Am I a Candidate for Allergy Immunotherapy?

What does your candidacy score mean?

Immunotherapy is the only allergy treatment that addresses the root cause of your symptoms rather than just managing them. It works by gradually retraining your immune system to tolerate the allergens that currently trigger your symptoms. Over three to five years of treatment, the immune system shifts from producing IgE antibodies (which cause allergic reactions) to producing IgG4 antibodies (which provide protection) and activating regulatory T cells (which suppress the allergic pathway long-term).

Not every allergy patient needs immunotherapy, and not every patient is a good fit for it. The candidacy score helps you assess where you fall on that spectrum.

Low candidacy (0-4) suggests your allergies are currently well-managed with existing approaches. Your symptoms are brief, limited to one or two months per year, responsive to over-the-counter medications, and have minimal impact on your daily life. Immunotherapy is a three-to-five-year commitment, and for patients whose allergies are well-controlled without it, the time investment may not be justified. If your situation changes (symptoms worsen, new allergens develop, medications stop working), your candidacy level may change too.

Moderate candidacy (5-8) means your allergies are bothersome but partially controlled. You have multiple symptomatic months per year and medications are helping but not fully resolving your symptoms. At this level, the decision comes down to whether the long-term benefit of immunotherapy justifies the time commitment for your specific situation. An allergy evaluation helps quantify the potential benefit by identifying exactly which allergens you react to and how strongly.

Strong candidacy (9-12) means your allergies are significantly affecting your quality of life despite medication use. You have symptoms across multiple seasons, medications provide incomplete relief, and your daily function is impaired during your worst months. This is the profile where immunotherapy provides the most dramatic improvement. Patients at this level typically see meaningful reduction in symptom severity, medication needs, and quality-of-life impact over the course of treatment.

Ideal candidate (13-15) means you have the strongest possible case for immunotherapy. Long-standing allergies, year-round symptoms, medication failure, and major quality-of-life impact. Patients at this level are living with a chronic, undertreated disease that is robbing them of function for most of the year. Immunotherapy is the intervention most likely to change their trajectory, and for many, it is what finally gives them their life back after years of suffering.

How immunotherapy actually works

The concept is straightforward: expose your immune system to small, gradually increasing amounts of the allergens you react to. Over time, this exposure retrains the immune response. The execution takes patience and consistency.

During the buildup phase (typically several months for shots, immediate for drops/tablets), the allergen dose is gradually increased. Your immune system encounters the allergen repeatedly at sub-clinical levels, not enough to trigger a full allergic reaction but enough to engage the immune cells that will eventually develop tolerance. Regulatory T cells are activated that suppress the IgE pathway. IgG4 blocking antibodies are produced that intercept the allergen before it can trigger mast cells. The threshold for allergic reaction gradually rises.

During the maintenance phase (the remainder of the three to five year course), the established dose is continued at regular intervals to reinforce the immune tolerance. Patients typically notice progressive improvement with each passing season. The first year on treatment may show modest improvement. The second and third years often show substantial improvement. By the end of the course, most patients have achieved 85-90 percent reduction in symptom severity (for shots) or 75-85 percent (for drops).

After completing the full treatment course, the benefit typically persists for years without ongoing treatment. This is what makes immunotherapy unique among allergy treatments: it is the only one with disease-modifying effects that outlast the treatment period itself.

Allergy shots vs. allergy drops: making the choice

Both achieve the same goal (immune tolerance) through different delivery routes, and each has advantages.

Allergy shots (subcutaneous immunotherapy) involve injections at the clinic. During buildup, visits are typically weekly. During maintenance, visits extend to every two to four weeks. The shots are given in the upper arm and monitored for 30 minutes afterward. Advantages: highest efficacy (85-90%), longest track record of research, covered by most insurance plans, all allergens combined in a single injection. Disadvantages: requires regular clinic visits, involves needles, and the 30-minute post-injection monitoring adds to each visit's time commitment.

Allergy drops (sublingual immunotherapy) are taken daily at home. You place drops under the tongue and hold them for one to two minutes. The first dose is given in the clinic under observation, but all subsequent doses are self-administered. Advantages: no needles, no clinic visits for dosing, convenient for patients with busy schedules or who live far from the clinic. Disadvantages: slightly lower efficacy (75-85%), requires daily adherence, may not be covered by all insurance plans.

FDA-approved sublingual tablets are available for specific allergens: grass (Grastek, Oralair), ragweed (Ragwitek), and dust mites (Odactra). These are taken daily at home and have strong clinical trial evidence. They target a single allergen, so patients with multiple allergies may need shots for comprehensive coverage.

The choice between shots and drops is personal. We discuss both options with every immunotherapy candidate and help them choose based on their schedule, distance from the clinic, comfort with injections, allergen profile, insurance coverage, and lifestyle preferences. There is no universally "better" option. There is only the option that fits your situation well enough that you will complete the full treatment course, because the benefit depends on finishing.

What happens at an immunotherapy consultation

The first step is allergy testing, which identifies exactly which allergens your immune system reacts to. Skin prick testing at our clinic takes about 20 minutes. Small amounts of common Central Texas allergens (cedar, oak, elm, pecan, Bermuda grass, Johnson grass, ragweed, dust mites, mold species, cat, dog, cockroach) are applied to the skin, and reactions are measured within 15-20 minutes. The results tell you not just what you are allergic to but how strongly you react to each allergen.

Based on the test results and your clinical history, your allergist discusses whether immunotherapy is appropriate, which type (shots or drops) fits your situation, what the expected timeline and outcomes are, and what the practical logistics involve. You leave with a clear recommendation and enough information to make an informed decision. There is no pressure and no commitment at the consultation. It is an information-gathering visit.

If you decide to proceed, the treatment formulation is custom-mixed based on your specific test results. Every patient's immunotherapy contains a different combination and concentration of allergens, because every patient's allergen profile is different. This personalization is why immunotherapy works where generic medications do not: it targets your specific immune problem rather than applying a one-size-fits-all approach.

Can immunotherapy prevent new allergies from developing?

Research suggests it can. Studies have shown that children who receive immunotherapy for allergic rhinitis are less likely to develop asthma later in life compared to children who are treated with medications alone. This is called "disease modification," and it is one of the most compelling arguments for early immunotherapy in patients with significant allergies, particularly children and young adults whose immune systems are still developing their patterns of response.

Immunotherapy may also prevent the development of new allergen sensitizations. Patients treated with immunotherapy for one or two allergens have been shown in some studies to be less likely to develop allergies to additional allergens over time. The regulatory T cells activated by treatment appear to have a broadly suppressive effect on the Th2 (allergic) immune pathway, not just for the specific allergens in the treatment but for the allergic tendency in general.

This preventive dimension adds another consideration to the candidacy decision. For a patient weighing "should I start immunotherapy now or just manage with meds for now?" the potential to prevent disease progression may tip the balance toward earlier treatment, especially for younger patients with decades of allergy exposure ahead of them.