Sublingual Immunotherapy (SLIT)

Please read the following frequently asked questions

What is sublingual immunotherapy?

The purpose of sublingual immunotherapy (allergy drops or SLIT) is to decrease your sensitivity to allergy-causing substances so that exposure to the offending allergen will result in fewer and less severe symptoms. It is not a substitute for avoidance of known allergens or for the use of allergy medications but rather a supplement to these treatment measures. Unlike injection immunotherapy, which is given as shots, sublingual immunotherapy is given as drops under the tongue.

What are the costs? Will it be covered by insurance?

Insurance plans do not cover sublingual immunotherapy. It is important to note, however, that sublingual immunotherapy may be a very economical choice. You will be provided more specific information at your office visit.

How do I start sublingual immunotherapy?

Request an appointment for allergy testing and evaluation to see if you are likely to benefit from sublingual immunotherapy.

How does the process work?

The first step is to confirm a patient’s allergies through the allergy testing. Then a custom-mixed vial of drops is prepared for the patient. Allergy drops are usually begun at a lower dose and gradually increased on a regular basis until a therapeutic dose is reached. Drops are administered by you at home daily. The first dose will be administered in our office.

What is the efficacy?

Allergy drops have been shown to lead to an alteration of your immune system’s response to naturally occurring allergens which allow you to tolerate exposure to the allergen with fewer symptoms. The amount of immunization is different for each person. Improvement in symptoms will not be immediate. It usually requires 3 – 6 months before any relief of allergy symptoms is noted. About 80 – 90% of patients on immunotherapy note significant improvement in their symptoms.

How long must I continue the treatment?

Most immunotherapy patients continue treatment for 3 – 5 years. Immunotherapy may be discontinued at the discretion of your doctor.

Is sublingual immunotherapy safe?

The allergens used for allergy drops are the same as those used for injections. However, the FDA specifically approved the allergens for injection use. Using them for SLIT is considered “off-label” use. Off-label use in the US healthcare delivery system is a legitimate, legal, and common practice. The protocol we use is endorsed by the American Academy of Otolaryngic Allergy. Dozens of research studies show that allergy drops are a safe, effective form of immunotherapy.

What are the adverse reactions?

Immunotherapy is associated with some widely recognized risks. There are NO reports of death associated with sublingual therapy.

• Local reactions – Local reactions are uncommon and usually restricted to itching of the mouth or upset stomach. These reactions usually occur immediately after taking a dose but can occur hours afterwards. Most reactions resolve themselves or are mitigated with dose adjustments. An antihistamine can be used as normally directed. You should notify your doctor immediately if you have any reactions.
• Generalized reactions – These reactions occur very rarely but are the most important because of the potential danger of progression to more severe conditions. These reactions include urticarial reactions (hives), angioedema or anaphylactic shock.
• Urticarial reactions (hives) – rash, swelling, and/or itching of more than one part of the body. This occurs within minutes of taking a dose.
• Angioedema – This is an extremely rare reaction to SLIT characterized by swelling of any part of the body, inside and out, such as the ears, tongue, lips, throat, intestine, hands or feet, alone or in any combination. This may be accompanied by asthma and may progress to the most severe reaction, anaphylactic shock.
• Anaphylactic shock is the rarest complication and has only been reported a few number of times. It is a serious event characterized by acute asthma, vascular collapse (low blood pressure), unconsciousness and, potentially, death.

What happens if I miss doses?

If more than one day is missed, do not try to “catch up.” Contact the office.

What happens if I become pregnant?

If you become pregnant while on immunotherapy, notify our office immediately so that the doctor can determine an appropriate dosage schedule for the drops during pregnancy.

What if I start new medications?

Please notify the office if you are starting any new medications, particularly medications for high blood pressure, migraines, and glaucoma. “Beta-blocker” medications may be contraindicated while on immunotherapy and will be handled on a case by case basis.

When do I reorder my vials?

During therapy, when your last vial is half empty, please call our office to order your new vial.

Do I still continue to see the allergy doctor?

Follow up office visits will be scheduled periodically to monitor your progress.

IF YOU HAVE OTHER QUESTIONS OR CONCERNS, PLEASE FEEL FREE TO ASK.