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What is Sublingual Immunotherapy

Allergy can be treated with sublingual drops

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?

SLIT works great for everyone with a diagnosed environmental allergy, including children as young as 4 years old and adults:

  • 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.

Symptoms

Sneezing and itchy eyes are symptoms of allergy

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.

Causes

Mast cell releases histamine

The symptoms are caused by aggressive reaction (hypersensitivity) of the immune system to certain allergens. An allergen is a substance that causes an allergic reaction. This means your immune system is in overdrive and producing an attack response against things that are normal and harmless.

For example, dust mites and grass are common allergens. 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.

Complications

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.

Prevention

Without 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.

Diagnosis

Skin test is used to diagnose allergy

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, cochroaches)
  • 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.

Treatment

Sublingual allergy drops are easy to administer at home

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.

ORDER ALLERGY DROPS ONLINE!

You can order allergy treatment at home after initial consultation

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.

REFERENCES:

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

https://acaai.org/allergies/management-treatment/allergy-immunotherapy/slit/

https://en.wikipedia.org/wiki/Allergen_immunotherapy#Sublingual

Efficacy of sublingual immunotherapy versus subcutaneous injection immunotherapy in allergic patients.

Saporta D. J Environ Public Health. 2012. PMID: 22523505

Sublingual immunotherapy for allergic rhino-conjunctivitis and asthma http://www.uptodate.com/contents/sublingual-immunotherapy-for-allergic-rhinoconjunctivitis-and-asthma

Clinical efficacy and immunological mechanisms of Sublingual and subcutaneous immunotherapy in asthmatic/rhinitis children sensitized to house dust mite: an open randomized controlled trial.http://www.ncbi.nlm.nih.gov/pubmed/20100188

Sublingual immunotherapy for the treatment of allergic rhinoconjunctivitis and asthma: a systematic review.http://www.ncbi.nlm.nih.gov/pubmed/23532243