From the Guidelines
Allergy steroid shots should be administered in a medical office, specifically in the office of the physician who prepared the patient's allergen immunotherapy extract, to ensure safe and effective treatment. This approach allows for immediate recognition and treatment of potential anaphylaxis, as well as modifications to the patient's immunotherapy schedule as needed 1. The medical office should have the necessary expertise, personnel, and procedures in place to handle any adverse reactions, and a physician or qualified physician extender should be present and immediately available to treat anaphylaxis when immunotherapy injections are administered.
Key considerations for administering allergy steroid shots in a medical office include:
- Ensuring the patient's current health status is stable and suitable for immunotherapy treatment 1
- Evaluating the patient for asthma symptoms and considering an objective measure of airway function before administering the allergy injection 1
- Having a plan in place for recognizing and treating anaphylaxis, including regular practice drills with office staff 1
- Administering the injection in a setting with trained staff and medical equipment capable of recognizing and treating anaphylaxis 1
In terms of specific procedures, patients should remain in the office for at least 30 minutes after the immunotherapy injection to monitor for any adverse reactions 1. The injection itself is typically quick, taking only a few minutes, and is usually administered into a large muscle, such as the buttocks or thigh. Patients may receive these injections every 3-6 months, though frequency varies based on symptom severity and individual response.
From the FDA Drug Label
Allergic states: Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity reactions, perennial or seasonal allergic rhinitis, serum sickness, transfusion reactions. The answer to the question about allergy steroid shots in office is that triamcinolone (IM) can be used for the control of severe or incapacitating allergic conditions, including asthma, atopic dermatitis, and perennial or seasonal allergic rhinitis, as indicated in the drug label 2.
- Key points:
- The drug can be used for allergic states
- It is used for control of severe or incapacitating allergic conditions
- Examples of conditions include asthma, atopic dermatitis, and perennial or seasonal allergic rhinitis
From the Research
Allergy Steroid Shots in Office
- Allergy steroid shots, also known as intramuscular corticosteroid injections (IMCIs), are used to treat seasonal allergic rhinitis (SAR) in patients who do not respond to first-line therapy 3.
- The efficacy and safety of IMCIs in SAR have been investigated in a systematic review, which found that four out of four placebo-controlled, randomized controlled trials reported a significant and relevant difference in efficacy in favor of IMCIs compared with placebo 3.
- However, the review also found a high risk of bias in the included studies, which were mostly executed more than 30 years ago, leading to an "inconclusive" rating and describing IMCIs as an "optional therapy" for severe cases 3.
- Specific immunotherapy (SCIT) has been shown to greatly reduce the need for systemic steroids in allergic rhinitis, with one study finding that 84% of SCIT-treated individuals did not need steroids after treatment 4.
- The use of systemic steroids to treat allergic rhinitis is still widespread, but SCIT has been found to be a effective alternative, with a lower risk of side effects and a reduced need for steroid injections 4, 5.
- The incidence of steroid allergy in patients with dermatologic conditions and steroid use is reported to be between 9% to 22% in adult patients and 25% in children, highlighting the importance of considering steroid allergy in patients who do not respond to or are made worse by topical steroids 6.