Are allergy immunotherapy injections administered in a Primary Care Physician (PCP) office?

From the Guidelines

Allergy shots should not be administered in primary care physician (PCP) offices, but rather in allergist offices or specialized clinics, due to the need for specialized training, equipment, and emergency protocols to handle potential severe allergic reactions. This is because allergy shots require a high level of care and monitoring to ensure patient safety. The standard protocol involves an initial build-up phase with injections given 1-2 times per week for 3-6 months, followed by a maintenance phase with injections every 2-4 weeks for 3-5 years. After each injection, patients must be observed for at least 30 minutes to monitor for adverse reactions, particularly anaphylaxis, as most serious systemic reactions occur within this time frame 1.

Some key points to consider when administering allergy shots include:

• The need for specialized training and equipment to handle potential severe allergic reactions
• The importance of observing patients for at least 30 minutes after each injection to monitor for adverse reactions
• The requirement for a physician or qualified physician extender to be present and immediately available to treat anaphylaxis when immunotherapy injections are administered
• The need for regular practice drills with office staff for handling systemic reactions to immunotherapy reactions

It is also important to note that patients at high risk of systemic reactions, such as those with a history of severe symptoms or comorbid conditions, should receive immunotherapy in the office of the physician who prepared the patient’s allergen immunotherapy extract, where possible 1. If you're considering allergy shots, it is recommended to request a referral to a board-certified allergist who can properly evaluate your allergies through testing, determine if immunotherapy is appropriate, and safely administer the treatment in a properly equipped setting.

From the Research

Allergy Shots in PCP Office

• Allergen immunotherapy can be administered in a physician's office, including a primary care physician (PCP) office, as it requires regular monitoring and potential treatment of systemic anaphylactic reactions 2.
• The administration of allergy shots in a PCP office is feasible, but it is crucial to ensure that the office is equipped to handle potential anaphylactic reactions and that the staff is trained to administer epinephrine 3.
• Clinical practice guidelines recommend that clinicians performing allergy skin testing or administering allergen immunotherapy must be able to diagnose and manage anaphylaxis 4.

Safety and Efficacy

• Allergen immunotherapy has been shown to have significant and long-lasting therapeutic and immunomodulatory effects for the management of allergic rhinitis, allergic asthma, and venom hypersensitivity 2.
• The risk of anaphylaxis associated with allergen immunotherapy can be reduced by regular assessment of the patient's health status, careful attention to dosing errors, and rapid recognition of symptoms 3.
• Epinephrine administration in response to allergen immunotherapy-related reactions is uncommon, typically occurs within the first week of treatment, and is rarely self-administered 5.

Clinical Practice Guidelines

• The American Academy of Otolaryngology-Head and Neck Surgery has published clinical practice guidelines on immunotherapy for inhalant allergy, which provide recommendations for the management of inhaled allergies with immunotherapy 4.
• These guidelines recommend that clinicians should offer or refer patients to a clinician who can offer immunotherapy for patients with allergic rhinitis with or without allergic asthma if their symptoms are inadequately controlled with medical therapy, allergen avoidance, or both 4.