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RUSH allergy shot procedure?

Hi everybody!

My allergist has recommended that I do what he calls a RUSH allergy shot treatment. Basically, for one day, I will be pre-medicated with prednisone, zyrtec, and zantac, then receive an additional injection every 20 minutes until the point of systemic reaction. He believes it will get me not to maintenance but at least maybe 2 months worth of injections.

We are trying to get me past this catch-22 of "I keep getting sick because I need allergy shots" and "I can't get allergy shots because I'm sick" ….. SO frustrating. I've done years of allergy shots in the past (in childhood and again in my 20s – I'm 44 now) but never had this trouble before.

Has anyone ever done a rush like this? What was your experience? I hadn't ever heard of it until this year.

While I want to do it, I do think it is risky. I had an ana rxn to allergy testing in June, then had another ana rxn to an injection in August. Since then I've only been able to get one injection because of asthma/allergies/sinus what-have-you. 

Thanks!

Jenny

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  • Jen

    Jenny – Sounds like it may help.  Have you discussed your concerns with the allergist?

  • K8sMom2002

    Jenny, I HAVE heard of rush allergy shot schedules … but I didn't think it was that quick of a pace.

    It sounds like you are really on the fence about this … could you talk to your doctor and perhaps seek out a second opinion to ease your mind and help you make a decision?

    Did you have to have epinephrine for your reactions? if you did … 

    My DD had an allergic reaction to an allergy shot that contained corn and required three epinephrine injections (she's got a life-threatening reaction to corn.) Both her then-allergist and the second-opinion/current allergist said no more allergy shots or any environmental immunotherapy for her. 

    But that was based on her unique situation. We discussed this at length with her doctors, and they are firm in their no. So as much as I would have liked for her to continue, they say no, that the earlier anaphylactic reaction rules that option out.

    Your situation might be different, so I think it's worth having a good long conversation with your allergist — the doc is a board-certified allergist, right? If not, then I would seek out the opinion of a board-certified allergist. 

  • jtomotaki

    Yes, we have discussed and weighed pros/cons quite a bit on several different occasions. I may be off on how quick the pace is but I know it will definitely give me a jump-start.

    At both reactions, I had two epi shots each time. The reaction wasn't like I expected though. It wasn't a panic-stricken "OMG I can't breathe! Quick grab the epi!" situation like I've always imagined. It was more "Hmmm, my face is really really burning and is the color of a cherry ….. You know, I'm tired. Talking is too much trouble right now ….. No thanks, I really don't want to try to take a deep breath right now, it hurts." Really, I would have ignored those symptoms but the NP was on top of her game.

    And yes, he is board-certified. Absolutely fantastic allergist. My son started seeing him about 11 years ago but I didn't see him for myself until this past summer. (Because, you know, I had outgrown all my allergies and surely allergies weren't to blame for my recurrent sinusitis, bronchitis & pnuemonia over the past 18 months!!)

    He is a lot more aggressive in his treatment plans than any other doctor we have seen.

     

  • K8sMom2002

    That's a tough call … but it is good you've talked with him about it. 

    Our DD's reaction started the same way, and of course rapidly got worse. I didn't realize how really rare anaphylactic reactions to allergy shots were until we were referred out to our current allergist who is at a teaching hospital. Usually, according to her (and she's the head of the department and the dean of the immunotherapy/allergy teaching) allergic reactions just involve local swelling. 

    When I pushed for maybe backing down the dose and trying the allergy shots, she shook her head and said very firmly, "No. After one anaphylactic reaction to an immunotherapy shot, immunotherapy is contraindicated." I asked about sublingual therapy (like GrasTek pills for grass allergies), and she said that the manufacturer had a black box warning for anyone who'd had an anaphylactic reaction. 

    But this was some years ago, and our allergist isn't your allergist. I only know that both of the allergists that we saw agreed that one anaphylactic reaction that required multiple epinephrine shots ruled out any more allergy shots for her. 

    The crazy thing was she'd flown through all of these shots and was at the last bump-up — at her previous check-up, her allergist had declared her "the poster child of allergy shots." It really shook him (the first allergist.). 

    I just looked up the article my doctor quoted me about the rate of systemic reactions to allergy shots … 

    For example, severe systemic reactions occur at markedly different rates depending on the frequency of administration of allergy injections. With conventional immunotherapy, the rates of severe systemic reactions are probably <1%, whereas with rush immunotherapy reported reaction rates have been in some instances >30%.

    Again, your situation may be different — and your doctor may have a plan in place to reduce the risk, or he may have a different protocol in place — like maybe having the injections done at your hospital. Or he may have access to different studies that are more recent or show something else. 

  • jtomotaki

    @K8sMom2002 after my reaction, I did ask if that meant no more shots for me, and was told they will decrease and go really really slowly ….. So …. hmmm, does seem to contradict the suggestion to do a RUSH day. 

    Thank you for posting the article link! Time to do some more researching. My RUSH appointment is scheduled for Feb 5th so I've still got time to decide.

  • K8sMom2002

    Oh, good! And you know, your doctor may have information on that study that puts it in a new light. Not all studies are created equally — I like to talk about that with my doc, too, so I'll make a copy of the study article and share it and ask, "Can you walk me through this? Is this something I need to be concerned about?"

    Has he talked to you about other things you can do to help get over this continual bout of illness? Has he suggested a pneumonia shot? 

    Mine did … after I came down the last time with pneumonia in May of 2016, my doc strongly urged me to get my pneumonia shot. I thought it was for senior citizens! And that it just helped with pneumonia … but it actually helps reduce the risk of a lot of different infections that are caused by the same bacteria. 

