Allergy shots -- "How?" & "Where?"

May 1, 2002

Great question! Everyone getting allergy injections should know the "How?" and "Where?" of them. One patient asked me, "Why? They're nurses. They should know what they're doing!"

Yes, they should. If a nurse doesn't know the proper method, it is her responsibility to find out before giving the injection.

But nurses are human. Just like everyone else, they are sometimes overworked, sometimes stressed, and sometimes make mistakes.

We send detailed instructions when one of our patients is getting injections in another clinic, and most other allergy clinics send detailed instructions to us also.

However, many medications are normally given intramuscularly (IM) in the deltoid muscle. Nurses unfamiliar with allergy injections may assume allergy shots are to be given by this method also.

Allergy shots often cause a large area of swelling and soreness when given in the muscle.

Subcutaneous (sub-q) injections are absorbed more slowly than IM injections, thus allowing antibodies to build up more slowly with less likelihood of systemic effects.

Allergy injections should be given sub-q in the "fleshy" outside back area of the upper arm. The shots should be given below the deltoid area and a few inches above the elbow.

For sub-q administration, the skin should be pinched up to pull it away from underlying muscle. A 1/2" needle is usually inserted at a 90 degree angle, while a 5/8" or longer needle is normally inserted at a 45 degree angle. However the angle is sometimes varied according to size of the patient.

The fact that we nurses are human is no excuse but it is reality. This is why it is important for you to know where and how your shots should be given.

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