What types of serum allergy shots (allergen immunotherapy) are used to treat severe allergies?

Types of Allergen Immunotherapy (Allergy Shots)

Allergen immunotherapy uses extracts containing specific allergens (pollens, dust mites, animal dander, mold, and insect venoms) administered subcutaneously to treat IgE-mediated allergic conditions. 1

Specific Allergen Categories Used

Inhalant Allergens

• Pollen extracts (tree, grass, and weed pollens) are the most commonly used allergens for treating seasonal allergic rhinitis and conjunctivitis 1
• House dust mite extracts are effective for perennial allergic rhinitis and allergic asthma 2
• Animal dander (cat, dog) extracts are used when avoidance is not feasible 1
• Mold spore extracts for patients with documented mold sensitivity 1

Hymenoptera Venom

• Venom immunotherapy (VIT) uses purified venoms from honeybees, yellow jackets, wasps, hornets, and fire ants 1
• VIT is indicated for patients with systemic reactions to stings, particularly those with respiratory or cardiovascular symptoms 1
• The standard maintenance dose is 100 μg of each venom 1

Conditions Where Immunotherapy is Effective

Immunotherapy is proven effective for allergic rhinitis, allergic conjunctivitis, allergic asthma, and stinging insect hypersensitivity 1

Not Recommended For:

• Food allergies (except oral immunotherapy for peanut allergy, which is a separate protocol) 1, 3
• Chronic urticaria or angioedema 1
• Atopic dermatitis has limited supporting data 1

Administration Protocols

Build-Up Phase

• Involves gradually increasing doses over 14-28 weeks with conventional schedules 1
• Injections given 1-3 times per week 1
• Accelerated schedules (rush or cluster immunotherapy) can achieve maintenance doses in 4-8 weeks but may carry increased systemic reaction risk 1

Maintenance Phase

• Continues for at least 3 years to achieve long-term disease modification and sustained tolerance 2, 3
• Maintenance dose for inhalant allergens varies by extract; for venoms it is 100 μg 1

Critical Safety Requirements

All immunotherapy must be administered in a physician's office or healthcare facility equipped to recognize and treat anaphylaxis 1

Mandatory Precautions:

• Patients must wait 30 minutes after injection, as most severe reactions occur within this timeframe 1
• Epinephrine must be immediately available as it is the treatment of choice for anaphylaxis 1
• Assess asthma control before each injection; withhold if asthma is poorly controlled or during exacerbations 1
• Consider measuring peak expiratory flow in asthmatic patients before injections 1

High-Risk Situations:

• β-blocker use is a relative contraindication (except for life-threatening insect venom allergy where VIT benefits outweigh risks) 1
• Severe uncontrolled asthma is a contraindication 1
• Patients with elevated baseline serum tryptase (suggesting systemic mastocytosis) require special consideration 1

Selection Criteria

Only clinically relevant allergens with documented specific IgE antibodies (by skin testing or in vitro testing) should be included in immunotherapy extracts 1

• Selection must correlate with clinical history of symptoms upon exposure 1
• The extract should contain only allergens that are clinically relevant to the patient's symptoms 1