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Stopping allergy immunotherapy cold turkey - what will happen?
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Ronzie1 posted:
I have been getting allergy injections (immunotherapy) for almost three years now. Initially I was getting them every 7 days, but the last year I've been getting them about every 14 days in an attempt to slowly ween myself off. At the moment, due to the recession and being out of a job, I just don't have the money to pay out of pocket anymore and continue the ween off process (which would probably take another year).

Does anyone know through experience what exactly will happen if I just completely stop the shots? Will my orignal symptoms come back as strong as they were before I started the shots? Will I retain any of the immunity that I've built up? Is there any chance the symptoms will come back stronger than originally?

I would ask my doctor, but I would probably get a biased opinion from him, considering he obviously wants my money and would prefer me to keep going if he knows I'm making a choice.
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Aqua14 responded:
From what I've read (and I do read the medical professional literature on allergy and asthma), it's hard to predict what EXACTLY will happen when you stop your allergy shots. We are all different, we all have different reactions to shots -- in fact in some people, allergy shots don't even work.

So it's possible that you can maintain your desensitization, maybe even permanently. It's possible that your symptoms may come back after several years, but they may come back more mildly. Eventually your symptoms may be comparable to before you started shots. But it's fairly difficult to predict.

One thing I would definitely question -- after almost 3 years, aren't you at maintainance level yet? Most people are, unless they have a lot of setbacks during the shot regime (meaning, they have to increase the allergen concentration in the shots very slowly due to severe reactions). I've been on shots for 39 months, and I only get my shots once per month; and I've been on maintenance for probably 2 of the last 3 years.

I would also question the necessity of "weaning" you off shots over the course of a year. I have not read that is necessary.

I will dig up and post a link to the medical guidelines for allergy shots from some of the professional allergists' societies. You could then discuss those with your doctor.

Hopefully this will help you, and I will post more shortly. Take care and good luck. Judy
 
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Ronzie2 replied to Aqua14's response:
Thanks Judy. I couldn't log into my new account so I had to create a new one. I appreciate your information, and I'd be interested to see the link to those guidelines.

I'm just not sure what will happen when if I stop the shots. The first time I went from 7 days to 14 days, I start having significant symptoms. My nose would run constantly and I always felt like I needed to sneeze. I'm worried that that could happen again if I stop completely, and I don't know if it would go away or not.

Thanks again.
 
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Aqua14 replied to Ronzie2's response:
I had another thought about this, after I read your second response. I wonder whether we are talking about the same kind of allergy shots.

When I referred to allergy shots, I meant "allergen immunotherapy," which is injections of small doses of allergen in order to provoke the immune system to desensitize. These shots are typically given for 3-5 years and the dose of allergen is gradually ratcheted up.

Reading between the lines, I wonder whether your doctor is giving you shots of steroid (such as Kenalog)? A steroid would certainly eliminate your allergy symptoms for some time. If in fact you are receiving steroid shots rather than allergen immunotherapy, then my response above is irrelevant.

Systemic use of steroids (such as oral or injected) are not normally used these days to control non-serious allergic symptoms (although I seem to recall their use back in the 1970s). Long-term use of systemic steroids cause serious problems such as osteoporosis, elevated blood sugar or diabetes, and glaucoma, among other conditions. They can also cause your body's adrenal system to shut down temporarily or sometimes permanently.

Can you please clarify as to what kind of shots you are on? Thanks. Judy

P.S. Have you thought about using allergy medications to reduce your symptoms between shots? Zyrtec would be a good start, and there are others that your doctor could prescribe, such as a nasal steroid (which does not have the side effects of systemic steroids, because very little of the steroid gets into the system).
 
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DUKE MEDICINE
Gregory M Metz, MD responded:
Allergen immunotherapy is typically given for 3-5 years. Allergy shots do not have to be weaned. Once you reach the maintenance dose (full dose), they are typically given every 1-4 weeks. Because the allergy shots induce changes in your immune system, the benefits usually last for an extended period of time even after stopping the shots. However, everyone reponds differently to the vaccine and stopping it. Some vaccines can be given once per month. I would talk about your concerns with your doctor. Hopefully, together you can formulate a plan that works for you.
 
