Alternatives to allergy shots such as sublingual immunotherapy, “allergy drops” or “sublingual immunotherapy” has become available in the United States but are still not FDA approved. They have been used for many years in Europe and may be effective for some patients with one or a few allergies. However, there may be a limit to their ability to help persons with many environmental allergies. This means that most insurance companies opt out of coverage for sublingual immunotherapy at present.
Allergy drops are best used in a patient with one or a few allergies, rather than the patient that is allergic to “everything”. It involves placing a liquid containing allergy extracts under the tongue, holding it there and then swallowing. This is usually only done once in the allergy clinic and then the patient self-administers his/her own allergy drops at home. Similar to allergy shots, the dose is started below the allergic threshold and gradually increased to the maintenance level. While similar, sublingual tablets are best used according to manufacturer recommendations.
While many patients with allergy shots notice partial relief by 3-6 months and feel better within the year after initiation, information about sublingual immunotherapy indicates that it may be necessary to use them consistently for 12-16 weeks prior and through the targeted allergy season and for up to 3 years for a noted improvement (about 30% improvement each season). Some patients will opt to start with allergy shots and bridge with therapy like allergy drops.
There is also great concern in the allergy community that patients tend to give these drops to themselves and do on occasion have severe allergic reactions. In clinical trials designed to prove safety and efficacy, some of these reactions were life-threatening and the frequency, if an effective dosage was given the reaction rate approaches that of allergy shots. Whereas a local swelling at the site of the injection is the most common adverse reaction to allergy shots, local reaction in the form of nausea, loose stools, and abdominal discomfort are common with allergy drops. Also, there is no consensus as to dosage adjustment with food or gastrointestinal illness. There is also a higher rate of inflammatory bowel syndrome and microscopic colitis in patients placed on sublingual immunotherapy although this is rare.
Nonetheless, this may be an option for a patient with one or several environmental allergies. If a year-long trial, however, does not work, it is still worth either continuing for a full three seasons or trying allergy shots as this method has been around since the early 1900’s and has a proven track record.
Because allergic reactions can be severe and state-of-the art knowledge is always changing, a patient should consider using an American Board of Medical Specialties Allergist & Immunologist when choosing who will oversee their treatment.
