Mountain Cedar Allergy Shots: Conquering Texas Cedar Fever
Mountain cedar allergy shots (SCIT) are the established standard of care for refractory cedar fever in central Texas — where Juniperus ashei produces the highest tree-pollen counts recorded anywhere in the US, up to 32,000 grains per cubic meter. Jun a 1, the major allergen, is characterized down to crystal structure and cross-protects the entire Cupressaceae family.
About Curex’s SCIT program
Curex’s at-home allergy shots (SCIT) are coming soon and focus on the most common environmental allergens:
- • Pollens — tree, grass, weed & ragweed
- • Pet dander — cat & dog
- • Dust mites
- • Molds — Alternaria & mold mix
Mountain Cedaris covered here for general education and may not be part of Curex’s current treatment set. Join the waitlist and our care team will help confirm your options.
Mountain Cedar Allergy Immunotherapy: How It Works
Allergy immunotherapy is the only long-term treatment that re-trains the immune system to stop overreacting to mountain cedar — rather than just masking symptoms with antihistamines or steroids. By gradually exposing the body to controlled doses of mountain cedar allergen, immunotherapy shifts the underlying allergic response and produces relief that often outlasts treatment by 7–10 years.
There are two evidence-based forms of mountain cedar immunotherapy used today, both built on the same desensitization principle but delivered very differently.
of sustained relief after a complete immunotherapy course — the only allergy treatment with proven long-term effect after stopping.
Allergy Shots (SCIT)
Weekly injections of mountain cedar extract in a clinic, escalating over 3–6 months until a maintenance dose is reached. Continued monthly for 3–5 years. Longest clinical track record for mountain cedar allergy.
- Strongest evidence base for severe and polysensitized patients
- Covered by most insurance plans
- Requires 50–100+ in-person clinic visits across the full course
- Or at home with no clinic visits— Curex’s Virtual Shot Room model delivers the same SCIT program with live video supervision by trained Curex clinical staff for the first injection from each new vial or concentration and restarts after gaps or reactions.
Allergy Drops / Tablets (SLIT)
Daily drops or dissolvable tablets containing mountain cedar extract, held under the tongue at home. Same desensitization principle, delivered without injections. WHO-recognized as an effective form of allergy immunotherapy since 2001.
- Taken at home — no weekly clinic trips, no needles
- Lower systemic reaction rate than allergy shots
- Curex offers prescription mountain cedar immunotherapy drops with allergist oversight
The rest of this page goes deep on allergen-specific immunotherapy with shots — protocol, efficacy data, side effects, and cost. If you’d rather skip the clinic and treat mountain cedar allergy with at-home drops, see how Curex sublingual immunotherapy compares below.
What is Mountain Cedar?
The biology, taxonomy, and clinical fingerprint of Mountain Cedar — the foundation of how SCIT targets it.
Juniperus ashei male cones releasing pollen in the Texas Hill Country during peak cedar fever season, December through February.
- Scientific name
- Juniperus ashei
- Family
- CupressaceaeCypress family
- Type
- Winter tree pollen
- Native to
- Central Texas Hill Country, southern Oklahoma, southwestern Missouri, northern Mexico
- Allergen proteins
- Jun a 1 (major) — pectate lyase, ~43 kDa, >90% IgE reactivityJun a 2 — polygalacturonase, ~43 kDa, minorJun a 3 — thaumatin-like protein (PR-5), ~30 kDa, ~30%Jun a 7 — gibberellin-regulated protein, ~7 kDa, minor
- Particle size
- ~22 μm
- Avoidance difficulty
- Nearly impossible
How Mountain Cedar Allergy Presents
Symptoms by body system — useful for distinguishing Mountain Cedar sensitivity from overlapping allergies and infections.
Respiratory
- Severe nasal congestion and profuse rhinorrhea during peak pollen release
- Sneezing episodes triggered by entering cedar-heavy outdoor areas
- Chronic postnasal drip and throat irritation throughout December–February
- Asthma exacerbations in sensitized patients at the highest pollen counts
- Sinus pressure and facial pain from prolonged nasal inflammation
Ocular
- Intense eye itching and watering (allergic conjunctivitis) during cedar season
- Bilateral eyelid swelling and periorbital edema at peak count days
- Photophobia and blurred vision from heavy tearing
- Persistent redness and burning sensation throughout the season
Dermal
- Facial flushing during high-exposure outdoor days
- Contact urticaria in patients who handle cedar wood or foliage
- Generalized skin itching during peak pollen days in highly sensitized individuals
Systemic
- Profound fatigue — cedar fever's hallmark systemic feature distinguishing it from a common cold
- Low-grade fever and body aches during the peak two-week pollen burst
- Cognitive fog and sleep disruption from heavy nasal blockage
- Diminished quality of life scores comparable to moderate flu during January peak
Dr. Dale Mohar of Kerrville, Texas said it plainly about cedar season counts: 'I quit counting at 20,000 because there's really no point. I just say 20,000-plus and call it a day.' For patients who fail antihistamines and nasal steroids in that environment, SCIT is not optional — it is the standard of care.
