Allergy shots (SCIT)

Subcutaneous immunotherapy, also known as allergy shots or SCIT, is a form of long-term treatment that decreases symptoms for many people with allergic rhinitis, allergic asthma, conjunctivitis (eye allergy) or stinging insect allergy. Allergy shots decrease sensitivity to allergens and often lead to lasting relief of allergy symptoms even after treatment is stopped.1,2

Anaphylaxis risk

Although the risk is low when SCIT is administered appropriately, life-threatening reactions do occur. Prevalence of severe reactions ranges from 1% for conventional immunotherapy to more than 34% for rush immunotherapy.1

Monitoring guidelines for anaphylaxis

Symptoms of an anaphylactic reaction can include swelling in the throat, wheezing or tightness in the chest, nausea and dizziness. Most serious reactions develop within 30 minutes of the allergy injections. This is why it is recommended that patients wait in their doctor's office for at least 30 minutes after they receive allergy shots, even though evidence shows that not all practices follow this guideline.1,2,5

Monitoring guidelines for anaphylaxis.

Self-administered immunotherapy

Another form of allergy immunotherapy, called sublingual immunotherapy (SLIT), was approved in the United States. Rather than shots, SLIT involves administering the allergens in a liquid or tablet form under the tongue, usually on a daily basis.1,6

The US Food and Drug Administration (FDA) has approved four allergy tablet products. Allergy tablets do not need to be given in a medical setting after the first dose. However, the FDA-approved product information for the four SLIT tablets includes a warning about the possibility of severe allergic reactions from SLIT and a recommendation that an epinephrine auto-injector be prescribed to patients receiving allergy tablets, in the event a severe allergic reaction should occur.6,9

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There’s only one recommended first line treatment for anaphylaxis.

More Important Safety Information (the following information applies to both Epipen and its Authorized Generic)

EpiPen® (epinephrine injection, USP) 0.3 mg and EpiPen Jr® (epinephrine injection, USP) 0.15 mg Auto-Injectors are intended for immediate administration as emergency supportive therapy only and are not intended as a substitute for immediate medical or hospital care. In conjunction with the administration of epinephrine, the patient should seek immediate medical or hospital care. More than two sequential doses of epinephrine should only be administered under direct medical supervision.

EpiPen® and EpiPen Jr® should only be injected into the anterolateral aspect of the thigh. Do not inject intravenously, into buttock, or into digits, hands, or feet. Instruct caregivers to hold the leg of young children firmly in place and limit movement prior to and during injection to minimize risk of injection-related injury.

Rare cases of serious skin and soft tissue infections have been reported following epinephrine injection. Advise patients to seek medical care if they develop symptoms of infection such as persistent redness, warmth, swelling, or tenderness at the injection site.

Epinephrine should be used with caution in patients with heart disease, and in patients who are on drugs that may sensitize the heart to arrhythmias, because it may precipitate or aggravate angina pectoris and produce ventricular arrhythmias. Arrhythmias, including fatal ventricular fibrillation, have been reported, particularly in patients with underlying cardiac disease or taking cardiac glycosides, diuretics, or anti-arrhythmics.

Patients with certain medical conditions or who take certain medications for allergies, depression, thyroid disorders, diabetes, and hypertension, may be at greater risk for adverse reactions. Common adverse reactions to epinephrine include anxiety, apprehensiveness, restlessness, tremor, weakness, dizziness, sweating, palpitations, pallor, nausea and vomiting, headache, and/or respiratory difficulties.

Indications (the following information applies to both Epipen and its Authorized Generic)

EpiPen® and EpiPen Jr® Auto-Injectors are indicated in the emergency treatment of Type I allergic reactions, including anaphylaxis, to allergens, idiopathic and exercise-induced anaphylaxis, and in patients with a history or increased risk of anaphylactic reactions. Selection of the appropriate dosage strength is determined according to body weight.

Click here for Full Prescribing Information for EpiPen.
Click here for Full Prescribing Information for the Authorized Generic for EpiPen


  1. Cox L, Nelson H, Lockey R, et al. Allergen immunotherapy: a practice parameter third update. J Allergy Clin Immunol. 2011;127(1 Suppl):S1-S55.
  2. American Academy of Allergy, Asthma, & Immunology website, Conditions & Treatments, Library, Allergy Library, Allergy Shots (Immunotherapy). Accessed 1/13/2020 at:
  3. EpiPen [prescribing information]. Morgantown, WV: Mylan Specialty L.P.; 12/2020.
  4. Epinephrine Injection, USP [prescribing & patient information]. Morgantown, WV: Mylan Specialty L.P.; 12/2020.
  5. Epstein TG, Liss GM, Murphy-Berendts K, Bernstein DI. AAAAI/ACAAI surveillance study of subcutaneous immunotherapy, years 2008-2012. J Allergy Clin Immunol Pract. 2014;2(2):161-167.
  6. American Academy of Allergy, Asthma and Immunology website. Sublingual immunotherapy for allergic rhinitis. Accessed 1/13/2020 at:
  7. Elenburg S, Blaiss MS. Current status of sublingual immunotherapy in the United States. World Allergy Organization Journal. 2014;7:24.
  8. Cox L. Sublingual immunotherapy for aeroallergaens: Status in the United States. Allergy Asthma Proc. 2014;35:34-42.
  9. Canonica GW, Cox L, Pawankar R, et al. Sublingual immunotherapy: World Allergy Organization position paper 2013 update. World Allergy Organizations Journal. 2014;7:6.
EpiPen® & EpiPen Jr® (epinephrine injection, USP) Auto-Injectors 0.3/0.15mg

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