Sublingual immunotherapy is a preventive treatment that uses allergy drops under the tongue to treat symptoms caused by pollens, molds, or even pet dander. The team of board-certified allergists at North Texas Allergy & Asthma Associates can help diagnose allergic responses and treat them effectively so patients can continue feeling their best. Call or schedule an appointment online to visit the staff at any of the three locations serving North Texas: Texas Health Dallas, Baylor Regional Medical Center at Plano, and Baylor University Medical Center at Dallas.
Sublingual drops offer a way to treat allergies without getting shots. In this treatment, the liquid medication is placed under your tongue, where it’s absorbed into the bloodstream. Sublingual immunotherapy works the same way as allergy shots, with each drop containing a small amount of the allergen, the substance that causes your allergy. Over time, the amount of allergen in each drop is gradually increased until your immune system learns to tolerate the allergen and your allergic reactions either stop or they’re significantly diminished.
The sublingual medication is based on your specific allergens and your degree of sensitivity, so the doctors will first learn about your medical history, then perform allergy testing to precisely target your allergens. Then sublingual drops are formulated to meet your individual needs.
Sublingual drops effectively treat a variety of allergies. They may be considered for allergies to:
Sublingual therapy may also help patients with atopic dermatitis, or eczema, especially children with mild cases of eczema. It’s also being studied for its ability to treat food allergies.
Sublingual drops have been tested in studies and used by many patients, where results show they’re safe and effective. When the entire course of treatment is finished, sublingual immunotherapy may result in long-term remission from allergies even after you stop taking the medication. It may also prevent new allergies from developing.
The thing about effectiveness is this — medications are only effective if they’re taken exactly as prescribed. That’s true of all medications, but it’s especially important for immunotherapy where you need to consistently increase the dose of allergen. Sublingual drops will be effective only if you take them exactly as prescribed.
Depending on the type and severity of your allergy, you may need to take sublingual drops daily, or several days each week, and the treatment lasts 3-5 years. If you tend to forget to take medications, it may help to come up with a calendar or chart to track your doses to be sure you stick with the treatment plan.
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.
Does insurance cover cost?
Insurance does not cover the cost, however you can use your HFA card.
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.
•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)
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.
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