When & Where Mountain Cedar Peaks
Allergen intensity by month and by state. Useful for timing SCIT start dates and travel planning.
12-Month Intensity
Peak: late December through January; secondary peak early February· ~10 weeks of intense exposure (December–mid-February); counts can exceed 32,000 grains/m³
US Exposure Map
2 high-intensity statesExposure intensity by state (text version)
- ME:
- Low
- VT:
- Low
- NH:
- Low
- WA:
- Low
- MT:
- Low
- ND:
- Low
- MN:
- Low
- WI:
- Low
- MI:
- Low
- NY:
- Low
- MA:
- Low
- OR:
- Low
- ID:
- Low
- WY:
- Low
- SD:
- Low
- IA:
- Low
- IL:
- Low
- IN:
- Low
- OH:
- Low
- PA:
- Low
- NJ:
- Low
- CT:
- Low
- RI:
- Low
- CA:
- Low
- NV:
- Low
- UT:
- Low
- CO:
- Low
- NE:
- Low
- MO:
- Moderate
- KY:
- Low
- WV:
- Low
- VA:
- Low
- MD:
- Low
- DE:
- Low
- AZ:
- Low
- NM:
- Low
- KS:
- Moderate
- AR:
- Moderate
- TN:
- Low
- NC:
- Low
- SC:
- Low
- OK:
- High
- LA:
- Low
- MS:
- Low
- AL:
- Low
- GA:
- Low
- TX:
- High
- FL:
- Low
- AK:
- Low
- HI:
- Low
What Mountain Cedar Cross-Reacts With
Patients sensitized to one allergen often react to others sharing similar proteins. This map shows the documented molecular overlaps.
Mountain cedar's major allergen Jun a 1 (pectate lyase) shares >75% sequence identity with the equivalent allergen in every other clinically important Cupressaceae species, making it the anchor for whole-family cross-protection in SCIT — a patient treated with mountain-cedar extract is simultaneously building tolerance to red cedar, Arizona cypress, bald cypress, and Japanese cedar.
Cup a 1 shares >75% sequence identity and >95% similarity with Jun a 1 (Midoro-Horiuti 1999)
Jun v 1 shares >80% sequence identity with Jun a 1 (Midoro-Horiuti 1999, JACI)
Cross-reactivity by IgE inhibition documented (Ramirez & Lockey, Ann Allergy Asthma Immunol 2012)
Jun a 3 thaumatin-like cross-reactivity; affects sensitized subset only
Jun a 3 thaumatin-like cross-reactivity; mild OAS symptoms in a subset
Cedar-Fruit Syndrome (Thaumatin-Like Cross-Reactivity)
A subset of mountain-cedar-sensitized patients with IgE to Jun a 3 (the thaumatin-like minor allergen) may experience mild oral allergy syndrome with certain fruits. Symptoms are typically limited to the mouth and throat and are much less prominent than in birch-pollen OAS.
Is SCIT Right for Your Mountain Cedar Allergy?
Answer five questions to see how well mountain-cedar SCIT fits your clinical profile.
How severe are your mountain-cedar (cedar fever) symptoms each December–February?
The Mountain Cedar SCIT Protocol
Mountain-cedar SCIT uses a non-standardized extract anchored to Jun a 1 pectate lyase. Your allergist will titrate the concentration and injection schedule based on your sensitization level and local pollen calendar — many central Texas clinicians begin build-up in late summer to reach maintenance before December.
The extract concentration is increased incrementally from the most dilute vial through progressively stronger doses. With at-home SCIT through Curex, build-up follows a conservative once-weekly schedule — Curex does not offer rush or cluster protocols. The first injection from each new vial or concentration is supervised live in the Virtual Shot Room by trained Curex clinical staff, with a prescribed epinephrine auto-injector confirmed on hand at the injection location and a 30-minute self-observation after each injection.
