Sublingual Therapy (SLIT)
Drops Under the Tongue
What are allergy drops?
Alpine Allergy Clinic is pleased to offer allergy immunotherapy that you can take at home. It’s called Sublingual Immunotherapy (SLIT) or allergy drops. Allergy drops work similar to allergy shots by slowly desensitizing you to the substances that cause your allergy reactions. The difference is that the antigen is placed under your tongue in liquid form. Not only are the drops more convenient, research also shows they are safe and effective for people of all ages.
Who should take allergy drops?
Although most allergy sufferers can benefit from allergy drops, they’re especially ideal for people who can’t tolerate or don’t respond well to allergy shots.
These people include:
- People who are not able to commit to weekly allergy shots
- Highly sensitive people (especially those with a history of anaphylaxis during skin testing or during allergy shots)
- Those with chronic conditions including sinusitis
- People who cannot tolerate injections
What are the advantages of allergy drops?
In addition to being able to treat patients of all ages safely and effectively, there are other advantages to allergy drops.
Lower overall cost, fewer clinic visits – Compared to shots, allergy drops cost less and require fewer clinic visits. Most patients receiving allergy drops need only a few clinic visits the first year, and once every 6-12 months thereafter until allergy visits are no longer needed.
More convenient – You can take allergy drops at home or wherever you need to be, making it much easier to be consistent with your treatment.
Less medication – Our patients report, and research confirms, that most patients report needing less medication to control symptoms after beginning allergy drops.
Enjoy healthier days – The end benefit? Feeling better. Patients typically report fewer clinic visits, hospitalizations, and less lost time from work and school after taking drops consistently.
Patients are expected to pay for the allergy extract at the time of their office visit. Any extract mailed to the patient will have to be paid before shipping.
We will continue to participate with your insurance company, as we currently do, for all other office visits.
Allergy Drops – The Steps
For all drops under your tongue, hold it there for thirty seconds before eating or drinking.
You will begin with a build up bottle.
With your build up bottle you will begin with a single drop under your tongue on day one. The second day you will use two drops, day three, three drops, day four, four drops. This escalation continues for ten days, until you reach ten drops under your tongue. At this point you may discard the buildup bottle and begin using your maintenance bottle. During the larger drop days you may split the drops (days 6-10), so on day ten if ten drops becomes difficult to keep under your tongue you may place five, wait, then place the remaining five.
Regular dosing with your maintenance bottle is three drops under the tongue once a day. Do not eat or drink for 30 seconds. The drops do not need to be taken at the same time every day like antibiotics.
If you miss a day, just resume the drops the next day as normal.
Subcutaneous Immunotherapy (SCIT)
Allergy shots, also known as subcutaneous immunotherapy (SCIT), have been used for more than 100 years and can provide long-lasting symptom relief. SCIT involves a series of shots containing small amounts of allergen into the fat under the skin. You will be required to wait in that office for 20 minutes after each injection to monitor you for a severe allergic reaction. (A rare occurrence, but it can happen).
Allergy Injections – The Steps
1. Vial test
The beginning of your treatment will start with a vial test. Vial tests are a way for us to confirm that the initial dilution is correct and your body will have an acceptable reaction to your mixture of antigens.
After a successful vial test you will begin the escalation phase of treatment. During this time your injections will increase with each visit. The beginning dose is 0.05mL and increases 0.05mL with each visit. The maximum dose that you will receive is 0.5mL. When you reach the maximum dose a new vial will be created for you that is a little stronger. This continues until the vial reaches full strength.
The number of visits needed to reach full strength varies from person to person. We all live busy lives and some weeks it is impossible to make it in to have your allergy shots. Don’t worry, we understand and will get you back on track in no time.
Additionally, some patients may need to increase at slower pace, repeating the same dose more than once may be required due to reactions like local swelling, itchiness or soreness at the injection site that are deemed more severe than normal. After a few repeated doses the reaction will go away because their body is getting use to the injections. That is what this “re-programming” is all about: getting your body use to antigens.
When all the antigens are at their full strength you have reached your “maintenance dose”. This will be a stable dose that you will receive for the duration of your treatment. This is when we will gradually diminish your allergy medications to a point where you’ll need them only when you are exposed to high levels of antigens.
After you begin responding well to your allergy shots we’ll begin to stretch out your injections.
The recommended schedule is:
- One injection every other week for one year
- One injection every three weeks for a year
- Once a month for one the last year.
Most patients stop their shots after 4-5 years, although some patients continue allergy shots for a longer period of time.
Reactions to Allergy Shots
There are two types of reactions that can occur:
Local reactions are fairly common and are experienced as redness, itching/discomfort, and/or swelling at your injection site(s), and usually are no larger than a quarter or half dollar (25-50 mm). This type of reaction can occur within minutes of your allergy shot(s) or several hours after administration. These reactions can last for minutes or several hours.
If a local reaction is not bothering you, you don’t need to do anything. However, if you experience pain, itching, bothersome swelling or redness, or “warmth” at the site there are some over-the-counter (non- prescription) medications that can be utilized at home. Please follow all medication package directions for dosage and administration.
Cold Packs/Compresses – can be applied to the allergy shot site(s) to help decrease swelling and “warmth.”
Hydrocortisone or Benadryl cream/ointment – can be applied to the allergy shot site(s) to help decrease redness, itching, and/or swelling.
Oral Antihistamines – can be taken your allergy shot(s) to help decrease itching, swelling, and redness. Do not double up on antihistamines if you have already taken a dose before your shots. You may take an over-the-counter antihistamine (such as Claritin, Benadryl, Zyrtec or Allegra). Please exercise caution when taking antihistamines, especially while driving or operating machinery, as some can cause drowsiness.
Tylenol/Acetaminophen – can be taken following your allergy shot(s) to help decrease pain and discomfort.
This type of reaction is very rare but it is possible for you to have a systemic or “life-threatening” reaction to your allergy shot. These types of reactions usually happen within the first 10 minutes of receiving a shot. This is why it is so important for you to wait in the office for 20 minutes after every shot.
Signs of a systemic reaction are: severe itching of the throat, nose, eyes, palms and/or skin; hives, sneezing, wheezing, shortness of breath, difficulty breathing; swelling of the tongue, lips or throat; faintness.
If you notice any of these symptoms after receiving a shot, report to the front desk or technician at once! If you are already out of the office call for medical support right away. If you have your epi-pen use it according to the directions and seek medical attention at once.