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Allergy Drops and Tablets

Allergy drops and tablets are oral allergy treatments that tackle allergies at the source. Instead of just treating symptoms, allergy drops and tablets treat the underlying cause of allergies, making you less sensitive to allergens over time. You may also hear these referred to as:

  • Sublingual immunotherapy
  • Oral immunotherapy
  • Sublingual allergy drop treatment

What Is Sublingual Immunotherapy?

Sublingual immunotherapy, also known as SLIT therapy, consists of liquid drops or tablets that users place under their tongue to lessen allergic symptoms from dust mites, timothy grass and other northern pasture grass pollens, ragweed, and more.

The U.S. Food and Drug Administration (FDA) has approved four types of sublingual tablets for treatment of allergies:

  • Odactra (from ALK Inc.) for dust mite allergy
  • Ragwitek (from ALK Inc.) for ragweed allergy
  • Grastek (from ALK Inc.) for timothy grass pollen allergy
  • Oralair (from Stallergenes-Greer) for up to five types of northern grass pollen allergy

Allergy drops, on the other hand, can contain one or more types of allergens. At present, allergy drops are not FDA approved and use is considered off label. By taking allergy tablets or drops consistently over time, it’s possible to lessen symptom severity as well as increase your tolerance to an allergen.

How Do Allergy Drops and Tablets Work?

Allergy drops and tablets train your body not to react, or to react less severely to an allergen by regularly exposing you to small amounts of the allergen over time. Each tablet described above contains a low dose of the triggering allergen. Allergy drops may allow coverage for more than one allergen at a time.

At first, SLIT is administered under the supervision of an allergist, but if you don’t experience any negative reactions to your first few exposures, allergy drops or tablets can be taken at home.

Over the course of the treatment, you can expect to experience fewer symptoms, although it can take several years for immunotherapy to work. In most cases, if you use allergy drops you’ll go through three phases of treatment:

  • Phase 1, months one to three: As you start oral immunotherapy, your body will get used to the treatment, exhibiting small changes in your allergen tolerance and symptoms.
  • Phase 2, three months to two years: This is the time when most of your uncomfortable symptoms should abate, either becoming less significant or disappearing altogether.
  • Phase 3, years three to five: In phase three, your body has developed a tolerance to the allergen that decreases your symptoms or their intensity. Relief usually lasts several years, but a small percentage of patients report indefinite improvement.

What Kinds of Allergies Can Be Treated with SLIT?

Allergy tablets treat only a small selection of allergies, including:

  • Dust mites
  • Ragweed
  • Northern grass pollen, including Timothy grass pollen

Dust Mite Allergies – Most people with an allergy to dust mites find they’re most symptomatic when indoors, particularly at home because dust mites enjoy household moisture as well as the lingering dust that’s common in busy households. Those with dust mite allergy may also find that feathers and pet fur, pollen, mold, and cockroaches cause them to have symptoms. Common symptoms include itchiness, a feeling of being unable to breathe, chest tightness, coughing, wheezing, teary and reddened eyes, stuffy nose, and sneezing.

Ragweed Allergies – There exist 17 ragweed species in the US. They release a powder in the form of a pollen that leads to throat itchiness, eye irritation, headaches, congestion, runny nose, and sneezing. If you already have asthma, you may experience more wheezing and coughing if you’re breathing in ragweed particles. Over 20 million people are allergic to ragweed, which is more severe in the fall. Ragweed season usually begins in September and can lead to hay fever or seasonal allergic rhinitis.

Northern Grass Allergies – Fescue, Rye, Johnson, Kentucky Blue, and Timothy fall into the northern grass family, which can trigger nose itching and running, congestion, and sneezing. If you already suffer from asthma, you might report an inability to breathe, tightness in the chest and congestion, and wheezing with your grass allergy.

How Effective Are Allergy Drops and Tablets?

Sublingual allergy tablet treatment is comparable to allergy shots in effectiveness. Both treatments offer long-term desensitization to allergens, relieving or eliminating symptoms during and after treatment.

Research into allergy drops and their efficacy is ongoing.  To date, they do not appear to offer the same degree of efficacy as allergy shots or tablets, but may be an appropriate alternative for individuals with multiple allergen sensitizations who cannot commit to the schedule for allergy shots.  At present they are not FDA approved and use is considered off label.

What Are the Side Effects of SLIT?

Patients react differently to SLIT, but most side effects are limited. If you have side effects, you are most likely to experience pain or discomfort in the stomach or mouth. This could include irritation such as itchiness, sores, or swelling in your mouth or throat. Rare, but serious side effects could include nausea and vomiting, breathing problems, or shock, among others. For a full list of side effects, talk to your allergist.

Most side effects will present within your first doses and are usually considered mild or local.  They generally tend to lessen with time.

How Often Should I Receive Allergy Drops or Tablets?

SLIT tablets and drops are not a one-and-done treatment. Instead, you’re committing to a multi-year therapy in which it can take months for you to start noticing results. Within roughly the first three months of oral immunotherapy, your body will have the highest rate of side effects. These occur as you get used to the treatment.

