Allergy Drops: An Alternative to Shots?

Allergy drops, or sublingual immunotherapy (SLIT), are drops prepared from allergen extracts that are the same allergen extracts that are used in subcutaneous shot immunotherapy. Instead of shots, they are placed under the tongue for approximately two minutes and then swallowed. Sublingual immunotherapy has been used in countries outside of the US for several decades. The World Allergy Organization endorses allergy drops, and more information can be found at their website.

How Are Allergy Drops Different from Medications?

Allergy drops (SLIT) differ from other over-the-counter or prescription allergy medications because they contain the allergens present in pollen, dust mites or animal dander to which the patient has allergic reactions.   They are administered in gradually increasing doses to induce tolerance in the immune system.

The drops are meant to reduce the overactive allergic branch of the immune system permanently. By changing how the immune system responds to allergens, patients experience improved allergy symptoms. They are not designed or effective for the immediate relief of symptoms, which means the patient taking allergy drops (SLIT) should still take their usual medications as directed by their physician until tolerance builds over the first 3-6 months.

What Is the Difference Between Allergy Shots and Allergy Drops?

Allergy shots are given by subcutaneous injection, while drops are placed under the tongue. The extracts used for both are the SAME, although the dosing and the frequency of administration differ.

Allergy drops will be taken every day, while shots are initially given weekly and eventually every 2-4 weeks. The key difference is that allergy shots must be administered in an office setting, while allergy drops can be administered at home.

Common Side Effects

Most common side effects are mild and include throat irritation, oral itching/irritation, oral numbness, mild swelling under the tongue, and tongue itching. In very rare cases, this can progress to a reaction involving the entire body that requires epinephrine. Generally, these mild reactions occur during the initial phase of dose titration and then resolve once the patient is on the maintenance dose, which is when they take the same dose every day. This maintenance dose is given during the first month after starting the allergy drops.

Are Allergy Drops FDA-Approved?

Although the same allergen extracts are used for allergy drops as for allergy shots, drop immunotherapy is a non-FDA-approved method of delivering the liquid antigen.  Use of allergy extracts under the tongue has recently received FDA approval, but only for a few tablet forms of allergens, such as ragweed, timothy grass, and dust mite.

Are They Effective?

There have been several studies looking at individual allergens and allergy drops (SLIT). These studies have shown, in most cases, significant improvements in symptoms and a decrease in the medications needed.  It’s harder to generalize the results of allergy drops (SLIT) than those of shot immunotherapy, as there are no ‘head-to-head’ studies comparing the two methods.

Are They Safe?

Although there is a very small chance of having a systemic reaction to the allergy drops, to date, there have been no reported deaths associated with the drugs used in Europe. We still recommend obtaining an auto-injectable epinephrine device to use in case of a severe or systemic reaction when you first start using the allergy drops (SLIT).  In general, reactions to allergy drops are probably less problematic than those that occur with shot immunotherapy.

Who Should Take Allergy Drops?

Allergy drops can be safe and effective for many allergy sufferers, there are a few people who will do especially well. These include:

• Those with a fear of needles
• Most children
• Those who are sensitive to only a few allergens, or who have severe symptoms during one or 2 allergy seasons
• Asthmatics
• Those who suffer from chronic sinusitis

Patients who have difficulty adhering to in-office allergy shot protocols, or those who travel quite a bit and cannot make it into the office on a regular basis due to work schedules.

Who Should Not Take Allergy Drops?

• Those with severe and uncontrolled asthma
• Those with a history of severe reactions to allergy drops in the past
• Those with a history of eosinophilic esophagitis

Can Allergy Drops Be Given for All Types of Allergies?

Allergy drops can be given for all types of airborne allergens… pollen, dust mite and animal danders.  They are not to be used for food allergies, stinging-insect allergies or medication allergies.

How Long Should I Take Allergy Drops For?

Like allergy shots, the current recommendations are to take allergy drops for 3-5 years. Most people will see symptom improvement in the first 3-6 months, so we generally recommend starting the allergy drops at least 12 weeks before your most problematic season.

Will My Insurance Cover Allergy Drops?

Currently, because there is no FDA approval, most insurance companies do not cover the cost of allergy drops or sublingual drop immunotherapy. Allergy drops usually do qualify for HSA or flex spending reimbursement. Check with your insurance company for further details.