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Allergy Drops vs Allergy Shots

Many people ask about “the drops under the tongue to treat allergies instead of shots.” Allergy shots (subcutaneous immunotherapy, or SCIT) are a long-standing, effective form of treatment for hay fever and respiratory allergies.

This involves injecting gradually increasing amounts of an allergen such as grass, cat or dust mite under the skin to build up an allergen tolerance and reduce annoying symptoms. It is highly effective in reducing and often eliminating allergy and allergic asthma symptoms. It is also a cost-effective method of treating allergies and is covered well by most insurance companies. Allergy shots not only treat allergies but are also a part of asthma treatment guidelines. It has been shown to be beneficial in improving allergic asthma and may even prevent asthma.

Sublingual immunotherapy (SLIT) is a variation of this therapy that delivers an allergen solution under the tongue rather than through injection. However, this form of therapy has not been approved in the United States. Some doctors are buying extracts licensed for injection and instructing the parents to administer the extracts using a dropper under the adult or child’s tongue. While FDA considers this the practice of medicine (and the agency does not regulate the practice of medicine), parents and patients should be aware that there are no allergenic extracts currently licensed by FDA for oral use. Consequently, there is no insurance coverage, and you will have to pay cash out of pocket for this treatment.

Despite its use elsewhere, it has not been approved for use in the United States because there are so many major limiting factors and unanswered questions regarding its use. First, there are not established effective doses. Patients doing SLIT are paying out of pocket for a treatment where the effective dose to use has not been determined by investigational studies. Second, the studies that have shown safety and efficacy with SLIT have only used one allergen extract, such as grass. It has yet to be shown to be effective when multiple allergens are combined together as we have to often do in the U.S. A study comparing timothy grass by itself with the same dose of timothy grass administered in combination with 9 other pollen extracts suggests that efficacy might be seriously reduced with administration of multiple allergen extracts sublingually. The average American is allergic to a variety of things and not just one thing. The typical allergen extract for use in the U.S. contains 8 unique allergen extracts. Until these limitations are overcome, the administration of allergen immunotherapy through the sublingual route must be considered as ‘‘investigational’’ in the United States.

There are many treatment options available for allergies, when investigating the most appropriate course of action for you or your children, I recommend seeking out a specialist who is board certified by the American Board of Allergy and Immunology for advice on allergy treatment. Studies show you will get more symptom control at lower cost when an allergist treats your allergies and asthma.

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