Is it safe to stop taking allergy shots (immunotherapy) after 5 years of treatment?

Stopping Allergy Shots After 5 Years

After 5 years of effective allergy immunotherapy, it is reasonable to consider discontinuation, as this duration meets the guideline-recommended minimum treatment period for achieving long-term tolerance, though you should discuss individual risk factors with your allergist before stopping.

Key Decision Point at 5 Years

The decision to stop immunotherapy after 5 years should be made jointly with your physician after evaluating several critical factors 1:

• 5 years represents the standard treatment duration recommended in guidelines for achieving sustained clinical remission 1
• Your response to treatment must be formally assessed before discontinuation 1
• Some patients maintain long-term remission while others relapse after stopping 1

Factors Supporting Discontinuation

You may be a good candidate to stop if:

• You have experienced significant symptom improvement during the 5 years of treatment 1
• You have not had systemic reactions during your immunotherapy course 1
• Your original allergic disease was not extremely severe 1

Risk Factors for Relapse

Be cautious about stopping if you have:

• History of very severe allergic reactions before starting immunotherapy 1
• Systemic reactions during your immunotherapy treatment 1
• Honeybee venom allergy specifically (if applicable) 1

Evidence on Treatment Duration

The evidence shows that 3-5 years is the critical threshold:

• Relapse rates are significantly higher with less than 3 years of treatment (62% vs 48% for those treated >36 months) 1
• At least 3 years of treatment is required for long-term tolerance and disease modification 2, 3, 4, 5
• 5 years provides better immunologic and clinical outcomes than shorter durations 1
• Studies demonstrate sustained clinical benefits for 2-3 years after stopping 3-5 years of treatment 1, 3, 4

Important Caveats

No test can predict who will relapse:

• There are no specific clinical markers that distinguish patients who will maintain remission from those who will relapse 1
• Skin test reactivity does not reliably predict outcomes after discontinuation 1

Relapse characteristics if they occur:

• Up to 15% of patients may relapse within 10 years after stopping 1
• Relapse reactions are typically much milder than pre-treatment reactions 1
• For inhalant allergies, relapse rates of 48-55% have been reported within 3 years of stopping 1

Recommended Approach

Schedule an evaluation visit with your allergist to:

• Assess your current symptom control and medication requirements 1
• Review your treatment history for any adverse reactions 1
• Discuss the severity of your original allergic disease 1
• Weigh the convenience burden of continuing versus the risk of relapse 1

If you decide to stop:

• Plan for close monitoring of symptoms after discontinuation 1
• Understand that restarting immunotherapy is an option if symptoms return 1
• Maintain regular follow-up with your allergist 1