Rough Pigweed Allergy Shots: The Ama r 1 Reference Species for Amaranthus SCIT
Rough pigweed (Amaranthus retroflexus) allergy shots are the molecular reference immunotherapy for the entire Amaranthus genus: a positive ImmunoCAP w14 test means IgE to Ama r 1, the Ole e 1-like major allergen that predicts cross-sensitization to all other pigweed species. No FDA-standardized extract exists; SCIT follows a non-standardized 3-5 year protocol per AAAAI Practice Parameters (Cox 2011). Understanding why your 'pigweed' lab test ran against A.
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
Rough Pigweedis 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.
Rough Pigweed Allergy Immunotherapy: How It Works
Allergy immunotherapy is the only long-term treatment that re-trains the immune system to stop overreacting to rough pigweed — rather than just masking symptoms with antihistamines or steroids. By gradually exposing the body to controlled doses of rough pigweed 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 rough pigweed 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 rough pigweed 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 rough pigweed 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 rough pigweed 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 rough pigweed 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 rough pigweed allergy with at-home drops, see how Curex sublingual immunotherapy compares below.
What is Rough Pigweed?
The biology, taxonomy, and clinical fingerprint of Rough Pigweed — the foundation of how SCIT targets it.
Amaranthus retroflexus (redroot pigweed) pollen is ~25 μm, wind-dispersed, and morphologically indistinguishable from Chenopodium album under light microscopy.
- Scientific name
- Amaranthus retroflexus
- Family
- Amaranthaceae (includes former Chenopodiaceae per APG IV)Amaranth family
- Type
- Annual weed pollen
- Native to
- North America; now cosmopolitan worldwide as a ruderal weed
- Allergen proteins
- Ama r 1 (Ole e 1-like, major)Ama r 2 (profilin, pan-allergen)
- Particle size
- ~25 μm
- Avoidance difficulty
- Nearly impossible
How Rough Pigweed Allergy Presents
Symptoms by body system — useful for distinguishing Rough Pigweed sensitivity from overlapping allergies and infections.
Respiratory
- Seasonal rhinitis with profuse nasal discharge and congestion, August-October
- Sneezing fits triggered by outdoor exposure during peak midday pollen dispersal
- Allergic asthma exacerbation during late-summer pigweed peak
- Post-nasal drip and chronic throat clearing during pollen season
- Sinusitis and facial pressure overlapping with fall weed season
Ocular
- Intense itching and redness of eyes (allergic conjunctivitis)
- Watery eyes worsened by outdoor wind exposure
- Periorbital puffiness on high pollen-count days
- Contact lens intolerance during August-October season
Dermal
- Contact urticaria from direct handling of rough pigweed plants
- Eczema flare in atopic patients during pollen season
- Pruritus of exposed skin on high-count outdoor days
Systemic
- Fatigue and cognitive fog during prolonged seasonal exposure
- Sleep disruption due to nasal congestion
- Profilin (Ama r 2) cross-reactivity may produce OAS symptoms with some raw fruits and vegetables
- Reduced athletic performance during August-October season in sensitized athletes
When a patient comes in with a positive 'pigweed' ImmunoCAP, that test is measuring IgE to A. retroflexus extract — which contains Ama r 1. A single positive w14 result tells us the patient's immune system recognizes the Ama r 1 protein, and that means they are sensitized to essentially all Amaranthus species. The A. retroflexus extract is not just one species' test; it is the reference for the entire genus.
When & Where Rough Pigweed Peaks
Allergen intensity by month and by state. Useful for timing SCIT start dates and travel planning.