Once the target maintenance dose is reached, injections are administered on a schedule individualized by your allergist. Jun a 1-specific IgE typically declines and IgG4 blocking antibodies rise over 12–18 months, producing the measurable symptom reduction reported in observational studies (Goetz; Ramirez & Lockey 2012). Continued 30-minute observation after each injection.
After completing 3–5 years of maintenance, your allergist will assess whether durable tolerance has been established. Many cedar-allergic patients in Texas experience lasting benefit for several years post-SCIT, though the duration of protection varies and some patients require extended courses.
Extract Concentration Ladder
You progress through each vial during build-up. Concentration increases ~10x per step.
What the Research Shows for Mountain Cedar SCIT
Mountain-cedar SCIT is supported by observational data and small controlled trials — enough to establish it as standard of care in central Texas, but without the large modern US RCT that exists for ragweed or timothy. Cross-protection across the Cupressaceae family is well-established via >75% Jun a 1 sequence identity.
- Symptom score improvement (observational)70%Goetz DW — observational series of mountain-cedar SCIT in Texas Hill Country patients showing substantial symptom reduction
- Jun a 1 / Jun v 1 sequence identity (cross-protection basis)80%Midoro-Horiuti T et al., J Allergy Clin Immunol 1999;104:608–612 and 104:613–617 — molecular characterization of Jun a 1 and cross-species homology
- Jun a 1 IgE reactivity in cedar-allergic patients90%WHO/IUIS allergen.org — >90% of cedar-allergic patients have IgE to Jun a 1
- Cupressaceae family cross-protection (Cup a 1 similarity)95%Midoro-Horiuti 1999 JACI — >95% similarity between Jun a 1 and Cup a 1 (Arizona cypress)
No large randomized controlled trial specific to mountain-cedar SCIT has been published as of 2025 — a significant evidence gap given that cedar fever is arguably the most severe single-pollen event in the United States. Clinical benefit is well-documented in observational series and small controlled trials (Goetz; Ramirez & Lockey, Ann Allergy Asthma Immunol 2012), and the molecular basis for family-wide cross-protection is among the strongest in tree-pollen immunology. SCIT remains the recommended intervention per AAAAI/ACAAI Practice Parameters for patients with refractory cedar fever.
Ready to skip the surprise bills?
At-home allergy shots (SCIT) are designed by board-certified allergists. See the listed SCIT plan rate in our pricing record and request a quote for eligibility, initiation and total care costs.
- MD-ledBoard-certified allergists
- QuoteTotal care estimate
- 50K+Patients treated
- HSA/FSAEligible
Mountain Cedar SCIT Side Effects
Mountain-cedar SCIT carries a side-effect profile consistent with inhalant allergen immunotherapy generally — local injection-site reactions are common and expected, while serious systemic reactions are rare when proper protocols are followed.
Local reactions
4 documented| Reaction | Rate | Severity |
|---|---|---|
Injection-site swelling Wheal and flare at injection site, typically resolving within 30–60 minutes; expected during build-up | Rate 30–50% | Mild |
Injection-site itching Localized pruritus at the injection site; managed with cold compress or antihistamine pretreatment | Rate 25–40% | Mild |
Large local reaction Swelling >5 cm at injection site lasting >24 hours; may require dose adjustment per JTF 2023 guidelines | Rate 5–10% | Moderate |
Delayed local induration Firm nodule at injection site persisting 1–3 days; typically resolves without intervention | Rate 3–8% | Mild |
Systemic reactions
4 documented| Reaction | Rate | Severity |
|---|---|---|
Rhinitis or conjunctivitis flare Sneezing, rhinorrhea, or eye watering within 30 minutes of injection; typically mild and self-limiting | Rate 1–3% | Mild |
Mild urticaria Generalized hives without systemic involvement; requires dose reduction | Rate 0.5–1% | Moderate |
Mild asthma exacerbation Bronchospasm during build-up in patients with asthma; pre-injection spirometry is standard practice for asthmatic patients | Rate 0.1–0.5% | Moderate |
Anaphylaxis Life-threatening systemic reaction; the reason a prescribed epinephrine auto-injector is confirmed on hand before the first injection and a 30-minute observation follows every dose; for at-home SCIT through Curex the first injection from each new vial or concentration is supervised live in the Virtual Shot Room by trained Curex clinical staff | Rate <0.1% per injection | Severe |
Mountain-cedar SCIT has traditionally been administered in an allergy office with epinephrine and resuscitation equipment available; for eligible patients, Curex makes safe at-home self-administration possible with a personalized serum sterile-compounded to USP <797>, a prescribed epinephrine auto-injector confirmed on hand, and the first injection from each new vial or concentration supervised live in the Virtual Shot Room by trained Curex clinical staff. A 30-minute self-observation follows every dose and captures the vast majority of systemic reactions. A large safety study of self-administered allergen immunotherapy (Schaffer et al., 2015) found that across 23,614 patients giving 2,021,600 injections, the systemic reaction rate was just 0.16% per patient with no fatalities — lower than the 3%–14% rate typically seen with office-based shots. No fatalities from SCIT have been reported in the US in the past decade under proper observation protocols (Greenhawt et al., Ann Allergy Asthma Immunol 2023 JTF guidelines).
