Sublingual Immunotherapy – Allergy Drops Placed Under the Tongue are an Effective Alternative to Shots

Get the drop on your allergies
Allergy drops and allergy shots (Allergen immunotherapy) are a preventative treatment for an allergic response to allergens such as pollen, mold, dust mites, and animal dander. Allergen immunotherapy fundamentally treats the underlying cause of the allergic reaction, while medications such as antihistamines and nasal sprays only temporarily treat the symptoms. Immunotherapy involves administering gradually increasing doses of the “causative allergen” to the allergic patient. The gradually increasing amount of the allergen induces a natural immunity or tolerance to the allergen. This reduces the patient’s allergic symptoms and lessens (and potentially eliminates) the need for medications.

Until recently, the only way to successfully administer allergen immunotherapy in the United States was by injections at the doctor’s office (thus the term “allergy shots”). Sublingual immunotherapy is now being introduced in the United States. It is an injection-free method of providing immunotherapy that offers patients the freedom to treat their allergies conveniently and safely in their own home.

How Does Sublingual immunotherapy Work?

Sublingual immunotherapy (SLIT or Allergy Drops) is the name given to allergy vaccines that are administered orally. The vaccine, rather than being administered by an injection, is administered as oral allergy drops that are placed under the tongue (“sublingual”) by the patient, held there for a short period of time, and then swallowed. Some medical authors call this route of administration the “sublingual-swallow mode” of immunotherapy. Sublingual immunotherapy is a unique immunotherapy modality that combines safety and convenience with excellent clinical benefit. Popular in Europe for many years, sublingual immunotherapy is now being introduced into the United States and is gaining in popularity as the ease and effectiveness of this method is recognized by busy patients as well as children and others who prefer to avoid needles. Advantages of sublingual immunotherapy include a safety profile that allows the treatment to be administered at home, avoiding the 30 minute wait in the office after injections, and saving the patient travel time and expense, as well as clinic visits. The lack of injections makes sublingual immunotherapy easier for children and many adults to tolerate the treatment. It is also an ideal treatment for patients who travel frequently or who live a long distance from their physician’s office.

How Well Does SLIT Work?

Although SLIT accounts for more than half of all allergen immunotherapy administered in Europe, it is currently considered “investigational” and “off-label” in the United States. Even though the allergen extracts that are used for subcutaneous (injection) immunotherapy (SCIT) and for sublingual immunotherapy (SLIT) are the same and are licensed for use in the United States for SCIT, the FDA has not yet approved the extracts for SLIT. Because of this “off-label” status for sublingual immunotherapy, insurance companies are not currently reimbursing this form of treatment, making the expense “out-of-pocket”. Nevertheless, the overall cost of SLIT is significantly less than a lifetime of allergy medications and office visits for allergy-related illnesses and is comparable to the overall cost of receiving subcutaneous (injection) immunotherapy. There are many published articles detailing the results of clinical studies and clinical experience with sublingual immunotherapy. Recently in March 2013, an article published in JAMA (The Journal of the American Medical Association) obtained data from 63 studies that showed evidence to support the effectiveness of sublingual immunotherapy for the treatment of allergic rhinitis. We anticipate that the insurance reimbursement issue will be resolved in coming years, as the FDA is currently looking at several oral allergy vaccine products for potential approval. Patients often ask if all allergy drop procedures are equal, and the answer is a definitive NO! There are many clinics throughout the United States that are offering a generic mix of sublingual immunotherapy that is preformulated, prepared by a vendor, and not specific to the results of your allergy testing. At CornerStone Ear, Nose & Throat, PA our clinic follows the protocols established by the American Academy of Otolaryngic Allergy (AAOA), the only national association in the United States that currently has a position statement on sublingual immunotherapy. We offer targeted sublingual immunotherapy specific to the antigens that you test positive for during your allergy testing, and your sublingual treatment bottles are prepared in our clinic not by an outside vendor. Sublingual immunotherapy offers substantial benefits without many of the problems associated with injection immunotherapy and is rapidly becoming the preferential treatment for airborne allergens (pollen, mold, dust mites, and animal dander).

William A. McClelland, MD, FACS - Board Certified Otolaryngologist (ENT)
About the Author
Otolaryngologist (ENT) at CornerStone Ear, Nose & Throat, PA
Dr. McClelland is a Board Certified Otolaryngologist (ENT) as well as the Founding Partner of CornerStone Ear, Nose & Throat, PA. His particular clinical interest is minimally invasive sinus surgery.
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