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.
Why utilize Allergy Immunotherapy?
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?
Comparison of Allergy Immunotherapy Delivery Methods
|Allergy Shots||Allergy Drops|
|Method of administration||Shot in arm/thigh/stomach||Drops under the tongue|
|Treatment location||Physician's office||Home|
|Treatment frequency||Weekly (shots)||Daily (drops under the tongue)|
|Treatment time before patient sees results||Six months to two years||Majority of patients improve in two to three months|
|Frequency of physician sits||Every week for years||Once every three months|
|Effective||Yes, but markedly decreased by low compliance||Yes, virtually no compliance problems|
|Duration of treatment||Three to five years||Three to five years|
|Risk of anaphylaxis||Small||Rare, none reported|
|Adverse reactions||Multiple; swelling, itching hayfever, etc.||No significant reactions are common|
|Allergy testing required||Yes, as needed||Yes, as needed|
|Contraindications||Yes (beta-blotters, history of anaphylaxis, young children, infants, severe asthmatics)||Caution with severe asthmatics|
|Time requirement||Driving each week to and from physician's office and waiting after each shot||Administer 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||Yes||No, 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.
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,