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Ronzie2 replied to Aqua14's response:
Hi Judy, yes it is immunotherapy that I'm on. I have two concerns with quitting cold turkey:

1) what kind of reaction could that produce? The problem being, when I went from getting shots every 7 days to getting shots every 14 days, my body couldn't handle it. I developed 'cold like' symptoms where my nose ran constantly and i constantly felt like i needed to sneeze. I'm worried that quitting shots at this point could cause a similar reaction.

2) If i only quit the shots for a year, and then go back to a doctor and resume immunotherapy, have I wasted the three years I've been on shots? In other words, will I have to started completely over at a low dosage just to build myself back up? This concerns me as I've already put a lot of time and money into this.

As to your comment on allergy medications. I've considered going on an over the counter medication while I take a year or two off from the shots. The problem is, I've heard these medicines have a side effect of dry eye. I already have a chronic dry eye problem, so I don't want to make it worse. And since I'm on a tight budget right now with no insurance, I can't afford expensive prescription meds.

Thanks
 
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Ronzie2 replied to Gregory M Metz, MD's response:
Hi Doctor, please see my concerns in my last reply to Judy. If you have any advice I appreciate it. Thanks.
 
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Aqua14 replied to Ronzie2's response:
Thanks for clarifying. I guess I was overthinking this.

What are you allergic to? Are you taking all the steps possible to avoid known allergens?

While antihistamines do have a drying effect, generally it's the first-generation antihistamines (Benadryl, Chlor-Trimeton) that are more troublesome in that regard. You might try one of the newer OTC antihistamines like Claritin or Zyrtec, both of which are also generic and much cheaper than brand.

Another OTC add-on remedy is Nasalcrom, a nasal spray. Nasalcrom is what's called a mast-cell stabilizer, which to some extent prevents the mast cells in your nose from bursting and releasing allergy chemicals like histamine. It's not that expensive but the downside is that you have to use it about 3-4 times per day and it is somewhat drippy. It might be worth a try.

A really cheap remedy which is surprisingly effective is a sinus saline rinse. I think I posted a link to information in the Resource area here; let me know if not. Essentially the saline rinse washes allergens out of your nose and is particularly good for congestion. If you did a sinus saline rinse a couple of times per day in allergy season you may have pretty good symptom relief.

Hope these thoughts help you. Take care. Judy
 
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DUKE MEDICINE
Gregory M Metz, MD replied to Ronzie2's response:
Typically, increasing the time between allergy vaccine doses does not cause an increase in symptoms if you are up to your maintenance dose. Some patients notice an increase in symptoms with spacing out the allergy vaccine, but this is not common. I would recommend talking to your dr. about this as he/she knows about your specific vaccine and administration schedule. If you go off the vaccine for one year, the build up phase would have to be restarted if you go back on it at a later date. Hope this helps.
 
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Christistheonlyway777 responded:
Try Allergena sublingual allergy drops. I also used to do the immunotherapy but found sublingual drops to be very affective and they save me time from having to go to the doctor to get an allergy shot and money; copays etc.
 
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tashklab replied to Gregory M Metz, MD's response:
I'm currently getting the Allergen immunotherapy. i was on my maintenance dose, but then i had an allergic reaction and went to the ER and ended up being allergic to the prednisone they gave me. i didn't get my shots for about a month. When I finally went it to get the shots the nurses put me back on my original diluted starting dose. Since then i have been becoming allergic to all the food i eat. first it was cheap packaged food, the all fruit, then all stuff with wheat and corn in to. just yesterday i had a coffee in the morning but by night time i had another coffee and was allergic. last night i was brushing my teeth and had to go to the ER because i reacted to my toothpaste.

this whole thing is scary and all these reactions cause my throat to swell almost shut.

my question is, is this happening because I got switched back to the lowest dose?

I've never had food allergies before. only after they stopped giving me my maintenance dose and put me on the lower one. all i can eat now is plain chicken. any help would be great!


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