Weekly Allergy Shots: The Conventional Build-Up Schedule
Weekly allergy shots are the conventional SCIT build-up cadence — 1–2 injections per week, single injection per visit, for approximately 24–28 visits over 3–6 months per Cox 2011 PP3. After build-up, the schedule extends to every 2–4 weeks for 3–5 years of maintenance. This is the most common US allergy shot protocol, but Tkacz 2021 MarketScan data shows 23.9% of patients never return after the first injection — the clinic-visit burden is the chokepoint. Curex delivers the same weekly SCIT at home for $129/month, with the first dose and every dose change supervised live over Zoom, so eligible patients keep the protocol without the office trips.
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Weekly allergy shots are the build-up phase of conventional SCIT — one injection per visit, once or twice weekly, for 24–28 visits over 3–6 months. After that, maintenance shifts to every 2–4 weeks for 3–5 years.
The essentials
Weekly is the schedule of the conventional SCIT build-up — the most common allergy shot protocol in the US and the one embedded in most allergy clinic infrastructure. Per Cox L, Nelson H, Lockey R et al., J Allergy Clin Immunol 2011;127(1 Suppl):S1–S55 (DOI 10.1016/j.jaci.2010.09.034): 'the frequency of injections generally ranges from 1 to 2 times per week, with a single injection given each visit. The duration of the build-up phase depends on the frequency of the injections but generally ranges from 3 to 6 months.' With weekly single injections, that is roughly 24–28 visits to reach maintenance. Medicare LCD L36240 describes build-up as 'anywhere from 8–28 weeks to achieve a maintenance dose.'
Curex pairs at-home IgE testing with board-certified allergist review to identify which allergens drive a patient's symptoms — then delivers the weekly SCIT itself as an at-home program for $129/month: a serum sterile-compounded to USP <797> standards, a prescribed epinephrine auto-injector confirmed on hand, and the first dose plus every dose change supervised live over Zoom, so the build-up schedule no longer requires weekly clinic trips.
Whether given in the clinic or at home, each build-up dose is followed by a 30-minute observation period per Cox 2011 PP3 — approximately 70% of fatal and systemic reactions to SCIT onset within that window, which is why Curex supervises the first dose and every dose change live over Zoom with a prescribed epinephrine auto-injector on hand. The dose ladder per Cox 2011 starts at 0.05–0.10 mL of the most dilute vial and escalates to approximately 0.5 mL of the maintenance concentrate. A representative ladder progresses in volume steps: 0.05, 0.10, 0.15, 0.20, 0.25, 0.30, 0.35, 0.40, 0.45, 0.50 mL across serial dilutions.
Missed-dose management is one of the most-asked questions during build-up. Per Cox 2011 PP3 interval-based dose-adjustment tables, build-up intervals are commonly 3–10 days; exceeding approximately 10–14 days typically triggers a dose reduction — the prior lower dose is repeated before resuming escalation. The longer the gap, the larger the reduction.
The real-world constraint is adherence. Tkacz JP et al., Curr Med Res Opin 2021;37(6):957–965 (DOI 10.1080/03007995.2021.1903848) found that 23.9% of 103,207 MarketScan AIT patients never returned after the first injection and only 43.9% reached the maintenance phase. Weekly clinic visits for 6 months are the structural bottleneck where most SCIT patients fail — the barrier Curex's at-home delivery is designed to remove for eligible patients.
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Treatment timeline — phase by phase
Conventional weekly SCIT follows a three-phase lifecycle: a 3–6-month weekly build-up phase, a 3–5-year maintenance phase with every-2-to-4-week visits, and a discontinuation phase after completing the full course. The weekly cadence applies only to the build-up phase — it does not continue into maintenance.
Dose escalates from 0.05–0.10 mL of the most dilute vial (silver-cap 1:10,000) through yellow (1:10), blue (1:100), green (1:1,000) to approximately 0.5 mL of the maintenance concentrate (red-cap 1:1) per Cox 2011 PP3. Each visit requires a mandatory 30-minute observation. Missed-dose rule: intervals exceeding approximately 10–14 days typically trigger a dose reduction per Cox 2011 interval-based tables.
