Immunology Testing

Allergen immunotherapy injections, or allergy shots, are prescribed for patients with allergic rhinitis or nasal allergies, commonly known as hay fever, allergic asthma or life-threatening reactions to insect stings. Immunotherapy is a medical treatment that has the potential to modify allergic disease. Studies have shown that it plays a protective role in allergic children, possibly preventing asthma from developing in patients with allergic rhinitis. Immunotherapy is considered for individuals who have moderate or severe symptoms not adequately controlled by allergen avoidance and/or medications. It is also appropriate when you want to avoid chronic medication use, or the medications are not tolerated.


Allergen immunotherapy (allergy shots) modifies the immune system, which results in reduced allergic symptoms to common allergens including pollens, molds, animal dander and dust mites. In most cases, the initial 6 to 12 month course of allergy shots is likely to gradually decrease sensitivity and continuation of injections leads to further improvement. The injections reduce sensitivities, resulting in fewer symptoms and use of fewer medications. It is important to maintain shots at the proper time interval; missing your shots for a short time may be acceptable but an appropriate adjustment in the dose of vaccine may be necessary for long lapses in injections.

There are generally two phases to immunotherapy: a build-up phase and a maintenance phase.

Build-up phase:

Involves receiving injections with increasing amount of allergen. The frequency of injections during this phase ranges from 1 to 2 times a week, though more rapid build-up schedules are sometimes used. The duration of the build-up phase depends on the frequency of the injections, but typically takes from 3 to 6 months.

Maintenance phase:

This phase begins when the effective therapeutic dose is reached. The effective therapeutic dose is based on recommendations from a national collaborative committee called the Joint Task Force, and was determined after review of several published studies on immunotherapy. Once the target maintenance dose is reached, the interval between the allergy injections can be increased. The interval between maintenance immunotherapy injections ranges from 2 to 4 weeks, but is individualized to provide the best combination of effectiveness and safety for each person. Shorter intervals between allergy injections may lead to fewer reactions and greater benefit in some people.


It is possible to have an allergic reaction to the allergy injection itself. Reactions can be local (swelling at the injection site) or systemic (affecting the rest of the body. Some conditions can make allergic reactions to the injections more likely: heavy natural exposure to pollen during its season, exercise after an injection and poorly controlled asthma. For your safety, prior to receiving an injection, you will be asked if you had a reaction after your last dose, any new medication was started, if you are experiencing illness or an asthma exacerbation.

(SLIT) is an alternative way to treat allergies without injections. An allergist gives a patient small doses of an allergen under the tongue to boost tolerance to the substance and reduce symptoms. Currently, the only forms of SLIT approved by the FDA are tablets for ragweed, northern pasture grasses like timothy, and dust mites. The safety and effectiveness of allergy drops is still being established by the FDA, and they are only used off-label in the United States. Dr. Amy Schiffman can evaluate your symptoms and provide you with the best options.

OIT, or oral desensitization for food allergies, is a medical treatment guided by Dr. Schiffman, during which the immune system is re-trained to tolerate food proteins or allergen through regular eating of small amounts of food. The outcome is protection from accidental exposure to a known food allergen. Some patients can freely consume formerly allergic foods at will. During OIT, the food allergen is administered slowly, in small but steadily increasing doses, until the patient is desensitized.

The first day of treatment is a build-up day, during which multiple doses of very small amounts of allergen are administered. This procedure may take up to 5 hours. The patient continues to eat a “safe dose” at home, once daily. Dose increases occur in the office, every 1-2 weeks, after assessment by the physician. After each dose there is a 1 hour observation period. Instructions on home dose administration, when to avoid dose increases, and treatment of side effects are reviewed at each office visit. The timeline for achieving the target dose depends on each individual patient. If everything goes well, some amount of the allergenic food will be ingested during the 4th – 6th month, and a whole serving of the allergenic food may be ingested by the 8th month. The allergenic food must continue to be consumed on a daily basis to maintain the ability to eat it safely.

Biologic therapy as the name implies, are products derived in some way from living organisms. These treatments include a variety of vaccines, blood components and proteins that are either derived from natural sources or are synthesized in the laboratory. Immune modifying biologic therapies target specific molecules in the body that contribute to an allergic disorder and are particularly relevant to patients with allergic and immunologic diseases. Biologic therapy is available for treatment of severe, allergic and eosinophilic asthma, atopic dermatitis (eczema), and hives.