Kenalog, an injectable corticosteroid, is a medication that reduces inflammation in the body, including inflammation related to allergies. Whenever possible, it is better to use corticosteroid medications that only go where they are needed. Specifically, corticosteroids can be sprayed into the nose for nasal symptoms, or inhaled into the lungs for allergy-related asthma, rather than injected or taken in pill form. This is preferable, because much of your body is not affected by allergies, and there is usually no reason to give a whole-body medicine. In addition, the doses involved with injected or oral corticosteroids are much higher than the doses in sprays, and therefore the side effects are greater. See my earlier answer about the side effects of corticosteroid medications for more information on this subject. Doctors will give someone a corticosteroid shot or pills to take by mouth for allergies when that person comes in with disabling symptoms (interfering with sleep or work performance) that have been going on for weeks. In this setting, injections or pills are sometimes the only treatment strong enough to work. It is important to start medications for allergies as soon as symptoms appear, and if you know what time of year your symptoms are typically the worst, then medication can be started a week or two before. If you don’t know exactly when to expect your symptoms, it is best to have prescriptions on hand so that you can start the medicines quickly, when you need them. This approach works far better than waiting until the symptoms become severe and require a much stronger treatment. Q2. I am taking allergy shots every week, one for cats and dogs and one for mold and weeds. I have gained 26 pounds since I started the shots six months ago. Could the shots cause me to gain weight? — Carol, Ohio No, allergy shots are not known to be associated with weight gain. On the other hand, some allergy medications are. If you are taking antihistamines on a regular basis, they may be contributing to your weight gain, as some of them are known to increase appetite. Perhaps you could talk to your doctor about using fewer antihistamines, and/or using steroid-containing nasal sprays instead. These don’t cause weight gain and are generally more effective, when used daily, for nasal allergy symptoms. Another medication that definitely contributes to weight gain is oral steroids, which cause both water retention and actual weight gain. The doses used in pills are much higher than those in steroid inhalers and nasal sprays, which is why the pills have so many side effects while the inhalers and nasal sprays don’t. You didn’t mention steroids in your question, but check with your doctor to make sure they aren’t a factor for you. Occasionally, I have a patient who feels very tired after his or her shots, which leads to a reduction in activity levels for a couple of days each week. This could also contribute to weight gain. I would suggest having a focused visit with the allergist who is treating you to think about what might be causing your weight gain. It is a significant amount, and I’m sure you are very frustrated. However, I wouldn’t advise just stopping the shots, because there is probably another reason. You would need to factor in any changes that occurred around the same time. For example, are you eating out more, exercising less, or did you change your job activities? Did you start any new prescription or over-the-counter medications? Also, if you are just six months into the allergy shot process, you are not yet seeing all the improvement that the shots should provide. That’s why it’s worthwhile trying to sort out the cause of your weight gain and persist with the shots for at least two years so you can see their full effects. Q3. While pregnant, I developed asthma, as well as polyps in my sinuses. I had sinus surgery to remove the polyps, but my problems persist with swollen nasal passageways and a chronic runny/stuffy nose. My ENT said my IgE level is over 400. He suggested allergy shots, but since I want to get pregnant again, he said I shouldn’t start the shots now. Why is that? Do you also suggest that women who are trying to get pregnant avoid allergy shots? — Patty, Maryland Allergy shots (or allergen immunotherapy) can be safely continued during pregnancy if a woman has not had any serious reactions to the shots previously, but it is not advised that women begin shots or increase the dose of their shots while pregnant. This is because allergic reactions to the shots, which are uncommon but can be dangerous, occur more often during the initial, buildup stage, when the dose is being increased. A severe allergic reaction could cause low blood pressure in the mother, and the baby might not get enough oxygen for a few minutes. In addition, the treatment for a severe allergic reaction — which is epinephrine — could temporarily reduce the blood supply to the baby. So rather than taking these risks, allergists avoid beginning or increasing allergy shots during pregnancy, an approach accepted by professional allergy and obstetrical societies. There is some preliminary evidence that mothers who get allergy shots while they are pregnant may lower their baby’s risk of being allergic, but more study is needed before this can be considered fact. You mentioned that the allergy shots were suggested because you had developed nasal polyps. Nasal polyps are a difficult condition to treat, and most people end up having surgery to remove them at some point. After surgery, many patients’ polyps grow back within three years, unless something dramatic is done to prevent this. The approach at my center after surgery is to begin treatment with a combination of medications, including nasal steroid sprays (used at maximal dose absolutely every day), montelukast (Singulair), and sinus saline rinses once or twice a day. All these therapies have been taken safely by pregnant women, although you should always ask your doctor about the best treatment in your particular circumstances. Q4. I am considering allergy shots for my daughter. If they work, will she be able to cut down on her allergy medications? Also, are the shots safe? Also called immunotherapy, allergy shots are an extremely effective and safe way of manipulating the immune system so that a person becomes less allergic, sneezes less, has decreased itching of the nose and eyes and, in the best case scenario, is able to reduce or even prevent wheezing. With this approach, small doses of allergens are given to the patient by injection and gradually increased as the person’s immune system learns to tolerate them. Immunotherapy is especially effective for allergies to pollen, dust mites, animal dander and insect stings. It’s not recommend as a treatment for food allergies. Allergy shots are effective in 85 percent of people who receive this method of treatment. However, they don’t cure allergies, so your daughter may still need some medication, depending on how effective the shots are for her. Q5. Can you explain how allergy shots work? I have horrible hay fever and would like to be able to stop taking antihistamines, which make me groggy. How early would I have to start for them to be effective? Thanks. — Diana, New Jersey Allergy shots, or allergen immunotherapy, is a form of vaccination much like vaccines against tetanus or measles. However, this form of vaccination injects a solution containing the item that the person is allergic to, unlike vaccines against infections (which contain small, harmless pieces of a bacteria or virus, or viruses that have been altered so that they cannot cause infection). For example, if a person undergoes allergen immunotherapy for ragweed pollen, they are actually getting injected with ragweed pollen. This does not result in a dangerous allergic reaction because allergy vaccines are given in a gradual manner, over a long period of time. In the case of an allergy to ragweed pollen, the process would start with weekly injections of very tiny amounts of ragweed. Each week, the person would return for a bit more, and over time, they would be able to tolerate more and more. The process can be accomplished using several different schedules, although the end result is the same. After a period of time, usually a few months, the person can tolerate large doses of ragweed pollen. This ongoing exposure produces multiple changes in the immune system of the patient; their bodies no longer see ragweed pollen as a dangerous thing that needs to be attacked, but rather something that can safely be ignored. Once the person can tolerate a strong dose of ragweed pollen, the shots can be reduced in number (but not strength) to once a month. Monthly shots should be continued for 3 to 5 years to reach the maximum benefit, but most people notice that their symptoms begin to improve within 6 to 9 months. By the second year, people usually notice a dramatic improvement. The drawbacks to allergen immunotherapy are the following:
There is a risk of an allergic reaction to the shots, which can be severeIt can be inconvenient to make frequent visits to the allergist’s officeIt can be expensive, although most insurance companies will cover the process, since it is cost-effective for members to be using less allergy medication
Most allergists will recommend allergen immunotherapy to patients who are not getting enough relief with combination medications (a nasal corticosteroid spray, an antihistamine, and antihistamine eyedrops if eye symptoms are prominent), or to patients who do not want to use medication. Learn more in the Everyday Health Allergy Center.
