Allergen Immunotherapy (AIT), commonly known as allergy shots, is a long-term medical treatment designed to change the immune system’s response to specific allergens. Instead of treating symptoms with medication, this approach aims to desensitize the body to substances like pollen, dust mites, or pet dander. AIT works much like a vaccine, slowly training the immune system to tolerate the allergen. This can significantly reduce allergic reactions and improve a child’s overall quality of life, offering lasting relief beyond daily symptomatic care.
Determining Candidacy: Age and Severity
Children can receive allergy shots, but most allergists recommend waiting until a child is at least five years old. The primary consideration is the child’s ability to cooperate with frequent injections and clearly communicate any adverse symptoms. Although the treatment can be safe for younger children, the practical requirements often make age five a suitable starting point.
A child is a good candidate if they have moderate to severe symptoms occurring for several months each year that have not responded well to standard allergy medications. The allergist also considers if the child is unable to avoid the environmental triggers causing distress. A comprehensive evaluation, including medical history and allergy testing results, guides the decision to proceed with immunotherapy.
Understanding the Immunotherapy Process
Before starting, a pediatric allergist performs allergy tests, such as a skin prick test or blood work, to identify the exact allergens causing the symptoms. This testing is crucial because it allows the medical team to create a personalized extract containing the mix of allergens to which the child will be exposed. The treatment process is divided into two distinct phases that require a significant commitment from the family.
The first phase is the “build-up phase,” where the child receives injections with gradually increasing amounts of the extract. These shots are typically administered one to two times a week for three to six months. The goal of this phase is to reach the highest dose that is both effective at inducing tolerance and safe for the child, known as the maintenance dose.
Once the maintenance dose is achieved, the treatment moves into the “maintenance phase.” This involves the same dose given much less frequently, usually every two to four weeks. This phase sustains the immune tolerance developed during the initial months and usually continues for three to five years. This cumulative duration is associated with the best long-term outcomes, with many children experiencing lasting relief even after the treatment concludes.
Safety Protocols and Potential Reactions
Protocols are in place to manage the risk associated with allergy shots in children. Following every injection, the child is required to remain in the clinic under medical observation for a mandatory 30-minute period. This waiting time is non-negotiable because most severe systemic allergic reactions, known as anaphylaxis, occur within this window.
Clinic staff are trained and equipped to immediately recognize and treat any severe reaction, including having epinephrine readily available. Although rare, a severe reaction requires prompt intervention because it can affect multiple body systems, such as breathing and circulation. Parents are also educated on identifying and differentiating between localized and systemic reactions.
The most common side effects are mild and localized reactions at the injection site, such as redness, swelling, or minor itching. These local reactions are expected and generally decrease as the child becomes more tolerant to the extract. If a child is sick with a fever or wheezing, the shot is typically postponed, as being unwell can increase the risk of an adverse systemic reaction.
Sublingual Immunotherapy (SLIT) and Other Options
For children who may not be good candidates for shots, Sublingual Immunotherapy (SLIT) offers a non-injection alternative. SLIT involves placing small amounts of the allergen extract, usually a tablet or drops, under the tongue. A significant advantage is that, after initial doses are administered medically, SLIT can often be safely continued at home, increasing convenience for families.
SLIT generally carries a lower risk of severe systemic reactions compared to injections, although mild side effects like itching in the mouth or throat can occur. The FDA has approved specific SLIT tablets for a limited range of allergens, such as certain grass pollens, ragweed, and dust mites. This contrasts with allergy shots, which can be formulated to treat a broader, customized mix of allergens.
Beyond immunotherapy, managing a child’s allergies includes other strategies. Environmental avoidance remains a primary approach to reducing exposure to triggers like mold or pet dander. Additionally, prescription medication management, including antihistamines or nasal corticosteroids, plays a significant role in controlling symptoms, particularly for those with milder allergies.