Episode 35 | Why You Have to Wait 30 Minutes After Your Allergy Shot

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Dr. Amber Patterson: Do I really have to wait in your office for 30 minutes after my allergy shot?

Dr. Kara Wada, MD: Yes.

Dr. Amber Patterson: We get it. The wait is long. You do need to wait in your allergist's office for 30 minutes after your allergy shot, and let's talk about why we're sticklers. Welcome back to Allergy Actually with your bestie allergist moms. So we are allergists, and as most allergy immunology specialists will tell you, immunotherapy is one of the best things that we can do for patients because we're literally retraining your immune system in the most natural way possible to function more normally and more balanced.

And guys, it's actually a little bit of a lift. Like we make it look easy, but we're really like putting some pressure on your immune response. And these shots can be dangerous if not properly prescribed and managed. And it's not the physical act of giving a shot that's necessarily hard, but it is what happens when things go wrong.

Why the 30-Minute Wait is Non-Negotiable

Dr. Amber Patterson: So why do we tell patients you have to wait 30 minutes in our office after an allergy shot?

Dr. Kara Wada, MD: Because you can react. And those reactions can be life threatening. I mean, just this week I had a patient at like the 28-minute, 32nd mark, started having more scratchiness in their throat, a little more coughing. And, you know, it's really important if someone has any of those signs or symptoms of a more systemic reaction that we recognize it and we treat it appropriately and quickly.

Dr. Amber Patterson: And that 30 minute number comes from data, our national societies. So we have two in the United States. We have two main professional organizations for allergy immunology doctors. So we have the American Academy of Allergy, Asthma and Immunology, and the American College of Allergy, Asthma and Immunology.

They're both a mouthful, but there are some allergists who, as their life's work have taken on surveying allergists every year supported by these two national organizations so that we're all working together and we get these surveys. And every year they're asking us, have any of your patients died? You know they're asking very poignant, clear questions about the safety and the outcome of the shots they're administering. And over time they've seen trends. You know, people have died from receiving allergy shots. And years ago the trend was, oh my gosh, the people that are dying are getting their allergy shots at home.

And it's not because the person who gave the shot didn't know what they were doing. It was delayed use of epinephrine to treat the shot. So guess what? Now we don't give allergy shots at home. And Dr. Shepherd has pointed to this in several of our episodes, where if you're being prescribed injectable allergy shots to give yourself at home, odds are that has been diluted down to what your doctor feels is safe because no allergist out there is going to give you the recommended high dose level of extract to treat your allergies and send you home with it. So anyways, back to that survey. So in more recent years, because we're still seeing every 2.5 million allergy injections, there is a death in this country. And the more recent years, it's been when injections are given to patients with uncontrolled asthma.

The High Risk of Shots with Uncontrolled Asthma

Dr. Amber Patterson: That a lot of times if you have asthma, you're not keyed into that, like you're used to it. So this 30 minutes comes because those people that had deaths from asthma, it's based on the timing of when the death occurred after the shot and when symptoms started, and all of that was used to say, yep, we think 30 minutes is the best bet. We really wish it was 60, but 30, you're gonna capture most of them. And 60, you're gonna be real hard pressed for people to stay that long in an office.

Dr. Meagan Shepherd: I was just gonna say that I wanted to clarify something. Whenever we say a systemic reaction, that means more of a full body reaction and we consider anaphylaxis to be, if you have more than one body system involved in a reaction, I always add the caveat. Or if you do just have one system, but it's very bad, you do not need to wait on breathing problems to administer epi, and that should be your first line choice. And we have developed such a culture in the US of unfortunately being afraid of giving epinephrine. And this still exists even in some ERs with paramedics, ambulance, anything like that. But it's such a safe medicine. But one of the other thoughts behind this too is that people now are so scared to treat reactions because of this historic thing of saying you had to go to the ER, or call 911 if you used epi. I would not feel safe even if the data didn't say within the first 30 minutes.

I would want that because I would not think that people would recognize and treat appropriately at home because we've been given this myth that epi is unsafe. And so that's one thing I just want to say, it's very safe. The reason that we had label. Well, I guess that it was recommended to go to the hospital is in the past. We used to think that allergic reactions came in waves. Like you would have a very bad reaction and then you would treat it and get better, and then it would come back several hours later. And so that was the reason for going to the hospital. Because you're having a reaction, not because you use the epi, the epi's very safe.

