Immunotherapy Treatment Preferences

Doctor standing up facing a mom and her tween child. He is shaking the child's hand and they are all smiling.

A recent study looked at how children’s fear of needles affects their parents’ choice between allergy shots and allergy tablets. The results show that kids who are scared of needles may prefer tablets, and most parents agree. This page explains what the study found and why understanding children’s preferences can make a big difference in their allergy treatment success.

Hayfever basics

Hay fever, also called allergic rhinitis, can make kids feel miserable. Sneezing, a stuffy or runny nose, and itchy eyes can lead to poor sleep, trouble concentrating in school, and even feeling angry or embarrassed. Managing hay fever often means avoiding allergens like pollen or dust, using over-the-counter medicines, or trying allergy immunotherapy (AIT).

An infographic explains allergic rhinitis (hay fever) in children, showing symptoms, effects, and management tips with cartoon images of a sneezing child and icons representing treatments and symptoms.

Allergy Immunotherapy (AIT) basics

AIT stands for Allergy Immunotherapy. It helps the body get used to things that cause allergies. Taking this therapy for 3 years can help reduce allergy symptoms. This may decrease the need for medication over time.

AIT can also help reduce the risk of developing asthma. For children who already have allergic asthma, it can reduce symptoms and the need for asthma medicine.

TYPES of Allergy Immunotherapy (AIT) 

There are two main types of Allergy Immunotherapy (AIT)

  1. Subcutaneous immunotherapy (SCIT) 
  • These are also known as allergy shots. 
  • After a specific dose is reached, the shots are given every 2 to 4 weeks at the doctor’s office. 
  • SCIT can be started in children of any age, but it is generally not recommended for babies or toddlers.
  1. Sublingual Immunotherapy (SLIT) 
  • These are tablets that dissolve under the tongue. 
  • They are taken every day at home, starting with the first dose.
    • Grass and ragweed tablets are approved for use in children 5 years and older. 
    • House dust mite tablets are approved for people 12 years and older.
  • SLIT is available for ragweed, timothy grass, and dust mite allergies.
  • Graphic featuring the logos of Allergy & Asthma Network and ALK Abelló with text about a survey on how parents decide for children with hay fever who fear needles.
  • A graphic shows text, “Most parents said their child was very scared or somewhat scared of needles,” above a yellow circle with icons of a child holding hands with two adults. Allergy & Asthma Network and ALK logos are at the bottom.
  • A graphic states "53% of parents said they talked to their child's healthcare provider about allergy shots" with a stethoscope icon, and logos for ALK Abelló and Allergy & Asthma Network.
  • Infographic stating "43% said they had discussed allergy tablets that dissolve under the tongue, called SLIT, with their healthcare provider," with a tongue icon and logos for ALK and Allergy & Asthma Network.
  • Graphic with text: "84% of parents liked the idea of SLIT best." Includes a large exclamation mark in a yellow circle and logos for ALK Abelló and Allergy & Asthma Network on a blue and white background.
  • Blue and yellow graphic with a syringe icon in a yellow circle and text reading “6% liked shots.” Logos for ALK Abelló and Allergy & Asthma Network appear at the bottom.
  • A graphic shows "10% did not have a preference." Above icons of a pill and a syringe. ALK Abelló and Allergy & Asthma Network logos are at the bottom.
  • A graphic shows text about parents of kids scared of needles: 95% liked SLIT, only 2% like shots. Below is a yellow circle with a syringe crossed out, and logos for ALK and Allergy & Asthma Network.
  • Blue background with text: "For very scared kids, more parents said their child would be okay with taking SLIT than getting shots." Image includes a yellow circle with a blue thumbs-up and logos for ALK Abelló and Allergy & Asthma Network.
  • Infographic with icons of a family and a doctor. Text: “Most parents of children who are scared of needles prefer SLIT instead of shots. Doctors and parents should talk about needle fear when deciding on allergy treatment.”.

What did the AIT & “Needle Phobia” study find?

This study examined the impact of a child’s fear of needles on a parent’s decision between two types of allergy immunotherapy (AIT). The two kinds of AIT are subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT). These treatments help children with hay fever, even if they do or do not have eye allergies. 

Parents of children aged 5 to 17 from the United States completed an online survey. The researchers wanted to understand the parents’ treatment preferences. About 1 in 3 parents said their child had a severe fear of needles, and almost half said their child had a moderate fear.

Many parents had discussed both treatment options with a doctor. Most parents (84%) preferred the tablet form. Parents whose children were very afraid of needles chose the tablet. Parents believed their child would be more willing to take the tablets regularly. These fears should be considered when making decisions about allergy treatment. 

What should parents know about the study?

These findings show that being scared of needles can affect which allergy treatment parents choose for their children. Most parents, especially those whose children are terrified of needles, prefer the idea of allergy tablets that dissolve under the tongue (called SLIT tablets) to allergy shots. This could help healthcare providers discuss the best treatment options with families. Listening to what children and parents are comfortable with may help more children stick with their treatment and feel better.

A blue syringe crossed out by a blue diagonal line inside a yellow circle, indicating "no injections" or "no drugs.

Insights on Allergy Immunotherapy Preferences

  1. Needle–Fear Paradox: Even though 81% of children were very scared of needles, 6% of parents still chose allergy shots over SLIT-tablets. This shows that fear of needles doesn’t always stop people from getting the shots.
  2. Doctor and Parent Preferences Do Not Match: Most parents (84%) liked the tablets best, but fewer had talked about them with a doctor (43%) than had talked about the allergy shots (53%). This suggests a gap and disconnect between what parents prefer and what the doctor prefers. 
  3. Acceptance vs. Preference Mismatch: For children who were very afraid of needles, 43% of parents said their child would accept shots, but only 2% actually picked shots. This means other influences besides fear might affect their choice.
  4. Low Needle Fear, High SLIT Preference: Even when children had low needle fear, 60% of parents preferred SLIT-tablets. This means that parents liked tables for reasons other than the ones mentioned.
  5. Age-Independent Fear: Children in the study were 5-17 years old. The study didn’t find that older children were less afraid of needles. The age of the child may not change the level of needle fear. 
  6. SLIT Enthusiasm Gap: While 95% of parents of needle-fearing children picked SLIT-tablets, only 93% said their child would welcome taking them. This hints at SLIT-tablets having some drawbacks.
  7. Shared Decision-Making Oversight: The study says doctors should talk about needle fear when helping families decide on a treatment. Sometimes, this important step is missed.
  8. Words Matter: The study used the words “under-the-tongue tablets” instead of medical jargon. This may have helped parents feel more comfortable choosing the tablets. This highlights the impact of how a doctor explains things on treatment decisions.

Degree of Fear of Needles and Preferred Allergy Immunotherapy Treatment Among Children with Allergic Rhinitis: Caregiver Survey Results
Rance K, Blaiss M, Gupta P, Nolte H, Scott EP, Gardner DD.
2024
Frontiers in Pediatrics
DOI:  https://doi.org/10.3389/fped.2024.1447619

This study is supported by funding from ALK