12-Month Intensity
Peak: mid-August through late September across most US and European ranges· ~10-12 weeks of intense exposure; Anderegg 2021 (PNAS) documented a 20-day earlier onset in North America 1990-2018
US Exposure Map
12 high-intensity statesExposure intensity by state (text version)
- ME:
- Low
- VT:
- Low
- NH:
- Low
- WA:
- Low
- MT:
- Moderate
- ND:
- Moderate
- MN:
- Moderate
- WI:
- Low
- MI:
- Low
- NY:
- Low
- MA:
- Low
- OR:
- Moderate
- ID:
- Moderate
- WY:
- Moderate
- SD:
- Moderate
- IA:
- High
- IL:
- Moderate
- IN:
- Moderate
- OH:
- Moderate
- PA:
- Low
- NJ:
- Low
- CT:
- Low
- RI:
- Low
- CA:
- High
- NV:
- High
- UT:
- High
- CO:
- High
- NE:
- High
- MO:
- High
- KY:
- Low
- WV:
- Low
- VA:
- Low
- MD:
- Low
- DE:
- Low
- AZ:
- High
- NM:
- High
- KS:
- High
- AR:
- Moderate
- TN:
- Low
- NC:
- Low
- SC:
- Low
- OK:
- High
- LA:
- Moderate
- MS:
- Moderate
- AL:
- Moderate
- GA:
- Moderate
- TX:
- High
- FL:
- Low
- AK:
- Low
- HI:
- Low
What Rough Pigweed Cross-Reacts With
Patients sensitized to one allergen often react to others sharing similar proteins. This map shows the documented molecular overlaps.
Ama r 1 (Ole e 1-like) and Ama r 2 (profilin) in A. retroflexus cross-react broadly within Amaranthaceae: virtually all Amaranthus species share Ama r 1, while Ama r 2 profilin cross-reacts with profilins in Russian thistle (Sal k 4), lamb's quarter (Che a 2), kochia, and even grass and ragweed pollen (Tehrani 2010 IJAAIM; Weber 2007 JACI).
Pooled Amaranthus extract; A. retroflexus is the primary reference species in the blend
A. palmeri has no species-specific allergens; fully captured by Ama r 1 cross-reactivity
Is SCIT Right for Your Rough Pigweed Allergy?
Answer 5 questions to see whether rough pigweed allergy shots match your clinical profile.
How severe are your rough pigweed symptoms (August-October)?
The Rough Pigweed SCIT Protocol
Rough pigweed SCIT uses a non-standardized A. retroflexus extract; the extract is the clinical reference for the Amaranthus genus and is often compounded with other fall-weed allergens in a mixed vial for polysensitized patients.
Incremental dose escalation beginning at 1:100,000 w/v — a highly dilute starting concentration — up to the maintenance target. The 30-minute post-injection observation period is mandatory to identify and treat any systemic reaction. Your allergist evaluates the local wheal-and-flare response at each visit before approving the next dose increment. Asthmatic patients may receive a pre-injection spirometry check.
Once the maintenance dose is established, maintenance injections sustain immunological tolerance. The rough pigweed extract is frequently compounded with Russian thistle, lamb's quarter, and ragweed in a single vial for fall-season polysensitized patients. Symptom benefit is expected to deepen with each passing fall season. Epinephrine auto-injector should be available throughout treatment.
The AAAAI Practice Parameter (Cox 2011) supports discontinuation after 3-5 years of maintenance in patients who have achieved good control. Many patients retain clinically meaningful benefit even after stopping injections, suggesting immunological reprogramming rather than purely symptomatic suppression.
Extract Concentration Ladder
You progress through each vial during build-up. Concentration increases ~10x per step.
What the Research Shows for Rough Pigweed SCIT
Rough pigweed SCIT lacks a species-specific RCT, but family-level Amaranthaceae data and weed-pollen immunotherapy practice parameters support meaningful efficacy across fall-weed sensitization patterns.
- Symptom score reduction — Salsola SCIT (family-level Amaranthaceae extrapolation)42%Tabar AI et al. 2014, JACI 134:99-105, N=48 (Salsola kali SCIT RCT; closest family evidence)
- Weed-pollen SCIT medication score reduction50%Cox L et al. 2011, JACI 127:S1-55 (AAAAI Practice Parameter — weed-pollen SCIT data)
- Sensitization prevalence — A. retroflexus in Mediterranean pollen-allergic patients22%Asero R et al. 2009, Int Arch Allergy Immunol (southern Italian sensitization rate 12-22%)
No published DBPC-RCT has studied A. retroflexus SCIT specifically. The Tabar 2014 JACI Salsola RCT provides the strongest within-family evidence for Amaranthaceae immunotherapy. Observational evidence and practice-parameter consensus support rough pigweed SCIT as effective for fall rhinitis and asthma. Patients should discuss the evidence extrapolation honestly with their allergist when making an immunotherapy decision.
