Self-administration of allergy shots

May 18, 2004

I'm most concerned about the beta blocker, but I will discuss that at the end of this response.

When a person receives an allergy injection, he is taking into his body a substance he is allergic to. The body begins building antibodies to fight this substance. As the dose is increased, the body continues to build more antibodies toward the offending allergen.

It's a delicate balance. Increasing the dose too slowly can delay progress toward enough antibodies to control allergy symptoms. Increasing the dose too fast can cause severe reactions to the shot itself. Your physician will tell you the proper increments of increasing the dose.

However many other factors play a role. Some of these include fever or elevated allergy symptoms before the injection, higher level of exposure to the allergen in the environment, or too long an interval between injections. Any of these can tip the delicate balance and cause a serious systemic reaction to the shot.

A severe reaction can also be caused by human error resulting in a dose that is too strong. Sometimes a severe reaction occurs for no apparent reason.

Because of these dangers, many allergists do not allow the injections to be self-administered. Many allergists require allergy shots to be administered in a medical setting equipped with emergency supplies where a licensed physician is immediately available.

Other physicians do allow self-administration of injections. It is the responsibility of these physician or their staff to teach where and how to give the injections. They should also provide verbal and written instructions of when to withhold the injection, when to call the physician for further instructions, and what to do if a reaction occurs. These physicians usually prescribe an EpiPen to be used in case of severe reactions. Be sure you know when and how to use the EpiPen, and what to do next.

Severe reactions may occur more often in persons taking a beta blocker medication, and these reactions don't always respond to the usual treatments. For this reason, most allergists do not prescribe allergy injections for those on beta blocker therapy. The American Academy of Allergy Asthma & Immunology provides guidelines for physicians on concurrent use of allergy shots and beta blockers. (See footnote.)

For a person on a beta blocker to receive an allergy injection away from a medical facility that has staff and equipment to handle these emergency situations is very dangerous. Be sure your allergist knows if you are on a beta blocker. Be sure any physician prescribing medicines for you knows if you are on allergy shots.

I'm also concerned that you mentioned that your husband is seeing a nephrologist. Mild kidney problems probably won't affect allergy injections. But more severe kidney damage can compromise the ability of the body to excrete medications including some beta blockers or medications used to treat allergic reactions. Be sure your allergist is aware of his level of kidney involvement. His allergist can determine whether allergy injections are safe for him.

Be sure to ask the physician or his nurse any other questions you have about administering the injections. Your husband's physician knows what is in the shots, your husband's medications and medical status, and what is best for him. Follow his advice closely and don't hesitate to phone him or his nurse if you are unsure about anything related to the shots.

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