If you’ve been getting allergy shots to control your allergy symptoms—or if you’ve avoided shots because of the pain and hassle but hate living with the runny nose, itchy eyes and wheezing—you’ll be happy to know about an alternative that has long been used in Europe and is finally gaining popularity in the US. It’s called sublingual (under the tongue) immunotherapy, aka allergy drops.

In addition to being a pain-free, do-it-at-home treatment, allergy drops have other advantages over shots, according to allergist Michael L. Lewin, MD, a faculty member at Weill-Cornell Medical College in New York City and private practitioner in Wilton, Connecticut, and New York City. Here’s how they work and why they’re worth considering…

HOW DROPS DO THE JOB

Immunotherapy works by desensitizing the body to a particular allergen (allergy-producing substance) that it perceives as a threat, whether that allergen is ragweed or dog dander or something else. Subcutaneous immunotherapy (allergy shots) is one form of immunotherapy…sublingual immunotherapy is another.

Allergy drops are customized for each patient based on the results of allergy testing. The liquid extract that’s used contains a very small amount of one particular allergen or of multiple allergens. Gradually, in incremental amounts, the allergen dosage is increased, enabling the body to build up tolerance. Over time, as the treatment calms the immune system’s reaction to the allergen, symptoms are reduced or prevented altogether.

Which allergies can be eased? Allergy drops can replace shots for a wide range of allergens, including those related to cats…dogs…dust mites…cockroaches…molds…grasses…ragweed…trees…and others. In addition, drops can treat some allergies that shots can’t treat, including those to poison ivy… formalin (a preservative used in many fragrances, cleaning products, textiles and adhesives)…and even some foods, including peanuts and milk. Note: Bee sting allergies can be treated only by injection, not with drops, Dr. Lewin said.

Allergy drop evidence: Many dozens of studies conducted in Europe have demonstrated allergy drops’ benefits, and now researchers in the US are finding similar positive results…

• In a review of 63 studies involving 5,131 patients, researchers from The Johns Hopkins University School of Medicine found moderate-to-strong evidence for significant improvement of asthma symptoms, runny/stuffy nose and eye inflammation among patients using sublingual immunotherapy for a wide range of allergies.

• A study published in The Journal of Allergy and Clinical Immunology found allergy drops effective in reducing symptoms and the need for allergy medication in patients allergic to ragweed, one of the most common allergens.

• A study that dealt with peanut allergy was particularly promising, given that accidental peanut ingestion can be fatal for people who are highly allergic. Published in The Journal of Allergy and Clinical Immunology, it reported that 70% of participants who received allergy drops for 44 weeks were able to tolerate at least 10 times as much peanut powder without developing symptoms as they could before treatment began.

 

In the US, the FDA approves specific antigens (substances that stimulate the production of antibodies)—and these antigens are the active ingredients in extracts used for allergy shots. It is legal for doctors to prescribe these same antigens “off-label” in the sublingual formulations used for allergy drops.

ADVANTAGE: DROPS VS. SHOTS

The main question for many allergy sufferers is this—Do drops work as well as shots? Unfortunately, we don’t yet have a clear answer to this due to a shortage of high-quality, head-to-head comparison studies. Among the limited studies that do exist, some find shots to be somewhat more effective…others rate the two therapies about the same. The World Health Organization endorses sublingual immunotherapy, Dr. Lewin noted—and in his own practice, where he administers both shots and drops, he has found both methods effective.

Allergy drops do have some distinct advantages over injections…

• Convenience. You can administer the drops to yourself at home instead of having to go to the doctor’s office. Caveat: You do have to remember to take the drops every day—whereas shots generally are given only every one to four weeks.

• Comfort. Unlike shots, which hurt and may leave red, tender lumps that linger for a day or more, drops involve no discomfort. Dr. Lewin described the taste as “pleasant.”

• Speedy relief. Drops start to work much faster than shots do. “Injection immunotherapy generally requires about a year of treatment before significant improvement in symptoms is experienced, whereas most of our drops patients see significant improvement within several months of beginning treatment,” Dr. Lewin said.

• Seasonal option. For seasonal allergies—trees, grasses and ragweed—there is a preseasonal drops protocol that allows patients to experience relief with just a six-week course of sublingual immunotherapy each year. Patients start taking daily drops in late February or early March for tree allergies…in April for grass allergies…and in July for ragweed allergies. “This preseasonal therapy is administered prior to the emergence of the seasonal pollens and is discontinued once those pollens emerge,” Dr. Lewin said. In contrast, shots are taken all year, even for seasonal allergies. Important: For nonseasonal environmental allergies—dust, molds, animal dander, etc.—drops, like shots, generally are taken year-round.

• Long-lasting effects. With both shots and drops, treatment typically continues for three to five years, after which many patients are able to discontinue treatment. For some patients, the relief is permanent…for others, symptoms return years later, at which point treatment can resume. For a small minority of patients, continuous treatment is needed to keep symptoms under control. “The possibility does exist for allergies to return fairly quickly after discontinuing treatment, but this appears to occur less frequently with allergy drops than with shots,” Dr. Lewin said.

• Safety. Allergy injections can trigger a rare but potentially life-threatening allergic reaction known as anaphylaxis. This is why a patient receiving allergy shots typically needs to wait in the doctor’s office for 30 minutes after an injection, to make sure that no adverse reaction occurs. In contrast, Dr. Lewin said, current studies on sublingual immunotherapy indicate that there have been no reports of anaphylactic reactions to allergy drops. That’s why patients can safely take the drops on their own at home. Side effects of allergy drops generally are limited to occasional, temporary and mild throat irritation, itchy tongue and/or swollen lips. Very important: Neither allergy drops nor shots are appropriate treatments for acute allergy attacks, and they cannot be substituted for a rescue inhaler, EpiPen or other emergency treatment.

What about cost? Insurance policies in the US generally do not cover allergy drops, nor does Medicare. If your insurance covers shots but not drops, it may be cheaper for you to get shots, depending on your copay. However, if you are paying out of pocket, drops provide a significant cost savings because they require far fewer doctor visits. Patients receiving drops generally need only about four visits per year, while patients getting shots typically need from 13 to 52 visits per year. As for the cost of the extract itself, Dr. Lewin said that the antigens for drop formulations cost significantly less than for shots.

Are you intrigued by the idea of escaping allergy shots and giving allergy drops a try? You can find allergists in your area by checking the directory of the American Academy of Allergy, Asthma and Immunology. To learn whether a particular physician uses sublingual immunotherapy, you’ll need to contact his/her office…but the trend is that an increasing number of allergists in the US are offering allergy drops to patients who are happy to put their painful shots behind them.