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What is Sublingual Immunotherapy


Sublingual Immunotherapy (SLIT) is a noninvasive treatment for allergy symptoms caused by allergens (substance that causes an allergic reaction.) Allergy shots (subcutaneous immunotherapy) have been a common treatment for environmental allergies in the United States for decades.

Unlike allergy shots, SLIT treatment is dissolved under the tongue (sublingual) and can be taken in the comfort of the home. Research studies found SLIT to be as effective as traditional allergy shots. An additional benefit to this therapy is that it eliminates the need for painful needle pokes and reduces the number of appointments at your medical office. A drawback to this therapy is that most insurance providers in the United States do not cover this treatment.

Who is a candidate for allergy drops?

Young man suffering from allergy to cat hair

Almost everyone who has allergy to airborn proteins (house dust, pet dander, molds, and pollens) can be effectively treated with SLIT. Even children and adults with disabilities can recieve this simple treatment.

SLIT is suitable for all ages from 3 years old and up. Children enjoy this treatment, because it is done at home and does not involve shots! It saves time to adults because there are no long visits to the clinic – the drops take 5 min to administer. This treatment is home-based due to safety and ease of self-administration.

We recommend SLIT for everyone who travels a lot. Immunotherapy with injections must be performed in the office only, and it is less efficient if you start missing many doses. SLIT is portable and can be stored at room temperature – it is easy to take it with you while traveling.

If you have a pet and developed allergy – SLIT will allow you to treat the symptoms efficiently and without the need to give your pet away. We love pets and believe in best treatment instead of abandoning your loved one!

Hay fever is a significant problem – it is allergic reaction to seasonal pollen of grasses and treas. Ragweed season is not very common for California, but it is a significant problem on the East Coast. Sublingual drops can be taken seasonally starting right before the pollen starts to fly. We love to see how fast our patient recover from annoying allergy symptoms. SLIT works within few weeks. Rapid schedules are available for those who come in the middle of the season – it works great.

What are SLIT advantages over other allergy treatments?

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SLIT has direct advantages over the allergy shots:

No systemic reactions (anaphylaxis) has been reported with that (a huge advantage compared to traditional shots)

You can keep pets when starting treatments

Starts working fast. It takes only one month to build up the top (protective dose) compared to allergy shots (it takes up to 6-8 month to see the benefit)

No weekly clinic visits. You need 3-4 visits a year to ensure your treatment works great.

Freedom of time and travel. Your SLIT can go where you are! It does not require refrigeration and can be carried in your backpack or purse. Ask for a Doctor’s note when flying and taking drops on a plane.

Which allergy symptoms SLIT can treat?

indian man rubbing nose

SLIT therapy is a long-term solution for environmental allergy symptoms. In the U.S., the FDA has approved its use for ragweed and northern pasture grasses (such as timothy and dust mites.) However, in European countries, SLIT therapy has been approved to treat a wide range of environmental allergies including some food allergies. About 20-30% adults suffer from allergies. Common symptoms include:

  • sneezing
  • runny nose
  • increased mucus production
  • itchy eyes
  • skin rash
  • coughing
  • shortness of breath

Seek medical care immediately if you are experiencing difficulty breathing.

How does it work?


The allergy symptoms are caused by aggressive reaction (hypersensitivity) of the immune system to certain normal proteins in your environment. There are many reasons why allergy starts. But one thing is certain – it is harmful for the body to have allergic inflammation. So, you want to treat it as soon as possible.

For example, dust mites and pets are common allergens indoors. Antibodies in your immune system wrongly perceive these things as harmful and will initiate a series of reactions causing inflammation and the release of a substance called histamine. This results in the annoying symptoms many people experience. It is also why patients with allergies need antihistamines – medicines that block histamine inside the body. But antihistamines have side effects and simply cover the symptoms. They do not treat the allergy.

SLIT, or sublingual drops is a long-term solution getting to the bottom of the problem. Drops contain the commercial extracts made of proteins that started your allergy. So, when you put the drop under the tongue, the cells of the immune system called dendritic cells take it up and bring it to the lymph nodes. There an education of the new lymphocytes starts in the right way – basically telling them not to attack these proteins. Once the new army of cells received a good education, they replace old cells and allergy stops. as you can imagine, it takes few years to complete re-education. But the good news – allergy drops stop the symptoms and inflammation within weeks!

Allergy shots work approximately the same, only allergen is delivered under the skin and taken up into various lymph nodes. Systemic reactions are possible if immune system is on “high alert”, such as recent significant exposure to the allergen or viral infection. That is why it needs to be administered in the office and monitored for at least 30 min by a professional. Shots also do not work that fast – the clinical symptoms start getting under control only half-way through the escalation schedule, which is approximately 4-5 month into the treatment.

Are there side effects?

