You or a family member may be starting treatment with oral allergy drops, also known as sublingual immunotherapy. Recently, we have found that many people have similar questions concerning this treatment option, and this information is designed to help answer many of those questions. Please feel free to speak with one of our staff members if your questions are not satisfactorily answered, or if new questions or problems arise. By working together on your treatment plan, we will have the best opportunity to control your allergy symptoms.

Why allergen immunotherapy?
Allergen immunotherapy is a type of preventative treatment for an allergic response to allergens such as pollen, mold, dust mites, and animal danders. Allergen immunotherapy treats the underlying cause of the allergic reaction, while medications such as antihistamines and nasal sprays only treat the symptoms. Immunotherapy involves administering gradually increasing doses of the "causative allergen" to the allergic patient. The gradual introduction of the allergen induces a natural immunity or tolerance to the allergen. This reduces the patients allergic symptoms and lessons (or eliminates) the need for medications.

Why sublingual immunotherapy (SLIT)?
Until recently, the only way to successfully administer allergen immunotherapy in the United States was through injections (allergy shots) at the doctor’s office. Sublingual immunotherapy is now being introduced in the United States and is an injection-free procedure that offers patients the freedom to treat their allergies conveniently in their own home.

What are some advantages of sublingual immunotherapy compared to traditional allergy injections?

There are numerous advantages of sublingual immunotherapy:

  1. The patient does not have to experience repeated injections or the potential for soreness at the injection site.
  2. There is less potential for a systemic anaphylactic reaction, and there have been no reported fatalities from sublingual immunotherapy. Consequently, sublingual immunotherapy may be administered in the privacy and convenience of the patients home.
  3. There is very little time commitment, as the treatment is administered once a day at home in a matter of minutes, eliminating the need for travel to the doctor’s office and the 30-minute observation period that is required after allergy injections.
  4. For patients living a great distance from the doctor’s office or for patients who travel frequently, sublingual immunotherapy offers the convenience of being able to self-administer the treatment

What conditions can be treated with sublingual immunotherapy?
Our clinic is currently using sublingual immunotherapy for the treatment of respiratory allergies secondary to airborne allergens such as trees, grasses, weeds, mold, dust mites, and animal danders. Although the drops are used in Europe for other types of allergic conditions, we are currently recommending them primarily for allergic rhinitis and allergic asthma.

How quickly will I see relief of my allergy symptoms?
Although treatment success varies from patient to patient, we anticipate improvement within the first few months. Maximum benefit may not be noted until one year of therapy has been completed. Adjustments to your dosing may be made each time the extract vials are renewed, providing opportunity for increased efficacy. For that reason, it is important to keep your Raleigh Capitol ENT doctor informed about how you are responding to the treatment.

How do I get started on sublingual immunotherapy?
Your Raleigh Capitol ENT doctor will take a medical history, complete a focused physical examination, and then order specific allergy testing, usually in the form of allergy skin tests. Once the evaluation and testing are completed, your physician will discuss specific treatment options with you and guide you in your treatment decisions. If you choose to begin sublingual immunotherapy, your specific treatment kit will be prepared, usually within one week. You will come to the clinic and complete your consent form, then take the first oral dose in the clinic. You may then take your treatment vials with you for administration of daily doses at home. Our allergy department staff will provide you with complete dosing instructions and renewal instructions. The staff will be available during routine office hours for phone advice concerning your sublingual immunotherapy. The Raleigh Capitol ENT physicians are available for emergency consultation after hours and on weekends.

Is there a minimum age for use of SLIT?
There are no age restrictions for sublingual immunotherapy, although it is rare to begin any form of immunotherapy before age two.

How will the dosing proceed?
There is an initial "build-up phase" that involves once-a-day dosing, beginning with a few drops from a lower concentration and gradually increasing both the drop number and the vaccine concentration over a period of 12 weeks. At the 12-week point, you will begin a once-a-day dosing regimen with three drops as the standard maintenance dose. This three drop-per-day dose will be continued for control of your allergies. The usual treatment course is three to four years, at which time a re-evaluation will be recommended. If you are doing well on maintenance immunotherapy, Your Raleigh Capitol ENT physician will want to see you in the clinic about every six to 12 months for a brief follow-up visit.

How will the drops be administered?
The allergen extract is provided in convenient amber-glass bottles with a dropper mechanism that allows easy dosing under the tongue. Dosing should be done in the morning. Drops are placed under the tongue and held there for two minutes, then swallowed. After that, there are no restrictions for eating or drinking. In addition, there are no restrictions on eating or drinking prior to taking the drops.

Do the drops have any taste?
Due to the glycerin additive mixed with the extract, the drops have a slightly sweet taste. However, since there are no taste buds under the tongue, most patients experience very little taste sensation.

How often do I take the drops?
The drops are taken once a day, every day, for three to four years. Treatment duration varies from patient to patient.

What if I forget to take the drops one day?
There is a dose adjustment schedule on the dosing record. In general, there will be no problem if you miss a day or two periodically. However, the best relief for your allergies will be experienced if you are taking the treatment every day. As with any preventative treatment, compliance is critical for success. The appropriate cumulative therapeutic doses are achieved only if daily therapy is maintained.

How long will a treatment set last?
The initial "build-up" treatment set will consist of four concentrations (four or eight vials, depending on your particular prescription) and last approximately 12 weeks. Thereafter, the maintenance treatment sets will consist of one concentration, one vial if you are on a "single kit" and two vials if you are on a "double kit." The maintenance kit will last approximately eight weeks.

How do I re-order my treatment set?
As you complete the second week in your final vial(s), you will call our office to order your renewal treatment along with payment information. The renewal treatment sets will be sent to you within two weeks of receipt of the order.

Do I need to keep the vials refrigerated?
The treatment vials contain a glycerin preservative, which helps maintain stability even at room temperature, probably for a period of weeks. However, it is best to keep the vials refrigerated to ensure maximum potency.

Are there any medications that could interfere with my sublingual immunotherapy?
As with subcutaneous (injection) immunotherapy, we do not recommend that you receive sublingual immunotherapy if you are taking a beta-blocker medication (usually used for high blood pressure or glaucoma). If you are started on any new medication by another doctor and you are not sure what the medication is, please call our office and discuss this with one of the nurses before taking any more sublingual immunotherapy.

What are the potential side effects of sublingual immunotherapy?
Reported reactions to sublingual immunotherapy include itching of the tongue or lips (the most common reaction), gastrointestinal symptoms such as nausea and cramping, skin rashes including hives, and, very rarely, headaches. Systemic reactions (anaphylaxis) have been reported and may include symptoms such as throat tightness, wheezing, and a drop in blood pressure. These systemic reactions are extremely rare; there has never been a reported incidence of a fatal reaction to sublingual immunotherapy. However, we recommend that you always have an oral antihistamine available for mild local reactions, as well as an epinephrine auto-injector available for systemic reactions. These precautionary measures will be discussed with you at the time sublingual immunotherapy is prescribed.

How will I receive my renewal vials?
Once the renewal order and payment have been received in our clinic, you may pick up the renewal prescription at the designated time or we can ship it to your home.

How do I pay for the treatments?
Patients may pay using cash, check, or credit card (Visa, MasterCard, or Discover).