Can’t keep up with allergy shots? Your other options

Allergy shots work. Separate Cochrane reviews found them effective against placebo in 51 trials (Calderón 2007), and they remain the standard of care in US allergy practice. The problem is the calendar: build-up usually means one or two clinic visits a week for three to six months, each followed by a 30-minute observation period, then a visit every two to four weeks for three to five years.

That is hard to keep. In the biggest real-world persistence study, Dutch pharmacy data on 6,486 patients, only 23% of people on shots were still on them at three years (Kiel 2013). If you have stopped, or never started because of the visits, you are in the majority, and stopping early is how the benefit is lost. The question worth asking is which route you can realistically finish.

Two things before you switch. First, tell the clinician who prescribed your shots; if you stop partway, restarting any route usually means a new build-up. Second, keep taking the medicines that control your symptoms today while you decide.

Tablets are the most thoroughly regulated alternative: standardized doses, large placebo-controlled trials, and FDA approval. They fit best if one allergen dominates your symptoms — grass season, ragweed season or year-round dust mite. They are usually filled at a pharmacy and may be covered by prescription insurance.

The limit is coverage. Most people who were on shots were being treated for several allergens at once, and there are no tablets for cats, dogs, molds, trees or most weeds. You can take more than one tablet only as your prescriber directs; each is a separate product with its own schedule.

Personalized drops use the same kind of allergen extracts as shots, mixed for your test results and taken under the tongue every day at home. Because the mixture is made for you, one bottle can cover several allergens — the practical reason people switching from multi-allergen shots look at drops.

Drops are compounded and prescribed off-label, made from FDA-approved allergenic extracts; off-label does not mean unsafe or experimental, and it is a long-standing practice. The evidence for sublingual immunotherapy overall is substantial: a Cochrane review of 60 trials found it reduced symptoms and medication use against placebo (Radulovic 2010). But most of that evidence comes from single-allergen products, and the 2017 AAAAI/ACAAI practice parameter declined to endorse customized aqueous drops on the evidence then available (PMID 28284533). Both facts belong in the decision.

Real-world data on multi-allergen drops is growing. A 2026 retrospective study of 2,897 adults treated through Curex reported clinically meaningful symptom improvement in 28% of patients at 12 months and 45% at 24 months (Tharpe 2026). It had no comparison group, included only people with at least a year of follow-up, and was written by Curex clinicians, so read it as encouraging rather than conclusive.

Drops are usually self-pay; insurance often covers the testing and consultations but rarely the drops themselves. Curex’s current plans are on getcurex.com/pricing; compare other providers at allergy drops providers compared. For the full trade-off, see allergy drops vs allergy shots.

Allergy shots are safe and effective, but they cause more systemic reactions than sublingual treatment, which is why US practice parameters advise giving them in a medical setting equipped to treat anaphylaxis, with a 30-minute wait afterwards (Cox 2011). Giving them at home is possible only with a protocol built for it.

Those protocols share four features: patient preselection that excludes higher-risk people (for example, uncontrolled asthma or a past systemic reaction); a slower build-up; supervision by the prescribing practice; and epinephrine at home with an adult trained to use it. The largest published safety analysis, of 23,614 preselected patients who self-administered about two million injections over one year, reported a systemic reaction rate of 0.16% per patient and no deaths (Schaffer 2015). The study was written by the company that runs the protocol, and its results apply to preselected patients on that protocol, not to anyone giving shots at home.

Ask your own allergist whether you would qualify. If you are told you would not, that answer is the protocol working.

If the build-up is the problem rather than the maintenance, ask about an accelerated schedule. Cluster immunotherapy gives several injections at each visit, so maintenance is reached in weeks instead of months; rush immunotherapy reaches it over one to a few days in a monitored setting. After that, maintenance visits continue every few weeks as usual.

The trade-off is safety. Accelerated build-up is a recognized risk factor for systemic reactions in US surveillance data (Bernstein and Epstein 2020), so clinics often premedicate. In one trial, pretreatment with omalizumab cut the risk of anaphylaxis during rush immunotherapy for ragweed about five-fold (Casale 2006) — a research approach, not a routine one.

Biologics are injected antibodies that block one step of the allergic response. Omalizumab (Xolair), dupilumab (Dupixent) and others are FDA-approved for conditions such as allergic asthma, chronic nasal polyps, eczema and chronic hives, and they can be life-changing for those conditions. None is approved to treat hay fever on its own.

In February 2024 the FDA approved omalizumab to reduce allergic reactions after accidental exposure to one or more foods (FDA announcement; Wood 2024). It protects only while you keep taking it. Biologics do not retrain the immune system to a specific allergen; the protection fades when the injections stop, and they are expensive. In some clinics a biologic is used alongside immunotherapy to make the build-up safer — the biologic protects, the immunotherapy changes the disease.

Antihistamines, steroid nasal sprays, eye drops and, for asthma, controller inhalers help you feel better today, and they are the right place to be while you decide on anything else. Reducing exposure — dust-mite covers, a HEPA filter, keeping pets out of the bedroom, showering after time outdoors in season — adds to them. Symptom medications help you feel better today; only immunotherapy changes the disease.

Allergy shots use FDA-licensed allergenic extracts by their labelled route. The four tablets above are FDA-approved products. Personalized allergy drops are compounded and prescribed off-label, made from FDA-approved allergenic extracts, the same as in allergy shots; off-label does not mean unsafe or experimental. Biologics are FDA-approved for the specific conditions on their labels.

If a single allergen drives your symptoms, ask your allergist or primary care doctor about a tablet. If you were on shots for several allergens and the visits are the problem, compare allergy drops and allergy shots and the providers who offer drops; Curex plans are on getcurex.com/pricing. If you are unsure whether you need to be seen in person, read what an allergist does and which parts an online service can do.