Once the maintenance dose is reached, the interval extends to every 2–4 weeks. Most US clinics anchor on a 4-week (monthly) interval per the Cox 2011 PP3 maximum. The 30-minute observation continues unchanged. Durham SR et al., NEJM 1999;341:468–475 showed 3 years of maintenance produces 4 years of post-discontinuation sustained remission.
Discontinuation after completing the full course yields durable remission per Durham 1999 NEJM. The PAT 10-year follow-up (Jacobsen L et al., Allergy 2007) extended pediatric durability to 10 years. No biomarker reliably predicts post-discontinuation relapse — the decision is clinical.
Same proven results. No clinic visits.
Curex's at-home allergy shots deliver the same allergen desensitization as clinic SCIT — for a flat $129/month, with no clinic visits and no facility fees.
See if at-home shots are right for youTreatment options side by side
Weekly conventional SCIT is the lowest-risk and most evidence-rich build-up protocol, but also the most adherence-demanding. Comparing it against accelerated SCIT schedules and home-based alternatives clarifies the tradeoffs.
| Treatment | Efficacy | Duration | Cost (5yr) | Convenience | Safety |
|---|---|---|---|---|---|
Weekly SCIT (conventional) | |||||
Cluster SCIT | |||||
At-home allergy shots (Curex SCIT) |
- Efficacy
- Duration
- Cost (5yr)
- Convenience
- Safety
- Efficacy
- Duration
- Cost (5yr)
- Convenience
- Safety
- Efficacy
- Duration
- Cost (5yr)
- Convenience
- Safety
For patients who cannot reliably attend weekly clinic visits for 6 months, Curex delivers the same SCIT allergy shots at home for $129/month — a serum sterile-compounded to USP <797> standards, a prescribed epinephrine auto-injector confirmed on hand, and the first dose plus every dose change supervised live over Zoom, with gradual week-by-week escalation matching the clinic protocol.
See if at-home shots are right for youFrequently asked questions
How often are allergy shots given during build-up?
During conventional SCIT build-up, allergy shots are given 1–2 times per week, with a single injection per visit, per Cox L et al., J Allergy Clin Immunol 2011;127(1 Suppl):S1–S55 (DOI 10.1016/j.jaci.2010.09.034). At once-weekly frequency, build-up involves approximately 24–28 visits over 3–6 months. At twice-weekly frequency, the same number of injections is completed in roughly half the calendar time. Each visit requires a mandatory 30-minute observation period — approximately 70% of fatal and systemic reactions onset within that window. Medicare LCD L36240 describes build-up as 'anywhere from 8–28 weeks to achieve a maintenance dose.'
What is the dose ladder for weekly allergy shots?
The conventional SCIT dose ladder per Cox 2011 PP3 starts at 0.05–0.10 mL of the most dilute vial and escalates to approximately 0.5 mL of the maintenance concentrate. A representative volume ladder is 0.05, 0.10, 0.15, 0.20, 0.25, 0.30, 0.35, 0.40, 0.45, 0.50 mL, progressing across five serially diluted vials. The ACAAI mixing guide uses a color code: silver (1:10,000), green (1:1,000), blue (1:100), yellow (1:10), red (1:1 maintenance). Patients should read the labeled concentration on each vial rather than relying solely on color — a 2023 study (Prudenti) found only 41% of US practices use the standard color-coding scheme.
What happens if I miss a weekly allergy shot?
Missed-dose management during build-up follows interval-based dose-adjustment tables in Cox 2011 PP3. Build-up intervals are commonly 3–10 days; exceeding approximately 10–14 days between injections typically triggers a dose reduction — the prior lower dose is repeated before resuming escalation. The longer the gap, the larger the reduction. During the maintenance phase, exceeding the scheduled interval by more than a few weeks typically triggers a similar dose reduction per Cox 2011 maintenance-interval tables. Patients should notify their allergist before a known scheduling gap so that a reduced-dose vial can be prepared. The specific dose-reduction magnitude varies by clinic protocol.
