Immunotherapy injections carry a small risk of a severe allergic reaction. These reactions occur with a frequency of 6 of every 10,000 injections. The symptoms usually begin within 30 minutes of the injection. For this reason, patients are required to remain in the office after routine injections so that such a reaction could be quickly treated. Because drugs called beta-blockers may interfere with the ability to treat these reactions, people who take beta-blockers are often advised to avoid immunotherapy. If patients are getting allergy shots and another clinician prescribes a beta-blocker medicine for high blood pressure or another reason, the patients must make sure to tell their allergy clinician.
In patients where the nasal polyps do not seem to respond to the above protocol (or if patient is refusing surgery), the addition of a very strong drug called Zyflo (zileuton) may be of benefit. This drug can cause liver damage (in <10% of patients) and as such, liver function bloodwork (AST/ALT) is required every month for 3 months and yearly thereafter. As long as the AST/ALT numbers do not exceed 150 (yes, it is higher than what is considered normal), it is generally considered safe to continue with this drug (though would check bloodwork weekly if that happens to ensure stability). Getting an immunologist involved in the care of such patients would also be beneficial, especially for those patients where the nasal polyps are particularly resistant to standard treatment.