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RATIONALE: The efficacy of subcutaneous allergy immunotherapy (SCIT) has been well established in pediatric patients with allergic rhinitis (AR) and asthma. Comorbidity between autism spectrum disorders (ASD) and atopy has been minimally studied, though a recent report found patients with ASD to have a significantly increased risk of asthma and AR. Many children with ASD have special health care needs, including management of avoidance reactions to medical procedures. Use of behavioral interventions to assist with medical procedures such as venipuncture has previously been described in children with ASD but has not been described specifically for SCIT. METHODS: We developed a visual schedule for allergy injections, provided a multimedia device for distraction, and utilized patient-specific positive reinforcement to aid in the administration of SCIT in a boy with ASD, AR, and asthma who had previously failed SCIT. RESULTS: Visual support and behavioral strategies allowed our patient to resume SCIT and achieve maintenance dosing. CONCLUSIONS: There is a higher prevalence of allergic disorders in patients with ASD. In children, it is well established that SCIT has long-term benefits for allergic asthma and can decrease further sensitization to environmental allergens. Many providers would not consider SCIT in a patient with ASD due to the need for frequent injections. We present the first described case of successful behavioral modification to weekly SCIT injections in a patient with ASD and fear of injections. Our experience may help in establishing protocols for SCIT in a population where there is a recognized need for specialized medical intervention.