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
Rough Pigweed SCIT Side Effects
Rough pigweed SCIT side effects are consistent with the standard inhalant SCIT profile — local injection-site reactions are common and manageable; systemic reactions are uncommon; anaphylaxis is rare but requires mandatory at-home observation to manage promptly.
Local reactions
4 documented| Reaction | Rate | Severity |
|---|---|---|
Injection-site wheal and flare Typical immediate IgE-mediated reaction; resolves within 30-60 minutes | Rate 30-50% | Mild |
Injection-site itching Ice application and oral antihistamine reduce discomfort | Rate 25-40% | Mild |
Persistent local swelling (>5 cm) Dose held or reduced; typically resolves within 24 hours | Rate 5-10% | Moderate |
Delayed local reaction (24-48h) | Rate 2-5% | Mild |
Systemic reactions
4 documented| Reaction | Rate | Severity |
|---|---|---|
Nasal/conjunctival flare Managed with antihistamine during observation period | Rate 1-3% | Mild |
Urticaria (hives) | Rate 0.5-1% | Moderate |
Mild bronchospasm Higher risk if pre-injection peak flow is suboptimal; asthma must be well-controlled before each injection | Rate 0.1-0.5% | Moderate |
Anaphylaxis Onset is almost always within ~30 minutes; Curex confirms a prescribed epinephrine auto-injector on hand and supervises the first injection from each new vial or concentration live in the Virtual Shot Room so a reaction can be treated immediately | Rate <0.1% per injection | Severe |
Systemic reactions are manageable and rarely life-threatening when epinephrine is on hand and dosing is supervised — exactly what Curex's at-home program provides: a prescribed epinephrine auto-injector confirmed on hand, a board-certified allergist overseeing the plan, and your first dose plus every escalation supervised live in the Virtual Shot Room. Patients with poorly controlled asthma should have their asthma optimized before starting SCIT.
SCIT vs Alternatives for Rough Pigweed
Rough pigweed-sensitized patients have four main treatment options, distinguished primarily by long-term disease modification versus ongoing symptom control.
| Criterion | At-Home SCIT (Curex)Best | SLIT | Avoidance | Medications |
|---|---|---|---|---|
| Effectiveness | High — family-level evidence | Moderate — European data | Minimal — wind-pollinated | Good symptom control |
| 5-yr cost | $3,500-$15,000 | $1,500-$5,000 | Low | $500-$2,000/yr |
| Duration | 3-5 years | 3-5 years | Ongoing | Ongoing daily use |
| Convenience | Self-administered weekly then monthly at home with Curex | Daily home dosing | Very difficult Aug-Oct | Daily pills/sprays |
| Safety | Prescribed epi on hand; first dose Virtual Shot Room–supervised | Lower systemic risk | Safe | Safe long-term |
| Lasting effect | Yes — post-treatment | Emerging evidence | No | No — symptoms return off meds |
At-Home SCIT (Curex)Best
SLIT
Avoidance
Medications
For patients with confirmed Ama r 1 sensitization and inadequate medication control, SCIT is the only disease-modifying option — and Curex makes it available without weekly clinic visits. Curex delivers personalized rough pigweed immunotherapy as one weekly at-home shot with pricing confirmed in a current program quote: a serum sterile-compounded to USP <797>, a board-certified allergist overseeing your plan, 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.
What Rough Pigweed SCIT Actually Costs
Most US insurers cover rough pigweed SCIT under standard allergy benefits when ordered by a board-certified allergist. Prior authorization is routinely required; your allergist's billing team typically handles this process. Actual out-of-pocket cost depends on your plan's deductible and co-insurance. Curex at-home IgE testing identifies specific rough pigweed 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 rough pigweed 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.
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Rough Pigweed SCIT — Frequently Asked
Quick answers to the questions patients ask most before starting treatment.
