. SLIT has only recently started to gain popularity in the United States, however, is not yet approved by the Food and Drug Administration (FDA).