Do Allergy Shots Hurt?

Reassurance and Easing the Pain of Allergy Injections

health care professioal giving a child an allergy shot
Do allergy shots hurt?. Daniel More, MD

Do Allergy Shots Hurt?

If given appropriately, allergy shots cause minimal discomfort. Many people and children are afraid of shots, but this fear is usually based on the pain caused by routine immunizations, such as a tetanus shot. These injections are given intramuscularly (into the muscle), usually in the upper arm, which is what causes pain and soreness.

Allergy Shots vs Immunization Pain

Allergy shots, on the other hand, are given subcutaneously (just under the skin) in the upper arm with a very small needle.

Many experienced allergy nurses will “pinch” the skin on the arm while giving the allergy shot, which helps ensure the shot does not go into the muscle and provides a numbing sensation where the needle goes through the skin (known as “pinch anesthesia”).

Easing the Discomfort of Allergy Injections (How to Decrease the Pain)

Other techniques commonly used to decrease the discomfort from allergy shots include the use of topical anesthetic creams and cooling sprays to numb the skin prior to giving the allergy shot. While these are commonly used and probably help reduce any mild pain that can occur with an allergy shot, they are not usually needed, especially after the first few injections.

Itching and Swelling After Allergy Injections

Like allergy testing, allergy shots can cause itching and swelling at the site of the injection minutes to hours after the shot. These symptoms are often uncomfortable, but not usually painful.

There are a number of ways to reduce or prevent these symptoms, such as taking an antihistamine a few hours before getting an allergy shot. Talk to your allergist about her recommendations regarding pre-treatments such as this.

Once the swelling has occurred, ice packs, topical steroids and non-steroidal anti-inflammatory drugs such as Advil (ibuprofen) can be used to treat any swelling or discomfort.

Talking to Your Child About Allergy Shots

It's important to be honest with your children. You do not want to lie and tell your child that the shots won't hurt. Children are trusting, and there are too many stories about adults who bitterly remember a parent or health care professional lying to them as a child by telling them their immunizations would not hurt.

Instead, it's best to mention that there will be some discomfort. Depending on the age of your child you may wish to mention what can be done to decrease this pain. Some parents offer to let their child squeeze their hand as hard as they can—in other words, try to make their parent more uncomfortable than the shot makes them. This may work for younger children.

Instead, with an older child you may wish to talk about the benefits of allergy shots; the discomfort she will be spared if she musters through the shots. If your child is naturally inquisitive, taking time to explain how allergy shots work can be helpful and leave your child feeling more controlled and empowered.

Some parents offer a small reward. Since most kids prefer time with a parent over something which can be purchased, you may offer to play your child's favorite game with her on the evening after her shots. Check out these ideas as well on how to talk to your child about shots.

Allergy Drops (Sublingual Immunotherapy) as an Alternative to Allergy Shots

You may have heard mention that there are sublingual immunotherapy (allergy drops) that can be used as an alternative to allergy shots. Allergy drops are placed under the tongue, often daily, and at home. (A pill form would not work as digestive enzymes would destroy the medication.)

If you are interested in this, do your research. There are only two types of drops currently approved by the FDA—those for grass and those for ragweed. Other allergy drops have been used in Europe for many years but are not currently approved by the FDA. Many mainstream allergists will not prescribe broad spectrum (other than grass or ragweed) allergy drops, but some health care professionals do prescribe these drops though they are generally not covered by insurance. If you are considering trying this method, make sure to talk to your allergist.

As far as safety, there have been no recorded severe reactions or death related to allergy drops. At the same time, the data we have on efficacy is mixed. In contrast, there is clear data that allergy shots can reduce many of the symptoms of allergies.

For Parents

The fear of discomfort certainly enters in as parents consider when to have allergy skin testing done for their child. They also wonder: "are allergy shots safe for children"? The best thing to to do is to prepare a list of questions and sit down with your child's allergist to discuss all of the risks and benefits of this type of treatment.

Sources:

Adelman, D., and T. Casale., eds. Manual of Allergy and Immunology 5th Edition. Boston: Little, Brown and Company. 2012.

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