Allergy Shots in Manhattan, NYC

Getting Started with Allergy Injections

Allergy injections are usually begun at a very low dose. During the initial build-up phase, the dosage is gradually increased on a regular basis (1-2 times per week) until the therapeutic dose (often called the “maintenance” dose) is reached. The maintenance dose will differ from person to person. Injections typically are given once or twice per week while the vaccine dose is being increased. The frequency reduces a chance of reaction and permits the maintenance dose to be reached within a reasonable amount of time.

Duration of Treatment

It usually takes 3 to 6 months to reach a maintenance dose. The time may be longer if there are vaccine reactions or if the injections are not received on a regular basis. For this reason, it is important that the recommended schedule be followed. If you anticipate that regular injections cannot be maintained, immunotherapy should not be started. Immunotherapy may be discontinued at the discretion of the doctor if the injections are frequently missed, as there is an increased risk of reactions under these circumstances. Most immunotherapy patients continue treatments for 3 to 5 years, after which the need for continuation is reassessed.

Adverse Reactions

Immunotherapy is associated with some widely recognized risks. Risk is present because of substance to which you are known to be allergic is being injected into you, some adverse reactions may be life threatening and may require immediate medical attention. In order of increasing severity, the following brief descriptions explain the nature of these potential reactions.

Local Reactions

Local reactions are common and are usually restricted to a small area around the site of the injection. However, they may involve the entire upper arm, with varying degrees of redness, swelling, pain, and itching. These reactions are more likely to occur several hours after the injection. You should notify the nurse if your local reaction exceed two inches in diameter or lasts until the following day.

Generalized Reactions

Generalized reactions occur rarely, but are the most important because of the potential danger of progression to collapse and death if not treated. These reactions may include:

  1. Urticarial reactions (hives) including varying degrees of rash, swelling, and/or itching of more than one part of the body. There may be mild to moderate discomfort, primarily from the itching. This reaction may occur within minutes to hours after an injection.
  2. Angioedema is rare and is characterized by swelling of any part of the body, inside or out, such as the ears, tongue, lips, throat, intestine, hands, or feet, alone or in combination. This may occasionally be accompanied by asthma and may progress to the most severe reaction, anaphylactic shock. In the absence of shock, the principle danger lies in suffocation due to swelling of the airways. Angioedema may occur within minutes after the injections and required medical attention.
  3. Anaphylactic shock is the rarest complication, but is a serious event characterized by acute asthma, vascular collapse (low blood pressure), unconsciousness, and potentially death. This reaction usually occurs within minutes of the injections and is extremely rare.

The above reactions are unpredictable and may occur with the first injections or after a long series of injections, with no previous warning. All generalized reactions require immediate evaluations and medical intervention. If a localized or generalized reaction occurs, the vaccine dosage will be adjusted for subsequent injections. Appropriate advice and treatment will always be from our office staff at the time of any adverse reaction.

Observation Period Following Injection

All patients receiving immunotherapy injections should wait in the office waiting area for 30 minutes following each injections, then as determined by physician/physician assistant. If you have a reaction, you may be advised to remain in the office longer for medical observation and treatment. If a generalized reaction occurs after you have left the office area, you should immediately return to the office or go to the nearest medical facility.

If you cannot wait the 30 minutes after your injection, you should not receive an immunotherapy injection. There are several allergy vaccine-related deaths each year in the United States. While most systemic reactions are not life-threatening if treated promptly, the fact does stress the importance of remaining in the clinic for the suggested observation time. If you do not remain in the office for the designated time, the doctor may recommend discontinuation of immunotherapy.

Initial Extract Prescription

Your initial prescription includes all vaccine vials that are required to reach a “maintenance” dose. In order to utilize these vials prior to their expiration date (3 months from date of preparation), you will need to receive injections at least once per week on a regular basis. Taking injections twice per week will allow you to reach maintenance level at about the same time as the expiration date. When you receive regular maintenance injections, the renewal vials generally last 2 to 3 months.


If you become pregnant while on immunotherapy, notify the office staff immediately, so that Dr. Stacey Silvers can determine an appropriate dosage schedule for the injections during pregnancy. Immunotherapy doses will not be advanced during pregnancy, but may be maintained at a constant level.

New Medication

Please notify the office staff if you start any new prescription medications, particularly medications for high blood pressure, migraine headaches, and glaucoma. “Beta blocker” medications are contraindicated while on immunotherapy, and your injections will need to be discontinued while you are taking a beta blocker.

Allergy Injection Schedule

Patients need to take antihistamines (Zyrtec, Claritin, Benadryl, etc.) at least 45 minutes to 1 hour before allergy injection. Allergy injections are offered in our office by walk-in and/or by appointment during the following hours. A minimum of 48-hour intervals will be given to a minor. Please be prepared to wait in the office for 30 minutes following each injection or time designated by the physician.

Schedule an Allergy Shot Consultation

If you struggle with frequent allergies, allergy shots may be an option for you. Patients in New York can contact Madison ENT to speak with specialist Stacey Silvers, MD to discuss their allergy treatment options. Dr. Silvers is board-certified by the American Board of Otolaryngology, has been named among America’s Top Otolaryngologists every year since 2003, and specializes in treating allergies. Contact us today to schedule your appointment in Manhattan.