Reactions related to allergy testing or immunotherapy administration
Injecting an allergen, for testing or treatment to which a patient is reactive, carries a risk of triggering a reaction to that allergen. Reactions to allergy testing and immunotherapy administration are different from a side effect or adverse event. Reactions to Allergy Immunotherapy are rare, but precautions are routinely taken when testing patients or administering injectable allergy vaccines in order to avoid or minimize their impact.
When a reaction of an injected allergen occurs, it usually consists of swelling and pain around the injected area. Less frequently patients can develop symptoms elsewhere, for example: nasal congestion, runny nose or headaches. Less frequently patients can develop diffuse skin itching, with or without rash, for example urticaria (hives). On rare occasions patients can develop cough or even respiratory distress. While these last circumstances are very rare, they could be serious so it is important that precautions are taken and it is very important that the patient complies with all the instructions given. Before deciding about this type of treatment, the patient must have a conversation with the treating physician. After a thorough evaluation it will be decided if testing or allergy treatment are appropriate for the patient.
Why can a reaction to a test or an allergy shot develop?
Allergies are a disease of the immunological system. Injecting allergens to which one reacts, and continue injecting them with a progressively larger dose carries the risk of overstimulating the immunological system leading into a reaction. This type of reaction can involve the respiratory system (like an asthma attack) or include other symptoms like throat tightness or difficulty swallowing.
The patients most at risk to develop a reaction are those with respiratory problems. These include patients with asthma or with symptoms like shortness of breath, cough triggered by exercise, or respiratory symptoms that respond to the use of an inhaler (even if the inhaler is used “only on occasion”).
For many patients with asthma or respiratory symptoms, the cause is often allergic. This type of patient can suddenly develop an asthma attack even if they never had an asthma attack before, just by an unexpected exposure to the allergens to which they are reactive (example: entering into a house that has cats, or a place with large amounts of dust or humidity).
For these patients, allergy vaccines (Allergy Immunotherapy) is the only treatment capable of lowering the risk of a reaction or even curing this condition. In other words, for patients with respiratory symptoms, the only way to obtain help of a permanent nature is by receiving immunotherapy.
So, the patient that has a risk of developing a severe reaction to allergy shots is the same patient that most needs this treatment as this patient is at risk of developing essentially the same reaction if unexpectedly exposed to any of the triggering allergens.
Safety measures during injectable Allergy Immunotherapy
- All patient that undergo immunotherapy, must carry an autoinjector of adrenaline. The autoinjector should be kept at hand for 24 hours after a skin test or allergy injection.
- At Associates in ENT & Allergy, all patients with asthma or with any type of respiratory symptoms will be started on an asthma inhaler to be used daily even if the patient has no respiratory symptoms at that time. This inhaler usually will be used for 2-3 months and then the patient will be reevaluated. If asymptomatic, the inhaler will be weaned off.
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