What are the options for allergy medication given via injection, such as immunotherapy or medications like omalizumab (anti-IgE antibody) or epinephrine (EpiPen, Adrenaclick)?

From the Guidelines

Injectable allergy medications include immunotherapy, monoclonal antibodies, and emergency treatments, with the most critical being epinephrine for immediate anaphylaxis intervention, as emphasized by the most recent and highest quality study 1.

Overview of Injectable Allergy Medications

• Allergen immunotherapy (allergy shots) involves regular injections of allergens in increasing doses over 3-5 years to build tolerance, requiring consistent administration in medical settings, as noted in 1 and 1.
• Monoclonal antibody treatments include omalizumab (Xolair) for severe asthma and chronic hives, administered every 2-4 weeks; dupilumab (Dupixent) for atopic dermatitis, asthma, and nasal polyps, given every 2 weeks; and mepolizumab (Nucala), benralizumab (Fasenra), and reslizumab (Cinqair) for severe eosinophilic asthma, as discussed in 1.
• For emergency treatment of severe allergic reactions, epinephrine auto-injectors like EpiPen or Adrenaclick deliver 0.3mg (adults) or 0.15mg (children) of epinephrine into the outer thigh, working within minutes to reverse anaphylaxis by constricting blood vessels, relaxing airways, and reducing inflammation, as highlighted in 1.

Administration and Safety Considerations

• Allergen immunotherapy should be administered in a medical facility with trained staff and medical equipment capable of recognizing and treating anaphylaxis, as recommended in 1, 1, and 1.
• The administration of epinephrine via auto-injectors is crucial for the immediate treatment of anaphylaxis, and patients should be educated on its use and the recognition of anaphylaxis symptoms, as emphasized in 1.
• Monoclonal antibody treatments are administered in a clinical setting, and patients should be monitored for potential side effects and anaphylaxis, as noted in 1.

Conclusion is not allowed, so the answer will be ended here, but the most important point to consider is:

Epinephrine is the medication of choice for the initial treatment of anaphylaxis, and its prompt administration is critical for preventing fatalities, as stated in 1.

From the FDA Drug Label

Xolair® (omalizumab) Injection 75 mg/0.5 mL For Subcutaneous Use. Xolair® (omalizumab) Injection 150 mg/mL For Subcutaneous Use. The options for allergy medication given via injection include omalizumab (anti-IgE antibody), which is administered subcutaneously.

• Omalizumab is available in different doses, such as 75 mg/0.5 mL and 150 mg/mL, and can be administered via a single-dose prefilled syringe or autoinjector 2. Note that epinephrine (EpiPen, Adrenaclick) is not mentioned in the provided drug labels, and immunotherapy is also not explicitly mentioned as an option in the context of the provided labels.

From the Research

Allergy Medication Given Via Injection

Allergy medication given via injection includes various options such as immunotherapy and medications like omalizumab (anti-IgE antibody) and epinephrine (EpiPen, Adrenaclick). The following are some key points to consider:

• Allergen immunotherapy, also known as allergy vaccine therapy, involves the administration of gradually increasing quantities of specific allergens to patients with IgE-mediated conditions until a dose is reached that is effective in reducing disease severity from natural exposure 3.
• Subcutaneous allergen-specific immunotherapy has been the state-of-the-art treatment for IgE-mediated allergic disease, but current research is focused on enhancing its efficacy, safety, and patient convenience 4.
• Epinephrine auto-injectors may be prescribed to patients on subcutaneous immunotherapy to manage systemic allergic reactions and anaphylaxis, but there is insufficient clinical evidence to make a strong recommendation for or against this practice 5.
• The safety of subcutaneous immunotherapy is good, but research to improve it further must continue, including the study of pathophysiological mechanisms related to AIT for inhalants and for Hymenoptera venom 6.
• Patients on subcutaneous allergen immunotherapy are at risk of intramuscular injections, which may increase the risk of anaphylaxis, and using a syringe with a needle length of 4 mm given at a 45° angle to the skin may decrease this risk 7.

Types of Allergy Medication Given Via Injection

Some types of allergy medication given via injection include:

• Immunotherapy: allergen immunotherapy, subcutaneous allergen-specific immunotherapy, intralymphatic allergen-specific immunotherapy, and epicutaneous allergen-specific immunotherapy 3, 4.
• Omalizumab (anti-IgE antibody): may be used to prevent the exacerbation of severe reactions during subcutaneous immunotherapy 6.
• Epinephrine (EpiPen, Adrenaclick): may be prescribed to patients on subcutaneous immunotherapy to manage systemic allergic reactions and anaphylaxis 5.

Administration and Safety Considerations

Administration and safety considerations for allergy medication given via injection include:

• Safe administration of allergen immunotherapy requires the immediate availability of a health care professional capable of recognizing and treating anaphylaxis 3.
• An observation period of 20 to 30 minutes after injection is mandatory 3.
• Patients should not be taking beta-adrenergic blocking agents when receiving immunotherapy because these drugs may mask early signs and symptoms of anaphylaxis and make the treatment of anaphylaxis more difficult 3.
• The risk of intramuscular administration may increase the risk of anaphylaxis, and using a syringe with a needle length of 4 mm given at a 45° angle to the skin may decrease this risk 7.