1. Allergy shots (Immunotherapy injections) are administered to allergic patients who have severe symptoms that affect their quality of life. Most allergic patients do not need allergy shots for treatment of their symptoms. If however, medications and/or environmental changes are not sufficient to minimize symptoms, allergy shots may then be the only effective option available. In persons who require multiple medications to control their symptoms, allergy shots may actually be a cost saving option when considering the pharmacy "co-pays" and the out-of-pocket expense of "over-the-counter" drugs such as "Claritin" and "Allegra."

2. Immunotherapy is usually very effective for the treatment of nasal allergies and approximately 95% of patients will improve on shots. Immunotherapy has also shown beneficial effects on asthma in some individuals and can decrease the incidence of sinus infections. Immunotherapy "turns off" the allergic reaction to plant pollens, molds, dust mites animal dander and insect venom over time. This is accomplished by the frequent administration of the material to which the patient is allergic. During the "build-up" phase of immunotherapy (the initial 3 to 6 months on the allergy injections), there is a gradual decrease in sensitivity to allergens. Allergy shots can "cure" allergies in many people but some must continue shots long-term to maintain good results. Unfortunately, up to 50% of patients with true "Allergies" (Allergic Rhinitis) also suffer from "Non-Allergic" rhinitis. Allergy shots do not treat the symptoms of "Non-Allergic" Rhinitis caused by sensitivity to environmental irritants. Nasal symptoms triggered by weather changes, tobacco smoke, perfumes, strong odors, exercise, diesel fumes, spicy food, dust, dirt and other irritants, may require medical treatment while on allergy shots.

3. "Conventional" Immunotherapy shots are usually administered in the upper arm. During the "build-up" phase, these shots are typically given once or twice a week using a schedule of progressive dosage increases until the "maintenance" dose is reached. The maintenance dose is usually reached within 3-6 months. Once you are on the maintenance dose, the time between injections can be increased, attempting to make the shot administration once per month. Maintaining your shots at the proper time interval is very important, however, missing shots for a short vacation or because of some other problem is usually acceptable. Missing shots for over one month may require temporary dosage reductions. To obtain optimal results, some patients may need shots more frequent than once per month. Annual periodic skin testing is done to judge the effectiveness of your shots. This information is use to modify the doses of allergens contained in your shots if necessary. Allergy shots are generally continued for a period of three to five years; after which your doctor may consider discontinuing the allergy shots for an observation period. This is usually considered only for those patients in who repeat skin testing has been negative for more than one year.

4. Immunotherapy injections may be associated with various types of side effects. Side effects are usually more common in the most severely allergic patients and in those with asthma. The most common side effect is swelling or inflammation at the injection site. These "local" reactions almost always improve over time. Allergy shots may occasionally be associated with more serious generalized "systemic" reaction(s).
   Symptoms or signs of these reactions may consist of hives, body tissue swelling distant from the injection site, increasing asthma symptoms, abdominal pain, diarrhea, dizziness and even loss of consciousness. Life-threatening reactions are extremely rare. Our office is prepared to treat any serious reaction that may develop, but if the allergic symptoms do not respond quickly to our treatment, it may be necessary to transport you to the near-by Emergency room at North Central Baptist Hospital for further monitoring. Since our office opened in 1999, we have not had any allergic reactions in our office that have required ER or hospital care.

5. In August of 2004 we analyzed the information we had accumulated from all allergy shots administered from 1/2002 to 1/2004. We found that about one out of every eleven patients (9%) treated with conventional allergy shots developed a systemic allergic reaction. These reactions were typically mild and easily treated in our office however, because reactions can rarely develop hours after an allergy shot, every person receiving shots is required to carry an epinephrine injector; just as all bee sting allergic persons are instructed to do. Our data collection also revealed that most allergic reactions occurred within 30 minutes after the injection. For this reason, all patients are required to remain on-site for 30 minutes after their allergy shot.

