Should corticosteroids be administered as immunotherapy (allergy shots)?

From the Guidelines

Steroids should not be given as allergy shots, as they are not a component of allergen immunotherapy, which aims to build tolerance to specific allergens over time. Allergy shots, or allergen immunotherapy, contain small amounts of specific allergens, such as pollens, dust mites, or animal dander, to help build tolerance over time 1. Steroids, while effective for treating allergy symptoms, work differently by reducing inflammation and suppressing immune responses. For acute allergic reactions, steroids may be administered separately as oral medications (like prednisone), topical treatments, or occasionally as injections (such as triamcinolone or methylprednisolone), but these are not considered "allergy shots" in the traditional sense.

Some key points to consider when evaluating allergy shots include:

• The maintenance dose and schedule of allergen immunotherapy, as well as the benefits and risks of continuing immunotherapy, should be evaluated after any immunotherapy-induced systemic reaction 1
• Local reactions can be managed with local treatment (eg, cool compresses or topical corticosteroids) or antihistamines, while systemic reactions can be mild or severe (anaphylaxis) and require epinephrine as the treatment of choice 1
• Steroids are generally reserved for managing severe symptoms or when other treatments have failed, as they can have significant side effects with long-term use, including weight gain, mood changes, increased blood sugar, and bone density loss. For routine allergy management, antihistamines, nasal steroid sprays, or allergen avoidance are typically first-line approaches, with traditional allergen immunotherapy reserved for those with persistent symptoms. The most recent and highest quality study on this topic is from 2024, which provides a comprehensive overview of immunotherapy for inhalant allergy 1.

From the FDA Drug Label

5.4 Corticosteroid Reduction Do not discontinue systemic or inhaled corticosteroids abruptly upon initiation of XOLAIR therapy for asthma or CRSwNP. Decrease corticosteroids gradually under the direct supervision of a physician.

The use of steroids as allergy shots is not directly addressed in the provided drug label. However, it does discuss the reduction of corticosteroids in the context of XOLAIR therapy.

• Corticosteroid reduction should be done gradually under medical supervision.
• The label does not provide information on administering steroids as allergy shots. 2

From the Research

Allergy Shots and Steroids

• The use of steroids as allergy shots is not directly mentioned in the provided studies 3, 4, 5, 6, 7.
• However, the studies discuss the effectiveness of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) in treating allergic diseases, such as allergic rhinitis and asthma.
• The studies suggest that both SCIT and SLIT are effective in reducing symptoms and improving quality of life, but the choice between the two routes of administration depends on various factors, including patient preference, safety, and cost-effectiveness 4, 5, 6, 7.

Comparison of SCIT and SLIT

• The studies compare the efficacy and safety of SCIT and SLIT, with some suggesting that SCIT may be more effective in reducing symptoms and medication use 5, 7.
• However, SLIT is considered to be safer, with a lower risk of systemic reactions 5, 6.
• The studies also discuss the importance of patient selection and the need for further research to establish the comparative effectiveness of SCIT and SLIT 3, 4, 7.

Steroids and Allergy Shots

• There is no direct evidence to suggest that steroids should be given as allergy shots.
• The studies focus on the use of allergen immunotherapy, which involves the administration of small amounts of the allergen to build up tolerance and reduce symptoms.
• Steroids are not mentioned as a component of allergy shots in the provided studies 3, 4, 5, 6, 7.