Background: Although most allergists agree that local reactions to immunotherapy are not predictive of future systemic reactions, the 2 main reasons for dose adjustments are the concern that local reactions cause discomfort that may lead to patient noncompliance and the concern that local reactions are predictive of future local reactions. Objectives: To determine patient perceptions regarding local reactions from immunotherapy. Methods: A survey on allergen immunotherapy was provided to patients. Participants were asked about the presence of local reactions, the size of their local reactions, and how bothersome these local reactions were. Patients were also asked if they had considered stopping immunotherapy because of these local reactions. Results: All 249 patients undergoing immunotherapy completed the survey. Seventy-one percent of the patients reported that they had experienced a local reaction during allergen immunotherapy. Of those patients who reported local reactions, 84.7% reported local reactions smaller than the palm of the hand and 81.9% deemed local reactions not to be bothersome at all or only slightly bothersome. Of those who experienced local reactions, 96.0% stated they would not stop immunotherapy because of these local reactions. Conclusions: Although most patients reported local reactions, these local reactions were usually small and not very bothersome. Most patients would not stop allergen immunotherapy because of local reactions.