You or a family member may be starting treatment with oral allergy drops, also known as sublingual immunotherapy (SLIT). Recently, we have found that many people have similar questions concerning this treatment option, and this hand-out is designed to help answer many of those questions.
Please feel free to speak with one of our staff members if your questions are not satisfactorily answered, or if new questions or problems arise. By working together on your treatment plan, we will have the best opportunity for good control of your allergy symptoms.
The gradual introduction of the allergen induces a natural immunity or tolerance to the allergen. This reduces the patient's allergic symptoms and lessons (and potentially eliminates) the need for medications.
There are numerous advantages of sublingual immunotherapy:
- The patient does not have to experience repeated injections or the potential for discomfort of the upper arm at the injection site. Some people, especially children, have a fear of needles or shots. The needles used for allergy injections are tiny and are only given under the skin, but it is still a "shot".
- There is less potential for a systemic anaphylactic reaction, and there have been no reported fatalities from sublingual immunotherapy. Consequently, sublingual immunotherapy may thus be administered in the privacy and convenience of the patient's home.
- There is very little time commitment, as the treatment is administered once a day at home in a matter of minutes, eliminating the need for travel to the doctor's office and the 30 minute observation period that is required after allergy injections.
- For patients living a great distance from the doctor's office or for patients with difficult work schedules, sublingual immunotherapy offers the convenience of being able to administer the treatment wherever the patient happens to be.
There are several distinct disadvantages of sublingual immunotherapy:
- Although sublingual immunotherapy (SLIT) has been used in Europe for many years and currently accounts for more than half of all immunotherapy administered in the EU, it is still considered "investigational" and "off-label" in the United States and currently does not have FDA approval.
- Although the extracts used for sublingual immunotherapy are the same as those used for injection immunotherapy, the sublingual administration is considered "off-label" and is currently not covered by insurance plans. Therefore, the cost of sublingual immunotherapy, although comparable to the cost of allergy injections, is an entirely "out-of-pocket" expense, not reimbursable by insurance.
- Although sublingual immunotherapy has been shown to be quite effective, it may not quite be as efficacious as traditional allergy injections.
Renewal prescriptions will be prepared and are designed to last approximately 2 months (2 vials if you are on a "single prescription" and 4 vials if you are on a "double prescription"). The most concentrated maintenance bottle is labeled 1:1 (red bottle). A 10 fold dilution of this is labeled 1:10 (yellow bottle). A further 10 fold dilution is labeled 1:100 (blue bottle) which is the weakest bottle that you will start treatment with.
However, we recommend that you always have an oral antihistamine available for mild local reactions, as well as an epinephrine auto-injector (Epi-Pen) available for major systemic reactions on the way to the ER/911. These precautionary measures will be discussed with you at the time sublingual immunotherapy is initiated.