Oral Allergy Drops ( No Needles, No Injections !! )
Allergist Answers Questions
Yes, Allergists now have an alternative to Allergy Injections!! READ ON . . . . . . .
Why Allergen Immunotherapy?
Allergen Immunotherapy is a type of preventive treatment for allergens such as pollen, mold, dust mites, and animal danders. While medications such as antihistamines and nasal sprays only treat the symptoms, Allergist prescibed appropriate Allergen immunotherapy treats theunderlying cause of the allergic reaction by inducing Immune tolerance to these antigens. It is done by administration of gradually increasing amounts of the specific antigens.
Why sublingual immunotherapy (SLIT)?
Until recently, the only way to successfully administer Allergen Immunotherapy in the United States was by injections (allergy shots) at the Allergist’s office. Oral Allergy Drops or Sublingual immunotherapy is now being offered by many Allergists in the United States and is an injection-free procedure that offers patients the freedom to treat their allergies conveniently in their own home.
What are some advantages of sublingual immunotherapy compared to traditional allergy injections?
There are numerous advantages of sublingual immunotherapy:
Main Advantage: No needles, No Injections, No Shots!
Much Less Risk of Systemic Anaphylactic Reaction, so that sublingual immunotherapy can be administered at home.
Time Savings: Treatment is administered once a day at home in a matter of minutes, eliminating the need for travel and wait in the doctor’s office, and the mandatory 30 minute post injection observation period that is required after allergy injections.(Average: 60 minutes in Allergist’s Office plus the to and fro travel time)
For patients living a great distance from the Allergist’s office or for patients who travel frequently, sublingual immunotherapy offers the only way they can get Immunotherapy.
For working people (including full time moms) with very busy schedules, for children who cannot miss school or sports, for professionals who cannot miss work , and for anyone who just does not have the time to go sit in the Allergist’s office every week, this is the solution.
What are the disadvantages of SLIT?
There are several distinct disadvantages of sublingual immunotherapy:
FDA “Off Label Use”: Although sublingual immunotherapy (SLIT) has been used by Allergists in Europe for many years and currently accounts for more than half of all immunotherapy administered in the European Union countries, it is still considered “investigational” and “off-label” in the United States, and currently does not have FDA approval. However it is perfectly legal for a doctor to prescribe it and for a patient to take it as prescribed
Financial: Since it is Off Label, most Health Insurance Plans in the US refuse to cover sublingual immunotherapy. Therefore the cost of allergy vaccine is fully borne by the patient. So each patient needs to evaluate if for an equally effective treatment, the above mentioned advantages in terms of money value of time, convenience and the needle prick factor are worth the expense. Additionally, since it is a medically prescribed treatment for an illness the cost may be tax deductible under medical expenses and /or in a Health Savings Account (Double check this with your tax advisor, please.)
Only For Inhalants: Sublingual immunotherapy has been shown to be as effective as Allergy Injections only for Inhalant Allergies. At present it is not recommended for Food Allergies, although this may change soon, as many studies are showing promise. SLIT is not recommended for Insect Sting allergies, Drug Allergies, Urticaria, or Contact Dermatitis Allergies (such as Poison Ivy Allergy).
How do I get started on sublingual Immunotherapy?
After your complete Allergy Evaluation if the treatment plan designed for you includes Inhalant Allergen Immunotherapy, your Health Care Provider will discuss injection and sublingual immunotherapy alternatives with you. Depending on the route you choose, appropriate allergy vaccine kit will be prepared for you, usually within one week. We will then need to see you in the office to answer all your questions, to have you sign the consent forms, to have you take the first dose in our presence, to observe you for at least a half an hour for any reactions, and to give you detailed instructions. If it is sublingual vaccine, you may then take your treatment vials with you for administration of daily doses at home. We will provide you with written dosing guidelines and renewal instructions and answer all your questions.
How quickly will I see relief of my allergy symptoms?
Although treatment success varies from patient to patient, we anticipate improvement within the first few months of treatment. Maximum benefit may take a year or so of regular therapy. Adjustments to your dosing may be made as the treatment progresses and the vaccine vials are renewed. We will expect you to keep us informed about how you are responding to the treatment. Of course, we will see you for periodic office visits on a regular basis.
Is there a minimum age for use of SLIT?
There are no age restrictions for sublingual immunotherapy, although it is rare to begin any form of immunotherapy prior to age five.
How will the dosing proceed?
There is an initial “build-up phase” that involves once-a-day dosing, beginning with a single drop from a lower concentration and gradually increasing the drop number and then the vaccine concentration over a period of 30 days. At the 30-day point, you will begin Maintenance dosing regimen with 5 drops as the Full Strength Vaccine. This 5 drop-per-day dose will be continued long term for control of your allergies as described below. We will need to see you in the office every three months at least thru the first year and then less often.
How will the drops be administered?
The allergy vaccines are provided in convenient Amber-Glass bottles with a pump dropper mechanism that dispenses accurate and exact drop size. Dosing should be done in the morning, preferably before breakfast. Rinse your mouth real well, open your mouth, lift your tongue so it touches the palate, then place the correct number of Drops under the tongue and hold it there for 2 minutes. There will be some salivation. Let it spread the vaccine under the tongue. Resist the impulse to swallow for two minutes by the watch. You can then slowly swallow the vaccine. A minimum period of two minutes of contact is necessary to ensure that the dendritic cells in the mucosa can firmly grab the antigens for transfer to the lymph tissue. Do not spit out the vaccine (except in the very unlikely event that you notice symptoms such as severe itching or swelling of the tongue) and do not eat, drink or rinse your mouth for a period of 5 minutes after dosing. After that, there are no restrictions on eating or drinking.
Do the drops have any taste?
Due to the glycerin additive mixed with the extract, there may be a slight sweet taste. However, since there are no taste buds under the tongue, most patients experience very little taste except momentarily when swallowing at the end.
Are there any medications that could interfere with my sublingual immunotherapy?
All kinds of immunotherapy, carries extra risk if you are taking a beta-blocker medication (usually used for high blood pressure, fast heartbeat, heart rhythm problems or glaucoma). Please inform your other doctors and pharmacist to warn you if any beta blocker containing drug is prescribed to you. If so, or if you are not sure what the medication is, please call our office and discuss before taking any more dose of the vaccine.
What are the potential side effects of sublingual immunotherapy?
Reported reactions to sublingual immunotherapy include itching of the tongue or lips (the most common reaction), gastrointestinal symptoms such as nausea and cramping, skin rashes including hives, and very rarely headaches. Systemic reactions (anaphylaxis) have been reported and may include symptoms such as throat tightness, wheezing, and a drop in blood pressure. These systemic reactions are extremely rare; there has never been a reported incidence of a fatal reaction to sublingual immunotherapy. However, you must always have an oral antihistamine available for mild local reactions, as well as an Epinephrine auto-injector (Epi-Pen® ) available for systemic reactions. These precautionary measures will be discussed with you at the time sublingual immunotherapy is initiated.
We look forward to serving you.
What does the Agency for Healthcare Research and Quality of the US Dept. of Health and Human Resources say about Allergy Shots and Allergy Drops. Read Here.