Is there an annual injection for severe allergies, such as anaphylaxis?

Annual Allergen Immunotherapy for Severe Allergies

Allergen immunotherapy is available as regular injections for severe allergies, including those that can cause anaphylaxis, but there is no single annual injection specifically for anaphylaxis prevention. 1

Understanding Allergen Immunotherapy

Allergen immunotherapy is a treatment approach that involves administering gradually increasing doses of allergen extracts to reduce sensitivity to specific allergens. This treatment is typically administered as:

• Regular subcutaneous injections (SCIT)
• Build-up phase: Gradually increasing doses over 14-28 weeks
• Maintenance phase: Continued regular injections (typically every 2-4 weeks)
• Not available as a once-yearly injection

Indications for Allergen Immunotherapy

Allergen immunotherapy is indicated for patients with:

• Allergic rhinitis, allergic conjunctivitis, or allergic asthma with demonstrable evidence of specific IgE and:
  • Poor response to medications or allergen avoidance
  • Unacceptable medication side effects
  • Desire to reduce long-term medication use
• Hymenoptera (insect) venom allergies with evidence of specific IgE antibodies 1

Safety Considerations and Anaphylaxis Risk

Allergen immunotherapy carries a small but significant risk of systemic reactions, including anaphylaxis:

• Rate of fatal anaphylaxis: approximately 1 in 2.5 million injections 1
• Rate of systemic reactions: approximately 0.5% of injections 1
• Higher risk in patients with:
  • Poorly controlled asthma
  • Patients taking β-adrenergic blocking agents 1, 2

Required Safety Measures

Due to the risk of anaphylaxis, allergen immunotherapy must be administered:

• Only by healthcare professionals trained in anaphylaxis recognition and treatment
• Only in facilities with proper equipment for anaphylaxis treatment
• With observation of patients for 20-30 minutes after injection 1

Emergency Management of Anaphylaxis

All facilities administering allergen immunotherapy must have:

1. Injectable epinephrine (1:1000)
2. Oxygen administration equipment
3. IV fluid administration equipment
4. Oral airway
5. Injectable antihistamines
6. IV corticosteroids
7. Vasopressors (e.g., dopamine, norepinephrine)
8. Stethoscope and sphygmomanometer 1, 2

Epinephrine is the first-line treatment for anaphylaxis, with intramuscular injection into the thigh being the preferred route for emergency treatment 1, 3, 4.

Patient Education and Self-Management

Patients at risk for anaphylaxis should:

• Carry self-injectable epinephrine (autoinjector)
• Be trained in proper use of autoinjectors
• Have a written emergency action plan
• Wear medical alert identification 1, 3

Alternatives to Allergen Immunotherapy

For patients who cannot undergo allergen immunotherapy due to contraindications or risk factors, alternatives include:

• Comprehensive allergen avoidance strategies
• Pharmacotherapy (antihistamines, leukotriene modifiers, corticosteroids)
• Consideration of biologics for specific allergic conditions

Important Caveats

• Allergen immunotherapy should be considered carefully in patients with severe asthma, significant cardiovascular disease, or those taking β-blockers 1
• The decision to use allergen immunotherapy must weigh potential benefits against risks of systemic reactions 5
• There is no single annual injection that can prevent anaphylaxis for a full year

Allergen immunotherapy remains an effective treatment option for many patients with severe allergies, but it requires regular administration under proper medical supervision rather than a once-yearly injection.