Allergy Immunotherapy

What is allergy immunotherapy?

Immunotherapy is a process that trains the body's immune system to build a tolerance to allergens (ignore their presence) over time. It is the only treatment available that actually "cures" an allergic person's sensitivity to allergy triggers. Unlike medications, which suppress symptoms but do not stop the underlying allergic reaction, immunotherapy builds immunity that counteracts and reduces the allergic reaction itself. Many consider this a more "natural" solution to the allergy problem.

We now offer two possible ways of administering allergy immunotherapy:

  1. Allergen immunotherapy by injection aka Allergy Shots
  2. Sublingual immunotherapy, aka “allergy drops” and "sublingual tablets"

What are traditional "Allergy Shots”?

Allergen immunotherapy by way of injections has been used for decades in the U.S. and throughout the world as a means of building lasting tolerance to pollens, dust mites, molds, cats, dogs, other pets, and even bee or fire ant venoms. After identifying what is causing allergy symptoms by allergy skin testing and/or allergy blood tests a specially customized vaccine is made containing these naturally occurring proteins. Through a careful build-up process over several weeks, followed by gradually increasing intervals between injections toward monthly maintenance dosing, allergic individuals can often build enough immunity to tolerate exposure to grass, wind, dust, or pets. Once adequate protection has been achieved, shots can generally be stopped with lasting results.

Advantages of “allergy shots”

  • 100 years of experience with use in the U.S. and the world
  • Well-established protocols for dosing, effectiveness, and safety
  • Proven long term beneficial effect after discontinuation of shots
  • Covered by most insurance plans
  • Can simultaneously build tolerance to many pollens and environmental allergens (dust mite, dog, cat, molds, grasses, trees, and weeds)
  • Can treat bee venom allergies
  • Maintenance dosing is usually once a month
  • Injections are quick, small volume, in soft tissue of arm (not in the muscle like most other vaccines)

Disadvantages of “allergy shots”

  • Injections may be an issue for needle phobic individuals
  • Requires travel to the office for administration
  • Requires observation in the office after injections to observe for possible reactions, and to assist with future safe dosing

What is sublingual immunotherapy (“allergy drops”)?

Sublingual immunotherapy is an alternative way to treat allergies without using shots. Small doses of an allergen are given under the tongue to build tolerance to the substance and reduce symptoms. Although this form of treatment has been used in Europe for years, FDA approval is pending in the U.S., with promising results in many clinical trials that have been ongoing for years. Materials are very similar to those used in the more traditional “allergy shots” but can be administered safely at home on a daily basis.

Advantages of “allergy drops”

  • Convenience of self administration at home (after the first dose given in the office under observation)
  • Lower risk of severe allergic reaction
  • Time savings by eliminating the need to drive to our office, observation time after injections
  • No needles involved, for those with needle phobia

Disadvantages of “allergy drops”

  • Most insurance companies are not covering the cost of the materials (though there may be cost savings by eliminating the need for driving to the office or co-payments for injections)
  • Pending FDA approval in the U.S., although this method has been used by allergists in Europe for many years
  • Long-term effectiveness and ideal length of treatment course are still under study
  • Desensitizing to many allergens at once may not be possible
  • Cannot use for bee venom allergy

Payment for Immunotherapy Treatment

Traditional allergen immunotherapy (“allergy shots”) are a covered service through most insurance carriers, though there may be a coinsurance amount that your insurance leaves as your responsibility. Our staff can assist you in checking insurance benefits. However, estimates quoted to us are not guaranteed to reflect actual insurance payment, so we encourage you to check with your insurance carrier directly to clarify your benefits.

Since sublingual immunotherapy is relatively new in the United States, at this time sublingual immunotherapy is not covered by most insurance carriers and the cost of the vials of medication will be the sole responsibility of the patient. If you are a good candidate for “allergy drops”, our staff can give you a breakdown of costs for the vials depending on the number of allergens you will be receiving.

How do I get started on allergen immunotherapy?

If the treatment plan designed for you after complete allergy evaluation includes allergen immunotherapy, your doctor will discuss injection and sublingual immunotherapy alternatives with you. Depending on the route you choose, an appropriate allergy vaccine kit will be prepared for you, usually within one week.

You will then need to be seen in our office for the first dose of either allergen injections or sublingual immunotherapy so that we can answer your questions, have you sign the required consent forms, take your first dose under our supervision, and be observed for at least a half an hour in order to safely monitor you for any reactions.

If you have chosen sublingual immunotherapy, we will provide you with written dosing guidelines and renewal instructions and be available to answer your questions during your office visit and thereafter. Finally, you will receive detailed instructions to follow at your home. When all is in order you may take your treatment vials with you for administration of your daily doses at home.

How quickly will I see relief of my allergy symptoms?

Although treatment success varies from patient to patient, we anticipate that you will see improvement within the first few months of treatment with either type of immunotherapy. 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. Your allergist will see you for office visits on a regular basis during the course of your treatment, in order to safely monitor and adjust your dosing as needed.

Is there a minimum age for use of “allergy shots” or “allergy drops”?

The ideal starting age for “allergy shots” depends on the severity of symptoms, response to other types of treatment, and the patient’s tolerance for injections. In most cases, this is age 6 yrs or greater, but in selected instances it may be possible and desirable to start earlier.

There are no age restrictions for sublingual immunotherapy, though it may be impractical for very young children since cooperation is required to keep the drops under the tongue for 2 minutes. Also, very young children may not be able to adequately describe any symptoms or side effects that might result, so that proper adjustment of the treatment can be made.

How will the dosing proceed?

For traditional “allergy shots”:

First, your own allergen extracts (“allergy serum”) are prepared to reflect your specific allergies found on skin testing. Our dosing protocol begins with a twice a week build up phase usually lasting about 10 weeks, gradually building tolerance to the allergens in your mixes. You begin by receiving small amounts of diluted “allergy serum”, gradually increasing the amount and concentration as tolerated till you reach a “maintenance dose”. This is the dose you will continue to receive throughout the course of your treatment. Then we will gradually move you to longer intervals between injections, till you are at monthly maintenance dosing. The decision regarding when to discontinue your injections will be based on your response to the treatment program. In order to minimize relapse of allergy symptoms after the shots are discontinued, approximately 5 years of monthly “allergy shots” are anticipated; stopping sooner may result in a greater risk of relapse.

For sublingual immunotherapy (“allergy drops”):

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 30-45 days. At the 30-45 day point, you will begin a “maintenance dose” 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 initially, possibly less often after 1-2 years depending on how well you are doing.

How will the drops be administered?

The allergy vaccines are provided in amber glass bottles with a pump dropper mechanism that dispenses accurately measured drops. Dosing should be done in the morning, preferably before breakfast. Rinse your mouth 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 extract under the tongue. Resist the impulse to swallow for two minutes. A minimum period of two minutes of contact is necessary to ensure that the cells in the lining of your mouth can grasp the proteins in the mix for transfer to the cells of your immune system. 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 types of immunotherapy carry extra risk if you are taking a beta-blocker medication (usually used for high blood pressure, fast heartbeat, heart rhythm problems or glaucoma). It is important to inform your other doctors and pharmacist so that they can 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 in order to discuss before taking any additional doses of your allergy 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 your sublingual immunotherapy is initiated.