And what we've learned over time that there are certain factors that make a biphasic so occurring sort of twice like that in waves reaction more likely to occur. And that's if you have a more severe initial reaction if you had to treat it with more than one injection of epinephrine if you have severe asthma, if you have peanut allergy. So the point is that that really happens, we think around 7% or less of the time. So, using epi is safe. So we all keep that on hand in our offices plus other gear. And this is probably something that you're unaware of because if you haven't had it used on you, you don't know that we have it there.

But there are other things that we keep on hand for resuscitation because again, even though it's rare, it really does happen. It's not something that we hope anyone experiences, but I don't think that giving someone an allergy shot and then letting them leave, you know, or giving them to take it at home.

I just don't feel like that's morally or legally defensible if someone has a reaction because of this. First do no harm. And so when you have an allergist who is sort of a stickler for those rules, and I think most of us are very like, it's not because we're just being rigid and again, feeling like making you follow a rule just because or anything like that. It's because there's real data that supports doing it that way, and we are very familiar with safety protocols and anaphylaxis protocols for which we all practice and prepare for in our offices. So it's such a safe place than just the home environment for that.

Dr. Amber Patterson: Yeah. And we do, you know, immunotherapy is very safe. It's, you know, these reactions are rare that we're talking about, but the 30 minute wait is all about you, the patient, and keeping you safe. And I don't care if you've been receiving shots for 20 years and that's a whole nother conversation, why are you still receiving shots after 20 years?

But my job is to keep you safe, if I'm the one prescribing your immunotherapy. So if you wanna keep getting your immunotherapy for the 21st year, you're going to wait in our office for 30 minutes after. Watch a show on your phone, read a book. We can all make 30 minutes fly by like that if it means you're safe.

Dr. Meagan Shepherd: We have some patients who are so excited actually because, especially parents, they're like, I get half an hour to sit here and read, look up Facebook, and I'm responsible for nothing. 

Options to Avoid the Long Wait (ILIT vs. SLIT)

Dr. Amber Patterson: Exactly. The other thing that I wanted to mention is if you add up all the times that you come into our office for traditional allergy shots and the wait period, it does seem like a lot. Like, you know, it's a lot of time in your life. So that's where if you're not willing to make that commitment, even if you've committed to it for years, but you're like, I don't wanna do that anymore, we have other options. We have the ILIT protocol that you can switch to. It's three injections, one every four weeks. After eight weeks, you're done. You do still have to wait 30 minutes after that, but it's only three times instead of a hundred times. Also it is just reduced risk of systemic reaction because you're instead of a hundred times you're getting a shot with that risk, it's three times. We also have SLIT that is very safe that you start in our office and there is a wait time to make sure you tolerate it. But then you take it home and there's been, you know, lots of safety studies done showing that that SLIT, under the tongue, tablets or drops, are safe to do at home. So you've got options. You don't have to, you know, if you don't wanna wait for 30 minutes, just ask what are my options? And we can get just switched over.

Why You Must Still Wait, Even If You've Never Reacted

Dr. Kara Wada, MD: Well, and I think, a couple quick little, you know, myth busters related to that. You know, just because you may not know anyone or you've never had a reaction doesn't mean that you couldn't have one. So, like tolerating all along there is still that potential. And sadly we saw this a fair bit during some of the COVID waves.

There was a time period where our clinic reactions increased and we think part of it was the virus just tweaked the immune system and made folks a little more reactive kind of during that time. Even though they felt fine, you know, when they came in to get their shot. Just, you know, the moon was in the right phase, kind of, you know, things lined up where they were more reactive.

ILIT Safety: Why It's Just as Safe, If Not Safer

Dr. Kara Wada, MD: And the other thing, you know, people have often asked me, gosh, is ILIT. Is it as safe because it is faster. It's only the three times are, you know, are you using more allergen, like you're injecting the lymph node? Like, I don't know. But actually it's just as safe if not safer from what we know. 

Dr. Amber Patterson: Multiple studies showing that. Yeah, that's a good point. 

Dr. Kara Wada, MD: All good things to keep in mind.

Dr. Amber Patterson: If you have ever dreaded that 30 minute post shot wait, remember, your safety is why it exists. It's on national and international guidelines. And your allergists are sticklers because they want to first do no harm, cure your allergies if we can and keep you safe while we're doing it. But there are also other options like ILIT or SLIT that reduce visits, reduce injection time.

Check the links in the description to learn more about the ILIT protocol and the Auni ILIT Learning Network allergist near you. Or talk to your allergist about your personal plan. Share this with anybody who grumbles at the 30 minute wait. It's time to bust the myths and make shots smarter. Thanks for joining us today on Allergy Actually.

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