Thread: Trading Shots for Drops: The New Approach to Allergies

Trading Shots for Drops: The New Approach to Allergies

By: Karen Barrow
If you suffer from the sneezing, runny nose, watery eyes and congestion of allergies, you may have considered getting allergy shots to help you cope. But the inconvenience of going to a doctor?s office for weekly injections, the pain of needles and the bothersome side effects of treatment may have deterred you from achieving long-term allergy relief.
A new form of allergy treatment, which takes the basic science behind the allergy shots and reformulates it in the convenient form of a few drops placed under the tongue, may be coming soon to provide convenient relief for allergy sufferers.

"Sublingual immunotherapy can be administered at home and it?s associated with minimal side effects largely limited to itching of the mouth." said Harold Nelson, MD, professor of medicine, National Jewish Medical and Research Center. "The downside is that it is not as effective as the injections. So while it may not be an advance, it is an alternative."

An allergy occurs when your body overreacts to pollen, dust or pet dander. Thus, when you inhale one of these particles, it sets off a red alert, triggering your immune system to release IgE and other immune substances to attack the foreign particles. Unfortunately, the IgE antibodies also trigger the release of other chemicals, like histamines, that widen blood vessels, leading to hives or the swelling of the nasal membranes, causing much discomfort. Allergy medicines work by blocking the action of the histamines, relieving the discomfort of allergies. However, immunotherapy works by preventing the IgE antibodies from attacking the allergen in the first place, preventing the cascade of events that cause most allergic symptoms from ever occuring.


Immunotherapy taken in the form of allergy shots is based on the idea that if you gradually inject increasing concentrations of the particles that set off your immune system, your body will gradually acclimate to the allergen and block the action of IgE, thus preventing the allergic reaction.

Sublingual immunotherapy, however, isn?t quite the same.

"With injection, you?re presenting [the allergen] to the regional lymph nodes, whereas with sublingual, you?re presenting it to the lining of the gastrointestinal tract. And the gastrointestinal tract handles things differently." said Dr. Nelson.

Thus, the effects of sublingual immunotherapy are not identical to injected immunotherapy. Because there is a limited amount of room under your tongue, smaller dosages are given at a time. The high doses associated with allergy shots, sometimes cause minor allergy symptoms, so a smaller dose may translate to fewer side effects, but it is also a less effective treatment. Several studies, using varying doses, have shown that immunotherapy does work, but only in the second year of use, while allergy shots work within the first year. Patients have to administer a few drops of liquid underneath their tongue and hold their tongue down for a few minutes to ensure that the liquid is being absorbed. This is done every day for about a month to raise one?s immune response. After this period, you enter the "maintenance" period, where the frequency of treatment decreases to a level that will keep your immune system levels where they should be to block IgE action. Allergy shots work similarly, shots are given once or twice a week for 4 to 6 months, until the maintenance period is reached, whereupon the frequency of shots is gradually reduced.

There are obvious benefits of this therapy; because a doctor is no longer needed to administer the injections, treatment can be self-administered at home. People who live far from a doctor?s office or travel often can still benefit from immunotherapy. And the injection-less treatment also means that kids?and squeamish adults?are more likely to follow through with treatment. Just don?t expect the benefits right away.

"I think [a candidate] has to be somebody who?s not in a hurry about seeing an improvement." said Dr. Nelson.

The FDA has been slow to approve this treatment since it is, as of yet, less effective than the traditional allergy shots. However, many countries in Europe have already approved it. If further studies show that sublingual immunotherapy is just as effective as traditional immunotherapy, or that more people are going to be willing to pursue, and follow through with, this treatment because of its convenience, you may eventually be saying "ahh" instead of "ow" to get rid of your sneezing and wheezing.

Help. I've been taking allergy shots for 9 months, and just now beginning to have signs of improvement. However the shots make me very very ill - in fact my allergist says I'm more allergic to the shots than my allergy trigger. ? I'm considering going to the drops? What say you?