Amaranthus retroflexus (rough pigweed) is the immunological reference for the genus because it is the only Amaranthus species with formally characterized WHO/IUIS allergens — Ama r 1 (Ole e 1-like protein) and Ama r 2 (profilin). Palmer amaranth (A. palmeri), despite being the most aggressive agricultural superweed in the Southeast and Midwest, has no species-specific IUIS-named allergens as of 2024 (WHO/IUIS database). This means allergy labs run the A. retroflexus extract under ImmunoCAP code w14 to test for any Amaranthus sensitization — a positive result at A. retroflexus accurately captures cross-reactive IgE to all Amaranthus species, including Palmer amaranth. The test is measuring Ama r 1 reactivity, not species-specific A. retroflexus antibodies.
Rough pigweed and ragweed are botanically unrelated and clinically distinct: rough pigweed (Amaranthus retroflexus) belongs to Amaranthaceae with Ama r 1 (Ole e 1-like) as its major allergen, while short ragweed (Ambrosia artemisiifolia) belongs to Asteraceae with Amb a 1 (pectate lyase) as its major allergen. There is no meaningful cross-reactivity between Ama r 1 and Amb a 1 — being allergic to pigweed does not protect against ragweed and vice versa. Both peak in August-October across most of the US, so many patients are co-sensitized to both and require separate immunotherapy coverage. A specific IgE panel that tests both w14 (A. retroflexus) and w1 (short ragweed) will clarify which — or both — are driving your fall symptoms.
Most patients with rough pigweed sensitization notice meaningful symptom improvement after completing the build-up phase and experiencing at least one full fall pollen season on maintenance therapy, typically 1-2 years into treatment. The build-up phase (3-6 months of weekly injections) progressively desensitizes the immune system, but clinical benefits accumulate gradually. Family-level evidence from the Tabar 2014 JACI Salsola RCT — the closest published controlled trial in Amaranthaceae — found statistically significant symptom improvement by the end of the first full maintenance season. Full benefit typically consolidates over 2-3 years. Your allergist can track progress using seasonal symptom diaries and rescue medication usage.
Component-resolved diagnostics (CRD) for Ama r 1 are not widely available in routine US clinical practice as of 2024, unlike Bet v 1 for birch or Amb a 1 for ragweed, which have commercial CRD assays. Standard testing is with the whole A. retroflexus extract (ImmunoCAP w14), which effectively measures the total IgE response including Ama r 1 and Ama r 2. Research protocols can test purified recombinant Ama r 1, but this is not commercially available. In clinical practice, a positive w14 and a consistent fall-season history is sufficient to support the diagnosis and treatment decision. Your allergist may combine this with a skin-prick test to confirm.
Yes, rough pigweed SCIT is typically covered under standard allergy benefit codes by major US insurers (CPT 95115 single injection, 95117 multiple, 95165 extract prep). Coverage requires a prescription from a board-certified allergist and usually prior authorization — most allergist offices manage this paperwork on your behalf. The specific out-of-pocket cost depends on your plan's deductible, co-insurance percentage, and in-network status of your allergist. Total out-of-pocket over a 5-year SCIT course typically ranges from $3,500-$15,000 depending on coverage. Requesting a benefits verification from your allergist's billing department before starting will give you the most accurate cost estimate.
You can typically continue your rough pigweed SCIT regimen after moving, as long as you find a local allergist to administer injections. The immunotherapy targets Ama r 1, which is present across the Amaranthaceae family — so even in lower-exposure regions, your sensitization persists and the treatment remains medically appropriate. Your new allergist will want to see your injection records, vial concentrations, and any local/systemic reaction history before continuing. If you have been on maintenance for a significant period without reactions, the transition to a new clinic is generally straightforward. Telehealth consultation with your original allergist can help coordinate the handoff.
Potentially, through profilin cross-reactivity. Ama r 2, the profilin allergen of rough pigweed, belongs to a pan-allergen family that cross-reacts with profilins in many raw fruits and vegetables (melon, banana, tomato, celery, and others). Profilin-sensitized patients may experience mild OAS symptoms — itching or tingling in the mouth and throat — when eating these raw foods during pollen season. However, profilin cross-reactivity accounts for only a minority of pigweed-allergic patients (profilins are clinically significant in about 10-20% of pollen-allergic patients). If you suspect food reactions alongside your fall pollen symptoms, your allergist can test for Ama r 2 (profilin) specifically to determine whether this pan-allergen is contributing.
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.
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