Sublingual Drops

image - North Texas Allergy & Asthma Associates

What is Sublingual Immunotherapy?

Sublingual immunotherapy (Allergy Drops) is the name given to allergy vaccines that are administered orally. Allergen immunotherapy is a preventative treatment to relieve allergy symptoms caused by allergens such as pollens, molds, dust mites, and animal dander. We perform skin testing (or blood test) to find out which allergens cause you to have allergic responses. We then customize your sublingual immunotherapy serum to these problematic allergens.

Medications such as antihistamines and nasal sprays treat the symptoms of allergic rhinitis and other allergy-related disorders whereas immunotherapy induces a natural immunity or tolerance to the allergen. The gradual introduction of the “causative allergen” to the allergic patient reduces the allergic symptoms and lessens (sometimes may eliminate) the need for medications. Until recently, the only way to successfully administer allergen immunotherapy in the United States was by 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 you the freedom to treat your allergies effectively in your own home.

Some Benefits of Sublingual Immunotherapy

•Treats the root cause of your allergy problems by inducing a natural immunity or tolerance to the allergen
•Proven effective in patients with allergic rhinitis (hay fever), and other allergic disorders
•Reduction in number of upper respiratory infections that require antibiotics
•Reduction in use of medications to control your allergies
•Improved quality of life compared to standard medical therapy
•More cost effective in the long run compared to daily medication to treat continuing allergic disorders
•Avoids the discomfort of injections and associated local reactions
•Allows the treatment to be administered at home, which saves you travel time and expense of coming into the clinic
•Less potential for a systemic anaphylactic reaction, and regarded as being very safe

Some Drawbacks or Risks of Allergy Drops

•Takes about 3-6 months to experience benefit and requires you to continue medication during the build-up phase
•Insurance companies do not cover this route of administration because it is still undergoing FDA approval
•Sublingual immunotherapy shows a lower range of symptom reduction in comparison to injection immunotherapy

How is sublingual immunotherapy given and for how long?

Typically allergy drops are given once a day, while increasing the concentration strength until the “maintenance” dose is reached (in about 30 days). Afterwards, this maintenance dose is continued on a daily basis at a stable dose. Allergy drops are usually continued for 4-5 years of maintenance therapy. At that time, we will make a decision about whether to gradually taper your drops or to continue the therapy longer.

Reactions to immunotherapy

•There is a possibility of having a severe allergic reaction, such as anaphylaxis.
• At the present time, there have been no fatalities reported from sublingual immunotherapy treatment
• Possibility of hives, and/or triggering of asthma symptoms
•Rarely rhinitis symptoms from the sublingual allergens
•May have swelling of the tongue or lips (usually transient and if it occurs, take an antihistamine)
•Itching in the mouth (usually goes away within the first month)
•Gastrointestinal discomfort (usually mild and transient)

Treatment of reactions

Take an antihistamine, which may reduce adverse reactions. Also, we recommend that you have an emergency epinephrine autoinjector (EpiPen) available with you. If you experience a generalized reaction, administer the Epi-pen, and proceed to the nearest emergency room (ER) or call 911. If you have any questions, please call us



How do I take sublingual immunotherapy (allergy drops)? The allergen extract is provided in convenient glass bottles with a dropper mechanism that allows easy dosing under the tongue. Place the drop(s) under the tongue and hold them there for 2 minutes. Afterwards you may swallow, or if local mouth itching occurs, then spit out the dose. You may want to apply the drops in front of the mirror or someone to ensure the proper numbers of drops are applied. Another alternative is to place the drops on a teaspoon, and then place them under the tongue. After the two minutes, you may eat and drink.

How are the drops administered? The most common delivery device for sublingual administration is a dropper tip. The tip delivers approximately 0.05 mL per drop (50'L). The most common maintenance volume with this device is 5 drops or 0.25 mL per day.

When should I take the drops? You should take the drops in the morning, once daily.

How will the therapy progress? 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 30 days. At the 30-day point, you will begin a once-a-day dosing regimen with 5 drops as the standard maintenance dose. This 5 drop-per-day dose will be continued for control of your allergies. The usual treatment course is 4-5 years, at which time re-evaluation will be recommended. If you are doing well on maintenance immunotherapy, we will want to see you in the clinic about every 6-12 months for a brief follow-up visit.

How long will a treatment vial last? The initial “build-up” treatment set will consist of three concentrations, and will last approximately 7 weeks. Thereafter, the maintenance treatment sets will consist of one concentration, and each vial will last approximately 28 days (two vials simultaneously if you have a lot of different allergens).

What if I forget a dose? 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 each and 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.

What do the drops taste like? Due to the glycerin additive mixed with the extract, there is a slight sweet taste. However, since there are no taste buds under the tongue, most patients experience very little taste sensation.

How do I re-order my treatment set? As you complete the second week in your final vial(s), you will complete the renewal form and send it back to us along with payment information. The renewal treatment sets will be sent to you within 2 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. However, it is best to keep the vials refrigerated to insure maximum potency. Avoid extreme heat or freezing of the extract vials

Is sublingual immunotherapy safe for children? There are no age restrictions for sublingual immunotherapy, although it is rare to begin any form of immunotherapy prior to age five years.

What should I check before taking the allergy drops? Always be certain that your oral antihistamines and your Epinephrine Auto-injector are available at the time of dosing. Always check the vial labels before dosing, to be certain that you have the correct vial and the vials are within the expiration date.

When should I not take the allergy drops? Do not take drops if you are running fever > 99.5, if you are wheezing or have a Peak Flow reading less than 70% of your personal best, or if you have any open sores or wounds in the mouth. Do not dose on days of dental procedures. Do not take allergy drops if you are also taking a prescription beta blocker medication. For women of child-bearing age, notify our office if you become pregnant. Please do not exercise 1 hour before taking allergy drops, or 4 hours after because this may rapidly increase the absorption of the allergens.