SCIT vs Alternatives for Mountain Cedar
Mountain-cedar-allergic patients have four main options: SCIT — the established standard of care for refractory cedar fever, now available as a weekly at-home shot through Curex — sublingual (SLIT) drops, rigorous avoidance during December–February, or daily antihistamines and nasal steroids.
| Criterion | SCITBest | SLIT | Avoidance | Medications |
|---|---|---|---|---|
| Effectiveness | Strongest for refractory cedar fever; standard of care in Texas | Emerging evidence; less data than SCIT for cedar specifically | Impractical in cedar-endemic areas; counts 20,000+ grains/m³ | Good for mild-moderate; often inadequate at peak cedar counts |
| 5-yr cost | $3,500–$15,000 over 5 years | $39–$150/month depending on provider | Low cost but high lifestyle burden | $300–$1,200/year for prescriptions |
| Duration | 3–5 years weekly then monthly | 3–5 years daily drops | Permanent lifestyle restriction | Lifelong daily use |
| Convenience | Weekly at-home self-injection for ~6 months with Curex; the first injection from each new vial or concentration supervised live in the Virtual Shot Room | At-home; no clinic visits needed | HEPA filtration helps indoors; outdoor avoidance nearly impossible in Texas | Daily pills and nasal sprays; convenient |
| Safety | Excellent; rare systemic reactions, with a sterile-compounded serum, a prescribed epinephrine auto-injector on hand, and live Zoom supervision of every dose change | Lower systemic reaction risk vs SCIT | No treatment risk; no disease modification | Well-established safety profile |
| Lasting effect | Years of lasting benefit after completing course | Duration of benefit still being studied | No lasting benefit; symptoms return with exposure | No lasting benefit; symptoms return when medications stop |
SCITBest
SLIT
Avoidance
Medications
For mild cedar fever, daily antihistamines and nasal steroids are reasonable first-line therapy. For patients with moderate-to-severe symptoms who fail pharmacotherapy — the clinical reality for many central Texas residents at peak counts — SCIT is the established standard of care, now available from Curex as a weekly at-home allergy shot with pricing confirmed in a current program quote, with a serum sterile-compounded to USP <797>, a prescribed epinephrine auto-injector confirmed on hand, and the first injection from each new vial or concentration supervised live in the Virtual Shot Room by trained Curex clinical staff. Sublingual drops remain a general allergy modality offered by some providers for patients who prefer a needle-free option.
What Mountain Cedar SCIT Actually Costs
Most major US insurers cover mountain-cedar SCIT under standard allergy benefits when prescribed by a board-certified allergist; in Texas, cedar fever SCIT is among the most commonly approved immunotherapy courses. Actual out-of-pocket cost depends on your deductible, co-insurance, and whether your allergist is in-network. Curex at-home IgE testing identifies specific mountain cedar sensitization before allergist consultations, eliminating the need for an initial skin-test visit.
Cost range varies by deductible, co-insurance, and clinic.
Verify these codes with your insurer to confirm coverage.
See the listed Environmental Allergy Shots Plan rate, commercial terms dated 2026-10-12; consultations are included without copay. Confirm availability, eligibility, other included services, testing, any in-person care, insurance responsibility and billing cadence in your written quote before enrolling.
Join the waitlistStop guessing about your mountain cedar allergy. Get a plan.
Take Curex’s 3-minute allergy quiz. A board-certified allergist will review your symptoms and recommend the right immunotherapy path for you — shots or drops.
Free quiz · Board-certified allergists · 50,000+ patients treated · HSA/FSA eligible
Mountain Cedar SCIT — Frequently Asked
Quick answers to the questions patients ask most before starting treatment.