6. "RUSH" Allergy shots are available at our office. This treatment option is offered as a convenience to those who would otherwise have difficulty complying with the schedule required by our "conventional protocol". With the RUSH treatment protocol, all of the shots normally administered from a single extract dilution bottle can be completed in a 3-hour session (seven shots). Two of the four dilution vials (the weakest strengths) can be administered by "RUSH" and may be completed in as little as 1 day. This would otherwise require 16 separate office visits using our "Conventional" allergy shot schedule. "RUSH" shots may provide more rapid improvement in allergy-triggered symptoms since the maintenance dose can be reached quicker. We have found that "RUSH" treatment is as safe as "conventional" treatment when medications (pre-meds) are given prior to the injection(s) to prevent allergic reactions. In our prior clinical experience, (2002-2004) we found that in 255 patients who completed "RUSH", only one allergic reaction occurred in anyone treated with either of the first two dilution vials. Since our pre-meds appear to protect against systemic allergic reactions, we now recommend that all persons on allergy shots, even those on the slower "conventional" build-up protocols take our chosen combination of pre-meds prior to their shots.

7. Fees: Alamo Allergy and Asthma Associates charges a fee for the bottles of allergy extract which we purchase from ALK - Abello. In addition, there is a clinic fee each time an injection is given. (RUSH Allergy shots are typically billed as "office time" and you are not charged for each shot). Your insurance may require you to pay a co-pay amount each time you visit our office. Although we are contracted with almost all insurance companies, coverage for allergy treatment varies. You are responsible for understanding the limitations of your plan. During the process of receiving allergy shots if your insurance benefits change, you are responsible for immediately providing us with this information. In the event that you discontinue allergy shots, you must understand that you are financially responsible for any unused portion of the extract.

*I am requesting to receive allergy shots under the supervision of Alamo Asthma & Allergy Associates. I have read and understand the risks and benefits of Immunotherapy (allergy shots) and all questions have been answered to my satisfaction. I chose to receive my shots by:
RUSH _____/ Conventional _____ treatment protocol. (Check one)

Patient Name _______________________________

Date ______________________________________

Patient Signature____________________________

(Form revised 08/2004)

Allergy shots offer many people their best option for the control of their allergy symptoms. In some situations, such as fire ant or bee sting allergy, shots are potentially life saving. Allergy shots have been shown to reduce the symptoms of asthma in persons with allergies, a potentially life threatening illness, as well. In addition to these health benefits, allergy shots can improve a severly allergic persons "tolerable quality of life." Allergy shots offer these people a realistic chance for medication reduction as well as the hope of a cure for this disease. The use of allergy shots also carries a risk for serious allergic reactions. Reactions to allergy shots can occur during the build-up phase or at the maintenance dosing level. Our office is prepared to treat allergic reactions when they occur and we have treated many "shots reactions" in the past, (as has every other allergy practice).

Our office is unique to San Antonio, Texas in that we have developed a protocol for administering allergy shots over a much shorter period of time than usual called "RUSH." Persons that receive "RUSH" allergy shots are required to take "pre-medications" to prevent allergic reactions. Our experience with "RUSH" over the last 4 years has provided us with several valuable insights. Over time, we have made many modifications to our recommended "Pre-meds" and this has resulted in a lower incidence of allergic reactions. Because we are convinced that allergy shots are safer when given with "pre-medications," we recommend that all patients on allergy shots take an antihistamine (H-1 blocker) such as Allegra, Zyrtec, or Clarinex, a H-2 blocker (Pepcid or Zantac) and a Leukotriene receptor antagonist (Singulair) at least one hour prior to your shot. In addition, all patients at Alamo Asthma & Allergy Associates are required to have immediate access to their Epi-pen at the time of their shot. Because reactions to shots may occur after the mandatory 30 minute waiting period in our office, (Although the great majority of reactions are seen within the first 30 minutes), you must bring your Epi-pen with you to your shot visit to receive your allergy shot.

This policy is designed for your safety. If you choose not to take "pre-medication" prior to your allergy shots, we request that you sign an acknowledgement that you understand that we feel this is not the safest course of action. We recognize that other allergy offices in San Antonio do not usually use pre-medications prior to their shots. We will assume that you would like to take "pre-medications" prior to your shots unless you indicate otherwise.

** ____I choose not to take pre-medications before my allergy shot given by the "conventional" protocol. (RUSH Immunotherapy is never given without Pre-medications.)

Patient Name: __________________________________

Date: _________________________________________

Signature: _____________________________________

Chart # _______________________________________

Asthma & Allergy Associates
104 Gallery Circle
Suite 126
San Antonio, TX 78258
Tel: 210.499.0033
Fax: 210.404.0926
» VIEW MAP