Sublingual Immunotherapy - Allergy Drops


Allergy symptoms result from the immune system reacting abnormally to a harmless substance as though it were a dangerous invader.

The mainstay of allergy treatment has been to treat the symptoms directly. That is, we use medications such as topical nasal steroid sprays to treat nasal congestion, or oral antihistamine pills to treat sneezing and runny nose. These medications do not treat the allergy, just the allergy symptoms.

For patients who struggle to control their symptoms adequately with medications, those who struggle with side effects of medication use, or those who simply desire to be less reliant on daily medications, immunotherapy should be considered.

Instead of just treating the symptoms of allergies, immunotherapy actually treats the allergy itself, down-regulating the abnormal and exuberant immune response to a more normal tolerance of the allergens.

There are two forms of immunotherapy currently being widely practiced in the United States: subcutaneous immunotherapy (SCIT, or "allergy shots"), and sublingual immunotherapy (SLIT, or "allergy drops"). Studies show similar effectiveness between the two treatments. Allergy drops therapy carries the advantage of being a safer and generally gentler approach, with lower incidence of both serious reactions and side effects. In fact, I have found that even patients who had to discontinue allergy shots because of side effects or reactions still tend to tolerate allergy drops just fine. Allergy drops is more convenient in that it is performed by the patient at home, whereas allergy shots need to be administered in a doctor's office.

In my practice, we offer allergy drops therapy. For the reasons noted above, we do not perform allergy shots.

The allergy drops are custom mixed based on an individual patient's allergy profile, which is determined by allergy testing. The drop is administered under the tongue by the patient once a day. Patients are instructed to allow the drop to stay in place without swallowing for 2 minutes, then to avoid eating or drinking for 10 minutes after each dose.

Allergy drops therapy progresses in 2 phases: escalation and maintenance. In my practice, we follow the well established American Academy of Otolaryngic Allergy (AAOA) protocol. During the escalation phase, the dose/concentration of allergens in the drop is gradually increased over a 3 month period up to a level that induces immune system tolerance. Once this level is reached, the same dose is continued as maintenance therapy. Studies suggest that a maintenance therapy period of 3-4 years is necessary to induce long term immune tolerance. At that point, many patients can discontinue therapy and still have many years, if not a lifetime, of allergy relief.

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© 2017 by Jonathan C. Mills, MD