Allergy Capital

Immunotherapy - safety issues and side-effects

You need to cooperate with you doctor to improve safety and reduce the risk of side-effects. You will normally be advised to wait in your doctor's surgery after injections, to avoid exercise afterwards, to avoid some heart / blood pressure medicines and to defer immunotherapy if pregnant.

Version 26 January 2003

IMPORTANT The information provided is of a general nature and should not be used as a substitute for professional advice. If you think you may suffer from an allergic or other disease that requires attention, you should discuss it with your family doctor.

Introduction
Immunotherapy is not a "quick fix" for allergies. You need to be committed for it to work, and to cooperate with you doctor to reduce the risk of side effects. As you are being injected with extracts of what you are allergic to, there is a risk of allergic reactions or other side-effects after injections. The relative frequncy of side-effects may vary according to the type and strength of the extracts used, rate at which the dose is increased, the sensitivity of the individual and whether they have other conditions such as underlying asthma, or an infection at the time of the injection.

Common side effects of desensitization

A small "diabetic" needle is used which may be uncomfortable, but rarely painful.
Everyone gets an itchy lump at the site of injection.
Sometimes larger itchy lumps are seen.
Your doctor may need to adjust the dose if the reactions are more severe.
Taking a non-drowsy antihistamine before or after the injection may help reduce the severity of these side-effects

Uncommon side-effects of immunotherapy

Very large local itch and swelling
Pain and bruising at the injection site (unless it is given accidentally into the underlying muscle)
Hay fever-like symptoms a few hours later
Asthma-like symptoms a few hours later
Tiredness/fatigue/flu-like symptoms in the few days after an injection

Serious side-effects are rare
There is also a risk of more serious side-effects after an injection. These are more common in the first few months of treatment, but can occur at any time. These may include:

Rash (hives) all over, throat/tongue swelling
Wheeze/asthma, even if you have not had it before
Dizziness, drop in blood pressure or even shock

To reduce the risks of side effects, you will normally advised to:

wait in your doctor's surgery after each injection
avoid exercising for a few hours afterwards
avoid some heart and blood pressure medicines (like beta-blockers) that may reduce the safety of the treatment.
avoid starting this form of therapy if you are pregnant

Immunotherapy and pregnancy
It is normally recommended to NOT start desensitization if you is pregnant. Some doctors may also recommend stopping treatment if you became pregnant. This is not because immunotherapy has been shown to cause malformations in the developing baby. Instead, the concern is that if mum has severe allergic side-effects after an injection, then the baby's oxygen supply may be interfered with.

The waiting period as a safety precaution
Most side-effects occur within 30 minutes of an injection. A waiting period of around 30 minutes (sometimes longer) is a standard recommendation so that you will be close to your treating doctor if there is a problem.

Reducing the risk of side-effects from the injections
Some simple precautions may reduce the risk of side-effects:

30 minute waiting period after each injection (often longer for bee / wasp venom injections).
Asthma should be stable before you starting immunotherapy.
It is not safe to have the injections if you are on some heart and blood pressure medicines known as Beta-blockers. The chemical name of these tablets often end in "ol". Examples include Anselol, Atehexal, Barbloc, Betaloc, Blocadren, Brevibloc, Cardol, Deralin, Dilatrend, Inderal, Kredex, Metohexal, Lopressor, Minax, Noten, Sotocor, Tenormin, Tensig, Trandate, Visken.
Some eyedrops used for the treatment of Glaucoma can cause problems because they contain Beta-blockers. If in doubt, check with your doctor.
If you are already on desensitisation injections and need to start a heart or blood pressure tablet, you should bring this up with your doctor.
You should not exercise for 6 hours after an injection to reduce the risk of a large local swellings and wheeze.
You must tell your doctor immediately if you develop itchy eyes, itchy nose or an itchy throat or chest, increased wheezing or if you feel light headed or faint in the waiting room.
You should also tell them if you feel sick in the stomach or develop itching or a rash. You should never simply "put up with these"!
You should also tell your doctor if you feel sick or have a temperature on the day of injection, as the injections may need to be delayed until you recover.
You must also tell us if you have skipped a dose or delayed it, as the dose may need to be adjusted.
You should tell your doctor if you developed hay fever or asthma symptoms a few hours after your previous injection. You may need to reduce your dose of allergen next time.
If you have a serious reaction or have ongoing side-effects, you should let your doctor know about it as soon as possible. A few minor changes to the therapy may allow you to tolerate it better.
Some doctors may suggest that you take a non-drowsy antihistamine a few hours before each injection. There is evidence that this not only may this reduce the severity of local itch and swelling, but may also reduce the likelihood of more serious allergic reactions.

Information on how allergen immunotherapy works and what it involves is described in an accompanying article.

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