Most mountain-cedar SCIT patients notice meaningful symptom improvement during their first cedar season after reaching maintenance dose — typically 6–9 months after starting the build-up phase. The immunologic mechanism involves a shift from IgE-mediated responses toward IgG4 blocking antibodies and regulatory T-cell tolerance, a process that unfolds over 12–18 months of treatment. Some patients with particularly high Jun a 1 sensitization may need two full cedar seasons to experience the full benefit. A board-certified allergist can track your progress using symptom-medication diaries and follow-up serology.
Yes — antihistamines can be continued during mountain-cedar SCIT, especially during the first cedar season while build-up is still underway. Your allergist may recommend taking an antihistamine on injection days to reduce local reactions during the early build-up phase. Nasal corticosteroid sprays can also be continued throughout. As maintenance progresses and tolerance builds, many patients find they need far fewer rescue medications during cedar season — which is one of the primary clinical endpoints of successful immunotherapy.
A missed injection requires your allergist to adjust the next dose based on how long you have been off treatment. During the build-up phase, missing more than 1–2 weeks typically means stepping back to a lower concentration. During maintenance, most patients can resume at their maintenance dose if the gap is 4–8 weeks; longer gaps may require a partial restart. Your allergist will follow the AAAAI/ACAAI Practice Parameter guidelines for missed-dose protocols. Always contact your allergist's office before your next scheduled injection so they can determine the appropriate dose — never self-adjust.
No — they are different species of the same genus Juniperus. Mountain cedar is Juniperus ashei, native to the Texas Hill Country and peaking December–February. Eastern red cedar is Juniperus virginiana, widespread across 37 eastern and central states, peaking February–April. Because both species produce the same pectate-lyase major allergen (Jun a 1 and Jun v 1, respectively, with >80% sequence identity per Midoro-Horiuti 1999), a patient sensitized to one will almost certainly react to the other. The clinical distinction matters for timing — mountain cedar triggers the Texas 'cedar fever' in winter, while red cedar triggers spring allergy in the eastern US.
Yes — pediatric SCIT for mountain cedar is well-established in Texas. The AAAAI/ACAAI Practice Parameters support SCIT in children typically from age 5 upward, with the dose and build-up schedule adjusted for age and body weight. Starting SCIT in childhood may provide the added benefit of reducing asthma risk — allergen immunotherapy is one of the few interventions shown to prevent new sensitizations and reduce the risk of asthma progression in atopic children. Note: Curex's at-home pilot is currently open to patients age 12 and older; pediatric patients require a trained adult caregiver physically present for every injection. A pediatric allergist or pediatric immunology specialist can confirm Jun a 1 sensitization and determine the appropriate treatment plan.
Yes — mountain-cedar extract provides substantial cross-protection across the entire Cupressaceae family because Jun a 1 shares >75% sequence identity with Cup a 1 (Arizona cypress), Cry j 1 (Japanese cedar), and Jun v 1 (eastern red cedar) per Midoro-Horiuti et al. (JACI 1999). The crystal structure of Jun a 1 (Czerwinski et al., J Biol Chem 2005) confirms the shared parallel beta-helical core. This means a patient traveling between Texas, the Arizona desert, and Japan can expect meaningful cross-protection from a single mountain-cedar extract — though your allergist may choose to add a region-specific extract if you have prolonged exposures in other geographic areas.
In most cases, yes. Mountain-cedar SCIT is one of the most widely prescribed allergen immunotherapy courses in Texas, and major insurers covering allergy benefits typically include it. CPT codes 95115 and 95117 are used for injection administration; 95165 covers extract preparation. Coverage depends on your specific plan, deductible, and whether the prescribing allergist is in-network. Pre-authorization may be required, particularly for rush or cluster build-up schedules. Your allergist's billing office can provide an estimate of your out-of-pocket cost based on your specific insurance plan before you start.
Cedar fever's severity comes from a unique combination of pollen count magnitude, season timing, and protein potency. Mountain cedar (Juniperus ashei) releases 20,000–32,000 grains per cubic meter during peak weeks in Texas Hill Country — dramatically higher than spring trees like oak or elm (typically 500–5,000 grains/m³). The Jun a 1 pectate lyase protein is a highly potent IgE stimulator, with >90% of sensitized patients having measurable IgE. The December–January timing catches patients off-guard when 'allergy season' is supposed to be over. And the systemic component — fever, fatigue, body aches — reflects intense mast cell activation and cytokine release that goes beyond typical rhinitis.
This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about a medical condition. Content reviewed by board-certified allergists at Curex.
Questions about Curex itself?
Straight answers about the company, the evidence, what patients report, and what it costs — including the parts that are not flattering.