    Here's an AAFA blog about it …

  • jtomotaki

    @K8sMom2002 Had a bunch of labs done yesterday to test for immune deficiencies. When we get those results, I'll get a pneumovax and then repeat same labs. So killing two birds with one stone! My pneumonia last spring was complication from flu virus — the ONE year that I didn't remember to get my vaccine. The immune test results my impact my RUSH decision.

  • K8sMom2002

    Fingers crossed that you don't have any immune deficiencies (why is it so hard for me to spell that?!) … glad you're getting your pneumo shot — I believe it has truly helped me (either that or I finally caught every bug known to man and became immune!) 

    How long will it be before you get the immune test results?

    And yeah, I've gotten a lovely case of pneumonia a time or two from a viral infection. Now part of my sick plan is that we use antibiotics if we even think it's a sinus infection because of my asthma. 

    It sounds like you're gathering all the info you need to make an informed decision — that's great! I know you and your doc will figure out the right decision for you!

  • jtomotaki

    The repeat labs will be run a month after the pneumovax – sorry I realize I didn't clarify that in my original message. So hopefully I'll have some answers in 5 or 6 weeks??

    My PCP had suggested doing this immune testing last spring when she referred me to the allergist. At that time he said "Well let's give immunotherapy a good shot first and then see if we need to do any further deficiency testing." Yesterday's allergy appointment was SUPPOSED to be a well-check, but I'm sick again. He told me he really would like to see me at some point when I am WELL just to see how a WELL me does on all the breathing tests.

    I told him I am tired of waiting around to see if I will ever be well! That's when I asked for further testing.

    BTW, started using BREO 5 weeks ago and my lung capacity test went from 83% (in June, on QVAR + ventonlin) to 67% (in Oct, on qvar + singulair + ventolin) to 95% yesterday!!  (on Breo, qvar, singulair, and ventolin.) Finally found a combination that works!

  • K8sMom2002

    Woohoo! So glad you did! That ought to make you feel better! 

    I hope the test results will help you decide the best path forward for you! 

    And I also hope the pneumo vaccine will help — I know it has seemed to help me. 

  • RedCoog

    So I'm currently sitting at my Immunologist office after doing a skin prick test. My back lit up like a xmas tree! I knew I was allergic to several things from past test and blood work, but not this bad. 

    We started to talk about allergy shots; not the first time it's been discussed with me. I really need to sit down and do some research on my own. 

    What has been the general experience from you guys on these shots? It's truelly an economic and time commitment, but if this is really effective on treating some of my asthma sysmptoms I would be fully engaged!

  • K8sMom2002

    Redcoog, hugs on the itchy skin prick test!

    It really depends on your asthma triggers, at least according to our doctor. If your asthma is triggered mainly by environmental allergens — grass pollen, weed pollen, etc., then this could be a good long-term solution for you. 

    Some folks I know have had excellent results from the shots. Kathy P, for one, has taken allergy shots, IIRC, and it's part of her long-term management strategy for her asthma. 

    As I mentioned above, the percent of people who have systemic allergic reactions to regular traditional shots is very, very low — 1 percent, IIRC. By making sure you follow your doctor's guidelines, you could possibly reduce that slight risk even more. Most likely your doc will prescribe epinephrine auto-injectors just because it's pretty standard (at least in my corner of the world) when you receive allergy shots. So that's a consideration of expense as well, although there are co-pay discounts and generics available now. Kids With Food Allergies (the food allergy division of AAFA) has a blog post called .

    My DD was one of the unlucky ones who couldn't continue, and we had to discontinue it before we could see if it would have done her any good. I am a strong believer in an ounce of prevention is worth a pound of cure, so I'd definitely research this and talk it over with my doctor if it were me.

  • jtomotaki

    An update on the RUSH procedure for allergy shots. After much deliberation, I decided to proceed. So on Monday, I received the first 11 weeks' worth of injections. With the pre-meds, I only had minor local reactions until the very last shot which was systemic and required epis. But I am SO glad that I did it. I also am thrilled that I actually had about 2 healthy weeks in there without flares. I do hope this will help keep me well enough to continue shots so that I will be well! If that makes any sense at all lol

    The aftermath was pretty rough …. I had had SO much zyrtec, benadryl, prednisone, and zantac plus the epi that I was really fatigued all day yesterday as well. Today is a new day and the fatigue is gone.

    Nutshell: I think it is worth the risks, at least in my situation.

     

  • K8sMom2002

    Oh, my goodness … hugs on the anaphylaxis! What's the plan now? Does your doctor suggest continuing or stopping with any more shots? And if so, where do you pick up? At the dose just before the last dose that created the systemic reaction?

    So glad you're feeling better, and thanks for giving us this update!

  • jtomotaki

    @K8sMom2002 My doctor does recommend continuing with the shots. They will take me back a few doses and ramp up even more slowly, hopefully twice a week. 

    The systemic reaction was bright red facial splotches and itching all around my chin and the back of my head. I felt like the epi was a little overly zealous on their part, but I know it is better to be safe. And it did help!

    And my breathing test was at 96%, pulse ox stayed at 98 all day long! I was really excited to see those good numbers!!

  • K8sMom2002

    Sounds like your allergist has a plan and is extremely careful and cautious. I know you've been frustrated trying to stay well enough to get these shots in. 

    I'd be excited to see those numbers, too! When do you have your next shots?

  • Melissa G

    @jtomotaki - how are you doing? How are the allergy shots going?

    @RedCoog - did you ever decide if you would start doing allergy shots?

  • jtomotaki

    Good morning — allergy shots are going okay. Had a set-back for the month of March with an upper respiratory infection that took a while to get over, but now back on track with weekly injections.

  • K8sMom2002

    That's great! I really hope they help … so many people comment how much allergy shots have helped them.