Sublingual Immunotherapy

If you suffer the misery of seasonal and other allergies, Manhattan Integrative Medicine offers a new form of treatment that can help your allergies – without painful allergy injections.

About Allergies

Allergies occur when your immune system comes in contact with a substance it identifies as a harmful intruder. Most allergens are harmless, but allergic reactions can be serious, even deadly. Food, drinks, and the environment are common sources of allergens.

According to the Agency for Healthcare Research and Quality (AHRQ), between 20 and 40 percent of adults in North American suffer allergic rhinitis, or hay fever. Globally, allergic rhinitis affects about 400 million people. Allergic rhinitis is considered a risk factor for asthma, a chronic inflammatory condition of the lower airways. For children and adults, effective treatment of hay fever often reduces the severity of asthma.

There are a variety of common triggers for hay fever and asthma, including:

  • Household allergens: Dust, mold, pet dander, and dust mites
  • Situational substances: Air pollutants like tobacco smoke, off-gassing carpets, varnishes, cleaners, and other products
  • Environmental allergens: Botanical allergens like pollen from grass, plants, and trees
Symptoms commonly associated with hay fever include:

  • Itchy eyes, nose, or mouth
  • Watering, red, or swollen eyes
  • Head and ear pressure, often with pain
  • Runny and congested nose, sneezing, and sinus pressure
  • General malaise and fatigue
Each year, allergic rhinitis, and asthma have a significant impact on the health of sufferers, including:

  • Reduced quality of life
  • Lost productivity and work days
  • Increased medical expenses, doctor, and emergency department visits
  • Decreased learning ability
  • Greater difficulty in social situations
  • Higher incidence of sleep disorders
If you suffer allergies, understanding your treatment options is essential.

Allergy Management in the United States

In the United States, until recently, the main form of treatment for allergies and allergic asthma was subcutaneous immunotherapy (SCIT), or the injection of small doses of specific allergens under – known as “allergy shots.”

In April of 2014, the U.S. Food and Drug Administration (FDA) approved the use of sublingual immunotherapy (SLIT).

Used in European countries for years, sublingual immunotherapy uses small doses of specific extracts to provoke an immune response in a patient. The word “sublingual,” simply refers to where the dosage is administered—under your tongue—where it painlessly dissolves.

While available in the United States as an off-label treatment prior to approval by the FDA, the acceptance of a sublingual allergen extract by that regulatory agency is a positive step for millions of allergy sufferers.

Understanding Sublingual Immunotherapy

Immunotherapy is a broad term used to describe stimulation of an immune response to manage or prevent a disease. Immunotherapy introduces material (like a germ or an allergen) to the human immune system to provoke an ultimately helpful response. It functions similarly to vaccines, which can protect you against certain viruses or bacterial infections.

The focus of allergy immunotherapy is the reduction of symptoms through the administration of small doses of allergens. As mentioned, two forms of allergen specific immunotherapy (ASI) include SCIT and SLIT.

Points about these treatments include the following:

  • Both treatments are considered effective for allergic rhinitis and minor asthma. The management of these conditions reduces long-term use of medication, associated costs, and the potential worsening of symptoms.
  • SCIT is administered through injection, usually in the upper arm. SLIT is given in tablet or droplet form under the tongue, where it dissolves.
  • Injections may be administered weekly. Allergy drops are administered daily.
  • Allergen specific immunotherapy works by increasing the dosage, and your tolerance, to a specific allergen. Over time, a target or maintenance dose is reached. The time to reach that target dose is different for SCIT and SLIT. SCIT may take longer to reach the target dose than SLIT
  • Subcutaneous injections are given in a physician’s office until the maintenance dose is reached. