Doctor wants to hold off on allergy shots. I would like them soon.
June 13, 2014 5:53 PM   Subscribe

My go-to OTC allergy med isn't working well, and my ragweed/pollen allergies are going crazy. I went to the allergist and she gave me a nasal spray to try, then said I could use allergy shots in the fall. I told her that I would like to try them right away (she said they have a chance of eliminating allergies, which would be a miracle!), but she doesn't want to use them yet. The nasal spray doesn't seem to be working. Should I force the issue, or is she right to be cautious?

Her reasoning is that since it's ragweed season, the shots could potentially make my allergic reactions worse. But the thing is... I honestly don't care if they get worse short-term; my allergy fits are already bad enough! I just want to get started on the shot therapy so my allergies are eventually GONE, or at least reduced in severity. I understand that I'd be on them for years, and I am prepared for the commitment.

Since the med she gave me (Dymista) isn't really working - and I've basically tried every other OTC option - do you think I should push for the shots this summer? I'm sure she has a point, but unless the shots bring me to death's door I'd like to start them soon since I'll probably spend my summer sneezing and wheezing anyway. Input from doctors, allergists, and whoever has been on allergy shots in the past are most welcome.
posted by BuddyBoo to Health & Fitness (14 answers total) 1 user marked this as a favorite
Allergy shots can cause anaphylaxis. My father has severe allergies and had to keep re-starting his immunotherapy protocol and eventually had to quite because of anaphylaxis reactions. I would trust your allergist if she says it's not recommended to start right now - it seems logical to me to start at a baseline immune response vs jumping in mid-allergy season. Even if you did start right now it will take years for immunotherapy to show results, so waiting a few months won't make much difference in the end.

But you could always get a second opinion, especially if you don't trust your allergist or if she's not explaining her reasoning well enough.
posted by muddgirl at 6:08 PM on June 13, 2014

I had immunotherapy for about 7 years as a kid and the MD is right about timing. You should really wait until after your allergy season to start.

It's not like a cortisone shot or something, it can take years to build up an immunity so you might not get any relief until a year or more down the line. And the "bad" reaction you get when your allergies are in season combined with a high allergen shot is unlike anything I've ever experienced. My arms looked like I had tennis balls under the skin and I was only 10.

That said, they really do work and if you can take being stabbed in the arm a couple times a week for months on end, its worth it. It looks like they don't do it for as long as they used to but I had a lot of allergies and it was a really long time ago.
posted by fiercekitten at 6:09 PM on June 13, 2014

You say you're wheezing--are you taking any sort of asthma or allergy medicine like singulair? OTC stuff doesn't help my seasonal allergies but singulair + dymista work well for me.

Also doing things like getting a HEPA filter for home and using a sinus rinse can be very helpful.
posted by inertia at 6:11 PM on June 13, 2014

I can't speak to allergy shots, but don't consider them your only remaining option. There are lots of prescription drugs that can help.

I take a combination of generic Claritin (OTC), generic Singulair (prescription, this one's an anti-leukotriene, and leukotriene is another chemical involved in allergic response, like histamine) and a multivitamin. And sometimes generic Flonase (this one's more expensive than the pills). And sometimes an inhaler. Each helps some on its own, but when I started taking them all together I could finally breathe again.

There are other nasal sprays. Try another -- the right one should be a great help. There are other pills. If you have bad allergies, you may need to throw a drug cocktail at it, at least during the bad seasons.

And shots will always be there when the timing is better.
posted by katieinshoes at 6:16 PM on June 13, 2014 [1 favorite]

I don't actually wheeze - I just wanted to rhyme :)
posted by BuddyBoo at 6:18 PM on June 13, 2014

If you just started the Dymista, do know that it takes a while to start working — there's a kind of build-up period before it really kicks in. But we're talking a week, max.

Good luck! And if you're really worried about anaphylaxis, some doctors will give you a prescription for EpiPens.
posted by you're a kitty! at 6:56 PM on June 13, 2014 [1 favorite]

Have you had the scratch and sub-dermal tests done to determine what your are allergic to? If you tested positive for pollens that are in prime season right now, your doctor has a reasonable argument for waiting until the fall to start the shots.

As a data point, I've been going for shots once a week for almost a year. Up until six weeks ago I barely had a reaction. As the pollen and the strength of the dosage of my shots has increased, I've had my first serious asthma attack and started experiencing noticeable reactions (redness and swelling) in both arms. In the grand scheme these are minor, but my doctor may end up dialing back my dose rather than allow me to risk a more severe anaphylactic reaction. And I am still on Fluticasone, Montelukast and a steroid inhaler.

