Pam Angle sits at her desk, next to several bottles full of things that would make a fair number of Oklahomans sneeze.
Extracts of mountain cedar, elm, oak, ragweed, Johnson grass and Bermuda grass pollens sit nearby.
After 30 years of filling allergy shots, Angle knows — the list of what people might need in their allergy shots is long.
“There are so many things in Oklahoma that grow here that people are allergic to,” said Angle, head filler at the Oklahoma Allergy and Asthma Clinic extract lab.
Each week, Angle and the other lab technicians fill about 1,000 orders for allergy shots, a therapy that involves injecting a small amount of an allergen into a person’s body on a regular basis over the course of three to five years in an attempt to build that person’s immunity to allergens, according to the National Institutes of Health.
Oklahoma City’s environment is not a friend to allergy sufferers, with the city ranking No. 4 on the Asthma and Allergy Foundation of America’s "Most Challenging Places to Live with Spring Allergies” list.
Dr. Dean Atkinson, an allergist at the Oklahoma Allergy & Asthma Clinic, said allergy shots give patients consistent exposure to allergens.
An allergy sufferer generally doesn’t get enough consistent exposure in the environment to develop resistance as quickly as they would with allergy shots, he said.
That’s if they stick with the shots.
“In the end, there’s probably close to 50 percent that will start that will finish up that three to five years,” Atkinson said. “You’ve got to keep going.”
Atkinson said the reason the treatment takes as long as it does is because of the risk associated with injecting allergens into a person’s system.
“If we could predict how much people would react, it would be easy, because then you could start them higher or go faster, but what happens is many people, because their body is not used to the dosing, they will actually react to the shots,” he said.
Most of the time, those reactions aren’t serious and involve itchy skin at the injection site, but people can develop serious symptoms if given too much of a dose, he said.
“If we really push people hard, they will tend to have more reactions to the shots,” Atkinson said. “That could be local reactions all the way to tightness, wheezing and shortness of breath.”
How effective is it?
Dr. Jody Tversky, clinical director of the Johns Hopkins asthma and allergy center, said the allergy shot system has been around for about 100 years.
“To date, really it’s the only thing we have that attempts to enact a permanent cure,” Tversky said.
Tversky said allergy shots are at least somewhat effective in about 80 percent of patients, although that’s an optimistic estimate.
For about one-fifth to about one-third of patients, allergy shots might do nothing. And then in another one-third of patients, allergy shots work reasonably well, but patients might still need some form of medicine.
“And in one-third of folks, it works so well, that they fix their nose and sinus allergies and fix their asthma,” he said.
For years, allergy sufferers have had three main options: stay away from whatever they’re allergic to, take allergy medicines or try allergy shots.
Allergy drops, which have gained popularity in Europe, are placed under a person's tongue and, although they might not be as effective as shots, some patients have seen some success with them, Tversky said.
Sublingual allergy drops have been approved by the U.S. Food and Drug Administration to treat grass and pollen allergies.
“In the end, 10 years from now, I think all of this will be considered archaic,” Tversky said. “I think we will be using DNA-engineered vaccines with more targeted components from pieces of the relevant allergic proteins.”