Does the weekly schedule continue forever?
No — the weekly build-up cadence applies only during the first 3–6 months of SCIT. Once the target maintenance dose is reached, the interval extends to every 2–4 weeks for the 3–5-year maintenance phase per Cox L et al., J Allergy Clin Immunol 2011;127(1 Suppl):S1–S55 (DOI 10.1016/j.jaci.2010.09.034). Most US clinics anchor on a 4-week (monthly) maintenance interval. After completing 3–5 years of maintenance, SCIT is typically discontinued and durable remission of 4+ years follows per Durham SR et al., NEJM 1999;341:468–475. The transition from weekly to monthly is one of the most welcome schedule changes for patients who have tolerated the build-up burden.
Why do so many patients drop out of weekly allergy shots?
Real-world adherence data from Tkacz JP et al., Curr Med Res Opin 2021;37(6):957–965 (DOI 10.1080/03007995.2021.1903848) found that 23.9% of 103,207 MarketScan AIT patients never returned after the first injection, and only 43.9% reached the maintenance phase. The weekly clinic-visit requirement during build-up — 24–28 separate appointments each requiring a 30-minute wait — is the dominant adherence barrier. Employment schedules, distance from an allergist practice (Wu I et al., AAAAI 2019: 81.5% of US counties have zero allergists), and lack of transportation all contribute. Patients who cannot commit to weekly visits for 6 months may be better served by cluster, rush, or home-based sublingual immunotherapy before they start.
What is the systemic reaction risk during weekly allergy shots?
The baseline systemic-reaction rate during SCIT across all phases and schedules is 0.1% per injection visit, with 7.1 grade 1, 2.6 grade 2, and 0.4 grade 3 systemic reactions per 10,000 injection visits per Epstein TG et al., Ann Allergy Asthma Immunol 2013 (PMID 23535092). One confirmed fatality occurred per 23.3 million injection visits during 2008–2012. The WAO Systemic Reaction Grading System (Cox L et al., JACI 2010;125:569–574) classifies reactions from grade 1 (mild rhinitis/urticaria) to grade 5 (death). If you experience throat tightness, difficulty breathing, generalized hives, or lightheadedness after an injection, call 911 immediately and use an epinephrine auto-injector if available.
How much do weekly allergy shots cost?
The CMS 2025 Medicare allowed amount for CPT 95117 (allergen immunotherapy, 2 or more injections) is $11.97 per FR Doc 2024-25382. The CMS 2025 allowed for CPT 95165 (preparation of multi-dose allergen extracts, per dose) is $13.91. During a 24–28-week build-up phase, patients accumulate 24–28 CPT 95117 charges plus extract preparation charges. Total annual SCIT costs typically range from $1,000 to $4,000 for the build-up year depending on insurance, facility type, and provider fees. Hospital outpatient departments (HOPDs) may add facility fees on top of professional fees, dramatically increasing out-of-pocket cost — a 2024 PBS NewsHour report cited $24,400 at one HOPD facility.
How does weekly SCIT compare to home-based alternatives?
Conventional weekly SCIT requires 24–28 clinic visits during build-up plus monthly visits for 3–5 years of maintenance — approximately 57–60 clinic visits over a 3-year course. Curex's at-home SCIT program removes those trips for eligible patients: the same weekly shot is self-administered at home for $129/month, with a serum sterile-compounded to USP <797> standards, a prescribed epinephrine auto-injector confirmed on hand, and the first dose plus every dose change supervised live over Zoom. FDA-approved sublingual immunotherapy tablets (Grastek, Oralair, Ragwitek, Odactra) are a separate needle-free modality that also avoids the clinic schedule, though they currently treat a narrower allergen range than SCIT for some patients.
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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.