Seconding that you try a combination of medications to get you through the rest of the summer. That your doctor is being cautious is a good thing.
posted by theBigRedKittyPurrs at 6:56 PM on June 13, 2014 [1 favorite]

I got allergy shots for a few years back when I was a teenager, and your doctor's decision makes sense to me. The allergy shot contains a small amount of the allergen that you're allergic to, and the amount is increased gradually, to build up your body's tolerance to it. If your body is already overwhelmed with allergies & flooding you with histamines, the shot isn't going to have any benefit, it's just going to add ammo to the attack on your system.

My allergies were to dust, molds, dogs, & cats. I think the shots were beneficial, but, my allergies weren't very severe - I grew up always having cats in the house so I had some immunities to them, I just tended to have a lot of sinus issues, to the point where the high school nurse said "I'm tired of seeing you in here so much" and gave me the allergist's name to give to my parents. So, I got the shots for a while, and I think they helped, but it's hard to say for sure since my symptoms were so vague, and maybe I would have grown out of them anyway.
posted by oh yeah! at 8:04 PM on June 13, 2014

I'm no allergist but I suspect that it is hard to imagine what an exponentially magnified level of misery is like (and whether you'd indeed be fine putting up with it) until you've experienced it, and then you can't undo what is done. I just know that I see patients in the ED not infrequently during this season who are desperately begging me for some other medication because they absolutely cannot handle living with their allergy symptoms any longer and have exhausted all options - and I really don't have much to offer them either, and I feel bad about it because they are so desperate. I thus feel that if I were you, and I did not feel like I was at "go to the emergency department and throw myself at a doctor's feet begging for mercy" level of allergy symptoms, I wouldn't really want to take the chance of going there if I could help it.

And certainly anaphylaxis is something that should give one pause, after all, it can indeed bring you to death's door and beyond.
posted by treehorn+bunny at 8:54 PM on June 13, 2014

Per my allergist, they will not give allergy shots until well out of and long before allergy season for your particular allergies. For me, that means shots starting next January.

For my nasal problems, I've been having good results with Omnaris (ciclesonide). You may wish to talk to you doctor/allergist about a prescription for an Epi-Pen, just in case, since your allergies sound pretty severe.

Her reasoning is that since it's ragweed season, the shots could potentially make my allergic reactions worse. But the thing is... I honestly don't care if they get worse short-term

You're already having severe allergic reactions. Adding more off your allergen into your system could easily trigger anaphylaxis, which could kill you pretty quickly. (Though one does hope that allergists' offices tend to have epinephrine handy.)

I'm assuming you've actually had scratch tests to narrow down your exact allergens?
posted by feckless fecal fear mongering at 7:34 AM on June 14, 2014

When you get the shots, if your reaction is above a certain level, they won't increase the dose. If you're starting at a point where that is more likely, it'll likely mean a slower progression anyway. You might want to see if anyone in your area does rush immunotherapy, when the allergy season is over. It involves many shots over a period of 1-2 days, while taking higher dosages of allergy meds & prednisone. It allowed me to skip ahead 6 months in the shot schedule.
posted by bizzyb at 10:11 AM on June 14, 2014

People are way overstating the risk of anaphylaxis. I have extremely bad allergies (like, the allergist wasn't sure the NP read my skin test results correctly), and I am on my third round of allergy shots (sadly the effects don't last forever). I have had exactly one anaphylactic reaction, and because you stick around the office after your shot, it was dealt with immediately.

The dosage when you start shots is so low that it's likely you will have no response at all, and it's not going to make your existing allergies worse. If you do react, you'll put some benadryl cream on it and call it a day. My allergist doesn't start people at the height of allergy season, but I am surprised that yours won't let you start at some point during the summer. If you can, ask another allergist what their policy is.
posted by goodbyewaffles at 9:03 PM on June 14, 2014

(Also because anecdata is not data, allergy shots are given in a controlled environment by a person who knows exactly what they are doing. I am on my phone and have no link, but IIRC the risk of dying from a shot is like 1 in 65 million, which makes it 65 times less likely than your getting a terrifying prion disease, which is a thing no one worries about. Soo.)
posted by goodbyewaffles at 9:30 PM on June 14, 2014

Okay, the allergy spray kicked in, and I'm doing much better. So, I decided I'll stay off the shots until the fall; better safe than sorry. Thanks for your input.
posted by BuddyBoo at 7:05 AM on June 20, 2014

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