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SLIT is one of the safest allergy treatment. With more than 70 years of its use in Europe and now US, there were no systemic reactions that would require epinephrine use.  Drops that applied under the tongue mix with saliva and get absorbed into lymph nodes, so there is no entrance into systemic circulation (as with allergy shots). That is why it is much safer.

Most patients take SLIT without any problems. The most common adverse reactions are itching of the oral cavity (mouth, tongue, or lip), throat irritation, nausea, and stomach ache.

There have been a tiny number of serious reactions such as mild systemic allergic reactions (about 1.4/100000 doses), but no deaths have been reported from this treatment since it was first introduced in Europe or US.

Is there other way to reduce allergy?

vacuum cleaner with a surprised cat

In addition to the SLIT treatment, the only true prevention is avoidance of the allergen.  Even people who receive SLIT should take all measures on indoor allergen avoidance and clean up. It is possible to continue having pets around while taking drops – talk to your doctor about medications you need to take until symptoms go away.

Healthy lifestyle always helps to keep immune system in check. Your house should be well-ventilated with enough sunlight to prevent moisture accumulation (which promotes mold and dust mite growth).

Nasal wash is another natural treatment that helps to prevent allergic inflammation in the nose. It is much better to remove mucus and allergen particles from the nose naturally with saline water, then to take antihistamines or even steroids.

How do I know if I need SLIT treatment?

Skin Prick Allergy Testing

There are multiple methods to test for allergies. Your medical provider will determine the best test based on the severity of your symptoms, the suspected allergy, and other criteria. One diagnostic method is a blood test.

The most common test is the allergy skin test. In this test, different potential allergens will be applied to the skin on your back and then monitored for a reaction. This can be completed in your provider’s office. Here is what can be tested:

  • pet allergy
  • mold (indoor and outdoor) allergy
  • indoor allergy (dust mites, feathers, small rodents, cockroaches)
  • tree, weed and grass allergy (hay fever)

With a skin test, results are typically available within thirty minutes. In some cases, your provider may advise you take a NAPT (Nasal Allergen Provocation Test). In this test, the suspected allergens are applied to each nostril. It is important not to take an antihistamine medication before any of these tests.

Once the allergen(s) has been determined from one of the tests listed above, your provider will customize your SLIT medication. This will come as a tablet or as liquid drops. No matter which formulation you receive, both are dissolved under the tongue and absorbed by the body through the lining of the mouth.

Similar to allergy shots, treatment occurs over a long period of time. The minimum duration of treatment is typically 12 weeks, but 3-5 years is the most common length of time. During this duration of time, you will gradually expose your body to increased amounts of the allergen. The goal is to desensitize your immune system’s response to these allergens.

Your first dose of SLIT medication will be taken in your provider’s office where you will be monitored for an adverse reaction. After this, you will be able to take the medication at home. It is very important to adhere to your provider’s instructions on when and how often to take the medication. Missed doses or taking incorrect concentrations of the therapy will negatively impact your results and may cause your treatment to fail.

Our Clinic proudly provides SLIT since 2010. We are helping people in many US States and in other countries (Russia, Israel, Montenegro etc.) to live allergy-free lives.

You can simply order allergy drops from home!

You can order allergy drops with online appointment and laboratory/skin test results sent in the email.

SLIT is not covered by commercial insurances. You can use FLEX/FSA or HSA accounts to reduce the cost (it is your tax-free money!) The price of your monthly treatment depends on the dose and amount of allergens you need to treat. Although it is an out-of-pocket expense, our patients think it is affordable and convenient. Indeed, if you calculate the saved co-pays and visits for the allergy shots, SLIT becomes a number one choice for many.

What can I read about science of SLIT?

We advise to read only articles published on official NIH Library of Medicine PubMed:

Recent advances in allergic rhinitis.  
Hoyte FCL, Nelson HS.F1000Res. 2018 Aug 23;7:F1000 Faculty Rev-1333. doi: 10.12688/f1000research.15367.1. eCollection 2018.PMID: 30210782

Local allergic rhinitis: Implications for management. Campo P, Eguiluz-Gracia I, Bogas G, Salas M, Plaza Serón C, Pérez N, Mayorga C, Torres MJ, Shamji MH, Rondon C.Clin Exp Allergy. 2019 Jan;49(1):6-16. doi: 10.1111/cea.13192. Epub 2018 Jul 5.PMID: 29900607

Efficacy of sublingual immunotherapy versus subcutaneous injection immunotherapy in allergic patients. Saporta D. J Environ Public Health. 2012. PMID: 22523505

Clinical efficacy and immunological mechanisms of Sublingual and subcutaneous immunotherapy in asthmatic/rhinitis children sensitized to house dust mite: an open randomized controlled trial.

Sublingual immunotherapy for the treatment of allergic rhinoconjunctivitis and asthma: a systematic review.