Are There Allergy Shots? Yes — 114 Years of Evidence Since Noon 1911

Allergy shots were first published in 1911. Leonard Noon's paper "Prophylactic inoculation against hay fever" appeared in The Lancet (1911;1:1572-1573) — Noon injected grass timothy pollen extract into hay-fever patients at St Mary's Hospital in London and measured immunity by conjunctival provocation challenge. His colleague John Freeman published a follow-up paper later that same year and subsequently developed the first rush protocol in 1930. The basic principle — inject small, escalating doses of the allergen to build tolerance — has remained unchanged for over a century, though the extracts, schedules, safety monitoring, and regulatory framework have been substantially refined. Modern SCIT is governed by Cox L et al. (J Allergy Clin Immunol 2011;127[1 Suppl]:S1-S55), updated approximately every decade by the AAAAI and ACAAI.

Allergy shots can treat most IgE-mediated aeroallergen and venom sensitivities. The 19 FDA-standardized extracts include grass pollens (timothy, Kentucky bluegrass, perennial rye, redtop, sweet vernal, Bermuda), short ragweed, dust mites (Dermatophagoides pteronyssinus and D. farinae), cat hair and pelt (Greer license #308), and Hymenoptera venoms (honeybee, white-faced hornet, yellow hornet, wasp, yellow jacket, mixed vespid). A larger non-standardized list covers many tree pollens (birch, oak, maple, cedar), additional weed pollens (mugwort, plantain), dog dander, cockroach, molds (Alternaria has the best RCT evidence; Cladosporium is also used). Tree pollens and most molds outside Alternaria are non-standardized, meaning extract potency varies by manufacturer. Allergy shots are NOT used for food allergy or chronic urticaria in standard practice (Cox 2011 PP3).

No — allergy shots and allergy testing are distinct procedures. Allergy skin testing (CPT 95004, percutaneous prick/scratch test, per allergen) is a diagnostic procedure that identifies which specific allergens a patient is IgE-sensitized to. It involves placing small drops of allergen extract on the skin and pricking through each — reactions are read at 15-20 minutes as wheals. Allergy shots (SCIT, CPT 95117/95115) are therapeutic — they use the same allergens identified by testing and inject them subcutaneously, gradually, over 3-5 years to induce immune tolerance. Testing comes first (diagnostic phase); shots come after (therapeutic phase). The CMS NCCI Policy Manual notes that testing and immunotherapy are not performed on the same day in standard practice. At-home IgE blood testing follows this same principle, measuring serum-specific IgE levels rather than skin reactions.

Allergy shots (SCIT) and Xolair (omalizumab) are both injectable allergy treatments but work through completely different mechanisms and have different indications. SCIT injects small, escalating doses of the specific allergen extracts to induce immune tolerance — it is an allergen-specific immunotherapy course over 3-5 years. Xolair is an anti-IgE monoclonal antibody that binds free IgE in the bloodstream, broadly blocking the IgE-mediated allergic cascade regardless of the specific allergen. Xolair is FDA-approved for moderate-to-severe persistent asthma, chronic spontaneous urticaria (CSU, 2014), and multi-food allergy prevention (2024). SCIT is not indicated for CSU. Both are given as subcutaneous injections, but Xolair is given every 2-4 weeks indefinitely (not a finite course) and is administered at an allergist or dermatologist office with a 2-hour observation on first dose.

Yes — most SCIT patients are sensitized to multiple allergens, and the custom-formulated extract vial reflects all clinically relevant sensitizations. Board-certified allergists select allergens for the formulation based on both IgE testing results and clinical history (not all sensitized allergens drive symptoms). Multiple allergens can be combined in a single vial, though allergens with cross-reactive or enzymatically incompatible proteins may need to be separated into different vials. The build-up and maintenance schedule does not fundamentally change with multi-allergen vials compared to single-allergen formulations. The physician's ability to identify which allergens are truly driving symptoms — versus incidental sensitization — is one reason the pre-SCIT allergy evaluation is essential.

Allergy shots are available throughout the US but access is highly uneven. Per Wu I et al. (AAAAI 2019), approximately 1.08-1.6 practicing allergists exist per 100,000 US population, and 81.5% of US counties have zero practicing allergists. Rural access is severely constrained: only 0.3% of rural counties have an allergist compared with 23.2% of urban counties. State-level Medicaid acceptance among allergists ranges from 13.4% (New York) to 72.3% (California) per Ho FO, Bilaver LA et al. (Am J Manag Care 2024;30[8]:374-379, DOI 10.37765/ajmc.2024.89588), meaning insured patients may face access barriers even in high-density states. At-home SCIT programs like Curex's directly address the geographic access gap: the serum is compounded and shipped to eligible patients nationwide, the initial evaluation and ongoing oversight are conducted via telehealth, and the first injection and every dose escalation are supervised live over Zoom — no physical allergist proximity required.