Your tolerance to the allergen in question then builds up over the next months, sometimes over several years. You may continue with regular allergy drop treatment for up to five years to keep symptoms at bay. This timetable can differ in some patients.

Are Allergy Drops or Tablets Right for Me?

To determine if allergy drops or tablets are a good option for you, ask yourself a few key questions:

  • Are you allergic to dust mites, ragweed, or northern grass pollen?
  • Is dust mite, ragweed, or northern grass pollen your primary allergy?
  • Have you used antihistamines or nasal corticosteroids with limited or no improvement in your symptoms?
  • Are you averse to needles or injections?
  • Can you commit to an oral medication routine that lasts for several years?

If you answered yes to these questions, then allergy drops or tablets could be a good way to reduce your allergy symptoms. If you answered no, you may want to review other options.

If you’re serious about SLIT or considering other options for reducing your symptoms, speak to your allergist. Your allergist will be able to evaluate your allergies, your symptoms, and the full suite of options available to you.

Is Sublingual Immunotherapy Covered by My Insurance?

While some insurance plans will partly or fully cover allergy shots or tablets, most of the time, insurance providers don’t offer allergy drops under the services they cover. Check your health insurance coverage before you schedule an appointment with your allergist for sublingual immunotherapy treatment.

Whether or not a medication gets insurance coverage often comes down to FDA approval and need for the medication. As the need for SLIT therapy increases, we’ll likely see more insurance providers including it in their plans.

FAQs

Are allergy drops or tablets different than other allergy medications?

Yes, allergy drops differ from the standard allergy medication a doctor or allergist might prescribe. Let’s consider the most common allergy medication, antihistamines. When the body has an allergic reaction, it releases histamine. Histamine causes the uncomfortable symptoms we experience, such as an itchy mouth, eye itching or tearing, runny nose, and congestion. When you take an antihistamine, it blocks histamine, thus reducing symptoms.

While antihistamines reduce allergy symptoms for many people, they do nothing to improve your tolerance to an allergen. You might feel okay if you’re exposed to an allergen when on a medication, but if you skip a dose, your symptoms will recur.

With SLIT therapy, you’re not only lessening your symptoms, but developing a tolerance to the allergen as well. That means that even if you miss an allergy drop or tablet, you should still have reduced symptoms, although you should always take every medication as prescribed by your allergist.

Are there alternatives to SLIT?

Yes. The best alternative to an allergy drop routine is an allergy shot routine. Allergy shots can target many of the same allergies as SLIT therapy and target more than one allergen per shot. However, allergy shots will always need to be administered by an allergist. There is no home-based alternative to SLIT that allows patients to administer medication themselves and achieve long-term results.

If you can’t receive allergy drops or shots for any reason, you can take either over-the-counter or prescription allergy medication like antihistamines or intranasal corticosteroids. If you have questions about which treatments would work best for your allergies, set up an appointment with your allergist.

How does SLIT compare to allergy shots?

The biggest differences between allergy shots and SLIT tablets are the delivery of the allergen and the number of allergens that can be targeted with each dose. Like SLIT, allergy shots deliver small doses of an allergen to the body to help improve tolerance. However, shots are subcutaneous and typically include more than one allergen.  Allergy shots start with very low doses of allergen and build up over time to a higher maintenance dose as tolerance increases.  Once the maintenance dose is reached, shot frequency is gradually decreased.

Unexpected and serious reactions to allergy shots are rare, but some patients experience itching and swelling at the injection site, making treatment uncomfortable.

In the past, allergy shots were the only option to reduce sensitivity to allergens long term. Today, SLIT tablets are seen as an effective alternative to injections for allergy symptoms that do not respond to corticosteroids and antihistamines.  Allergy drops may be an appropriate option for patients with multiple allergies who cannot undergo allergy shots.

Do allergy drops have side effects?

Like any medication, allergy drops can have side effects. Reactions vary by patient but are usually mild. Common side effects include:

  • Sneezing
  • Increased mucus secretion that can sometimes drip into your throat
  • Coughing
  • Headaches
  • Swelling, itching, or sores near your mouth, throat, or ears
  • Breathing problems including wheezing or shortness of breath

Side effects tend to appear early in treatment and usually aren’t serious. Many are also easily remedied by cutting back on the dosage of the allergen you receive. In some instances, it’s possible to have severe reactions such as anaphylaxis from an allergy drop, since it does contain an allergen. Anaphylaxis could be fatal and requires immediate medical treatment.

Are allergy drops safe for children?

Yes. Allergy drops are safe for children and carry no more or less risk for children than they do for adults. Side effects typically don’t differ from adults to children, with minor irritation being most common at the start of treatment.

Parents often choose SLIT therapy for their child if their son or daughter doesn’t like needles and isn’t responding to over-the-counter antihistamines or other prescription medications. As with any new treatment, get in touch with your allergist and determine if SLIT therapy would benefit your child.

Allergy Drops at Carolina Asthma & Allergy Center

If you’re interested in getting more information about allergy drops or other immunotherapy treatments, such as allergy shots, contact us. We’re available to answer any questions you have or help you schedule an appointment to get started.

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