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Q. How can I decrease the chance that I have a bad reaction to allergy shots?

A. There are many things that you can do to decrease your chance of a bad reaction. First and foremost is to wait the recommended 30 minutes in your allergist's waiting room. Through studies, this has been found to be the time when most bad reactions occur. And it is important that your doctor can treat you quickly if you start to have a reaction. If you leave before the recommended wait time and have a reaction outside of the allergist's office, then there will be a delay in treatment of the reaction, which can result in a more life-threatening outcome. Second, you should always let the nurse/doctor know immediately if you are experiencing any symptoms of a reaction or notify your doctor if you ever experience these symptoms later on in the day after your shot. Symptoms of a reaction can include itching, runny nose, itchy watery eyes, coughing, shortness of breath, hives, swelling, or just feeling like something is different from when you came in. Other things that can decrease your chance of having a bad reaction to the allergy shots is to not come in for your shots if you are having severe allergy symptoms, symptoms of asthma such as wheezing or shortness of breath or use of albuterol, or an upper respiratory infection. You should also let your doctor know if you are started on any high blood pressure medications, particularly beta blockers, since this can make it harder for your doctor to treat you if you were to have a reaction. Also, you can discuss with your allergist about possibly prescribing injectable epinephrine that can be carried with you on the day of your shots, since this is what we would use to treat you if you were having a reaction.

Q. I have seen some information on the internet that suggests that allergy shots can be more effective if given directly into a lymph node. Is this correct? If so, is this something that is available now?

A. The concept of injecting immunologic material within a lymph node (or intralymphatic) has existed for a number of years, mainly in the setting of experimental anti-cancer therapy. Targeted cancer immunotherapy, placed directly into a lymph node, may more effectively target the source of problems at a lower dose than would otherwise be needed. As we are always looking for ways to improve treatment of allergies, this idea is being studied - among many others - to determine its potential.An article published in 2008 by researchers in Switzerland indicates this new approach might work well in allergy treatment (Senti G, et al Proc Natl Acad Sci U.S.A. 2008; 105:17908-17912). In this study of 165 people, a series of 4 doses of grass immunotherapy were injected into an inguinal (groin) lymph node. The intralymphatic therapy was found as effective in this group as those recieving 3 years of traditional allergy immunotherapy (subcutaneous immunotherapy). Subsequently, the same researchers in Switzerland have also shown its effectiveness in treating allergies to cat dander, and bee venom - but these later studies were done in mice, not humans. Intralymphatic allergen immunotherapy treatment remains experimental at present and is not available as a treatment in the United States.

Q. I have a lot of allergy problems and I m tired of taking medicine that doesn t work very well. Several of my family members take allergy shots at home and tell me I should do them too. I called my local allergist and asked if they did allergy shots at home. I was told that they did allergy shots for their patients but the shots had to given in a doctor s office. I m confused. I am interested in allergy shots if they help but why do some people do them at home and others in a doctor s office?

A. Firstly, we should address allergy immunotherapy (shots) in general. For those people who have allergic nasal symptoms, asthma or atopic dermatitis and are able to receive allergy shots, those shots have been shown to be very effective. As a board-certified allergist, I believe the best physicians to prescribe allergy shots are those trained as allergists (certified by the American Board of Allergy/Immunology). Secondly, while allergy shots are relatively safe, there is a low but real risk of a systemic allergic reaction to the shot - each time you receive one. This is the reason allergists have their patient s receive shots in a doctor s office and then wait for thirty minutes afterwards, to decrease the risk that a serious life threatening reaction would occur back at home. Allergic reactions, whether they are to allergy shots, medications or foods can progress rapidly and should not be taken lightly.

Q. My new Allergist retested me for allergies for mold and trees. I tested positive for 28. I have been taking allergy shots for 43 years monthly. Yes, 43 years. I am 56 years old. My new doctor suggested that I stop taking allergy shots because she said they are no longer benefiting me. I am so confused. I have not had a cold and allergy problems for the past 20 years. I am so afraid that if I stop taking the shots, I will get sick again. I am so lucky to be very healthy and I attribute that to my allergy shots. What do you think? I just spent 1 hour on the web reading aaai and acaai and can't find a page where this addressed. The only I found was that I may feel good for 3 yrs. Isn't my body relying on these shots after 43 years. Please respond as soon as possible. My doctor wants me to make up my mind. She will keep me as a patient and continue to give me my regular shots for only 1 more year.

A. The most prudent path is to stop the shots for a while and see how the patient does. The three year concept comes from a study that only lasted 3 years and so the study didn't answer what truly happens- and that is some people are "cured forever", in others symptoms come back. My own policy is to recommend after 5 years that patients quit and see how they do. Many patients over the years stay well, others need to resume allergy shots. In that case after another 5 years they don't want to quit again and I understand that. I think the allergist's recommendation is sound since skin tests can be positive and patients are not symptomatic from the allergies. I hope this discussion is helpful.

Q. I forgot my allergy serum/extract at home and I need it for the summer (being spent away from home). My brother now has it and can get it to me in a few ways:

A. The best method is to carry it by hand in a small cooler with some ice. However, we do ship extracts by mail without ice. If you put it in checked luggage it will freeze and will be ruined. The amounts are small enough to permit security to pass it through.