Is There a Single Shot That Can Cure Seasonal Allergies?

Posted on Tue., June 10, 2008
By Stephen J. Daniels, MD

Hey, doc, I need an allergy shot. My brother-in-law's doctor gave him one, and he's completely cured. Can I get one?"

I could see that Max (not his real name) was suffering: his eyes were watery, red and swollen, he kept clearing his throat, and his nose was red from so much wiping.

May and June are allergy season in Contra Costa County, especially in Central and East county.

Max's desire to get a shot and have his symptoms be gone for the rest of the allergy season was certainly understandable.

There are so many treatments for seasonal allergies, from over-the-counter medicines and sprays, to pills, syrups, sprays and shots that need a doctor's prescription. What treatment is best?

In my experience, the treatments that work best for most people with the fewest serious side effects are prescription steroid sprays for the nose, such as Nasarel, Nasonex and Vancenase AQ, and a variety of prescription eye drops, including Cromolyn and Patanol, for allergic eye symptoms.

These put the medicine directly on the problem, and the side effects are minimal, even if used continuously for months or years on end. But these are often expensive, and require daily or more frequent use.

So, what about "the shot" that Max wanted? This refers to a long-acting glucocorticoid ("steroid") shot such as Depomedrol. It's cheap, convenient, and I've never seen it fail to alleviate, or at least improve, allergy symptoms.

Note that these steroids are related to, but different from, the anabolic steroids used by athletes to build their muscles.

But physicians disagree about the advisability of giving steroid shots for allergies. Some give it to their allergic patients as an initial therapy. Some refuse to give steroid injections for seasonal allergies altogether. Most physicians, however, reserve it for cases of severe allergies that are unresponsive to pills or sprays.

Doctors frequently use steroid shots for severe asthma, so why not for severe seasonal allergies? Perhaps it is because asthma can be life-threatening, whereas seasonal allergies "only" make one miserable.

Some doctors think that the shot is too potentially dangerous for an illness that is "only" unpleasant.

In almost 30 years of medical practice, though, I have seen very few bad reactions or serious side effects that were definitively caused by a single (even annual) long-acting steroid injection for allergies or asthma.

Cases of severe hip joint degeneration, possibly from a steroid shot, had other possible causes, such as alcoholism or prolonged (six months or more) continuous steroid use.

Steroid shots can cause high blood sugar levels in diabetic patients, but these can usually be addressed by more frequent blood sugar testing and medication dose adjustments.

Other side effects include swelling, anxiety, insomnia, mania and depression, which, in rare instances, can be dangerous.

One strategy might be to use a short-acting steroid to assess the potential side effects. If well-tolerated, a longer-acting steroid shot might be indicated.

Steroid injections for seasonal allergies are controversial and should be discussed with your doctor. Ideally, you know and agree with your doctor's philosophy of medical practice, and your doctor knows you, your medical history, and how to balance the benefits and risks of a steroid injection for you.

Daniels practices family medicine at the Concord and Pittsburg Health Centers of Contra Costa Health Services, the county health department.