Allergy Shots: Underused Treatment?

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.