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Dear Dr. Roach: After giving myself allergy shots at home for years, my allergy doctor’s group has decided that it’s too dangerous for patients to do this anymore. The allergy practice will no longer send a vial unless you can prove the shot will be given in a medical facility. Even if you are a nurse or doctor yourself, you still must prove that the shot will be given in a medical facility! Of course, there is a charge per shot if you drive across town to have the allergy practice’s nurse give it.

Not long after getting this notice, I read an article about a local child who has improved an insulin injection device. After the alteration, several more doses could be extracted. The article also mentioned children being able to give themselves insulin shots at school!

This is such an obvious money grab. How can it be safe for children to give themselves insulin at school but too dangerous for adults to give themselves shots at home?

Do you know any reason for this change of policy for giving shots other than docs who can’t get more patients, so they bleed the ones they have dry?

P.S.

Dear P.S.: Insulin therapy is very different from allergy shots. Insulin is routinely given at home, work and school, and is very safe.

The difference with an allergy shot is that you are getting a substance you are known to be allergic to. Comparatively, there is a significant risk of an allergic reaction. Only 3 to 5 percent of people getting allergy immunotherapy will have a systemic reaction, and only 1 out of 5,000 shots or so will require epinephrine. That might not sound like a high risk, but for a busy allergy clinic, that means about one person per month. The epinephrine is used to both treat and prevent life-threatening reactions.

The guidelines from allergy experts clearly state that injections must be given under qualified medical supervision. Your doctor’s group was not following the standard of care before.

Dear Dr. Roach: I keep hearing advice to sneeze into your elbow. My arms are unusually long, and my elbow is too far out to contain the sneeze or cough.

I worked in a hospital kitchen, and when we had to cough or sneeze, we were told to pull our scrub top over our nose and create a place to contain the germs.

That seems to be the better thing to do, to me. I also learned, the hard way, to wear a T-shirt underneath.

J.T.

Dear J.T.: That’s hysterical.

The main point is not to cough or sneeze into your hands, especially for people who work with food and those who work in a hospital. If a tissue isn’t handy, the elbow cough is one method. In fact, I just watched a video on the “Dracula cough,” which teaches children to cough as if they were wearing a cape. Using your shirt is another method. None of these methods is perfect, but any one of them is a lot better than sneezing into your hands or into the air with no protection at all.

I’m sure some people will appreciate your advice about the T-shirt as well.

Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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