Sublingual Immunotherapy

Breathing shouldn’t come with difficulties. Here at Side Health™, you can learn about your allergy triggers, diagnosis, and how to treat your allergies.

What is Sublingual Immunotherapy?

An allergy develops when your body mistakes something that is harmless as foreign and creates an antibody immune response.

Immunotherapy works by giving you a small amount of what you are allergic to so that your body develops tolerance to these substances over time. Traditional immunotherapy is given as shots in your arm, whereas sublingual immunotherapy (SLIT) is given through drops under your tongue. SLIT is used to treat airborne allergies such as pollen, dust mites, molds, feathers, and animal dander.

Sublingual Immunotherapy

Why utilize Allergy Immunotherapy?

Among the wide variety of treatment possibilities available today, allergy immunotherapy is the only treatment that targets the cause of allergies and alters the natural course of the disease, which for many patients may lead to:
Improved quality of life
Decreasing need for symptomatic therapy such as antihistamines and nasal sprays
Freedom to enjoy outdoor activities during allergy season
Fewer problems having pets at home or visiting family or friends with pets.

How safe is SLIT?

SLIT has been shown over the years to be very safe. Most commonly, patients will experience mild, local reactions such as minor itching of the mouth, lips or tongue. Other symptoms may be systemic which means it affects a different area of the body. These symptoms may include sneezing, redness and itching, or hives. Serious reactions to SLIT are very rare, but patients should be monitored for them. It is important to inform our team of any side effects experienced with allergy drops and to seek treatment for any moderate-to-severe reactions.


What are the advantages of SLIT compared to injection therapy?

Compared to traditional injection therapy, SLIT is more convenient, requires fewer clinic visits, and costs less for many patients. Most importantly, allergy drops are a safe, effective treatment for young children, asthmatics, and those with underlying medical conditions that prevent them from being candidates for injection therapy.

Comparison of Allergy Immunotherapy Delivery Methods

Allergy ShotsAllergy Drops
Method of administrationShot in arm/thigh/stomachDrops under the tongue
Treatment locationPhysician's officeHome
Treatment frequencyWeekly (shots)Daily (drops under the tongue)
Treatment time before patient sees resultsSix months to two yearsMajority of patients improve in two to three months
Frequency of physician sitsEvery week for yearsOnce every three months
EffectiveYes, but markedly decreased by low compliance Yes, virtually no compliance problems
Duration of treatmentThree to five yearsThree to five years
Risk of anaphylaxisSmallRare, none reported
Adverse reactionsMultiple; swelling, itching hayfever, etc. No significant reactions are common
Allergy testing requiredYes, as needed Yes, as needed
Contraindications Yes (beta-blotters, history of anaphylaxis, young children, infants, severe asthmatics) Caution with severe asthmatics
Time requirementDriving each week to and from physician's office and waiting after each shotAdminister yourself in the comfort of home and hold for two minutes under tongue
Insurance coverage for allergy testing Yes, but call your insurance for your specific benefits Yes, but call your insurance for your specific benefits
Insurance coverage for shots/drops YesNo, possibly on a case by case basis

What is the process and how do I get started?

Identify – Before starting treatment, it is essential that allergies are tested and confirmed through history and blood testing. We will begin with a patient questionnaire and a televisit with one of our providers to dive deeply into your allergy history.

Test – We are able to test you for a broad range of allergens from a simple blood sample. Our office will send you a blood sample kit with a simple finger stick that will be used to apply a few drops of blood to a card. The card is then mailed back in an envelope to be analyzed.

Order – Your provider will review the results of your testing with you and order individualized vials based on your history and the results of your blood testing. The most commonly treated allergens include house dust mites, pollens (from grasses, trees, and weeds), dander (from pets and other animals), and molds. The products mixed for your allergy immunotherapy are called allergenic extracts. These are natural, purified preparations made from the actual allergen source and are approved for clinical treatment.

Mix – Your individualized vials will be mixed. Usually patients undergoing allergy shots are receiving 2-4 injections each time, one for each vial. With SLIT, the serum is most often mixed into 1 vial.

Treat – Once you receive your vials, it is important that you call our office so that we can set up a telemedicine visit for you. Your provider will walk you through the way to use your vials and watch you administer your first dose. Simply administer the number of drops indicated for that day under your tongue and hold the medicine there for a couple of minutes. It will be important to take your medication daily as instructed and ideally at the same time of day. Your provider will work with you to develop a treatment plan and determine the frequency of your visits.

What are the phases and what is the duration of treatment?

Immunotherapy occurs in two distinct phases: build-up and maintenance. The “build-up” process begins with the administration of a weak concentration of an allergen extract. Your immunotherapy dose will become increasingly stronger until you reach the maximum dose. This phase can be as short as a few weeks or several months depending on your sensitivity to the allergens and your specific treatment plan. Once you have reached your maximum dose, you enter the “maintenance” phase of treatment. Immunotherapy is recommended for 3-5 years. However, the length of treatment is determined by your degree of symptom relief and your physician’s recommendation.

Contact our team so we can provide you with a consultation to determine if sublingual immunotherapy is right for you.
For more Q & A about sublingual immunotherapy,

Question & Answer


What types of allergies can be treated with allergy drops?

Allergy drops are effective for indoor and outdoor allergens, such as grass, weeds, trees, molds, non-stinging insects, dust mites, and animal dander.

How do I take drops?

Patients take the drops themselves at home. The allergen extract is provided in bottles that have a dropper. Drops should be taken in the morning. Patients should place drops under the tongue, hold there for two minutes, then swallow. We recommend no food or water for a period of five minutes after taking a dose. After that, there are no restrictions for eating or drinking. There are no restrictions for eating or drinking before taking the drops.

How often do I take the allergy drops?

First, there is a “build-up phase.” This involves once-a-day doses of drops that start at a lower concentration. Gradually, the number of drops and vaccine concentration increases over a period of several weeks/months. After this initial phase, patients transition to a once-a-day dose. The usual course of treatment is 3 to 5 years.

What do I do if I forget to take my drops for a few days?

Resume the drops as before without any change. If it has been longer than 3 weeks, contact your provider.

How long will it take before I begin to feel improvement in my allergy symptoms?

Many patients begin to see results as early as 3-6 months or shortly after reaching maintenance. The key to success is being patient and consistent in taking your medication. Your chances of seeing improvements in your allergy symptoms drastically increase the closer you follow your physician’s treatment plan.

How long will treatment last?

On average, treatment with allergy drops are once daily for 3-5 years. In some severely allergic patients, treatment may last longer.

What do the drops taste like?

The glycerin additive mixed with the extract gives a slight sweet taste. Since there are no taste buds under the tongue, most patients experience very little taste sensation.

Do I need to keep vials refrigerated?

The glycerin additive is a preservative which helps to maintain stability. However, it is best to keep vials refrigerated, when possible, to insure maximum potency. Avoid extreme heat or cold.

When should I not take my allergy drops?

If you are running a high fever, wheezing, having difficulty breathing, have open wounds in your mouth, recently had a dental procedure or have a Peak Flow reading of less than 75% of your personal best, do not take your drops. If you are, or become, pregnant please notify your provider.

What type of allergy testing is performed?

A simple blood test is utilized via fingerstick.

When do I need to be retested for my allergies?

Typically there is no need to retest. Your provider will evaluate your progress with therapy and order retesting as needed.

Do I need to have an Epi-Pen?

Yes. Although rare, it is important to have an Epi-Pen available in case of a moderate-severe allergic reaction to allergy drops.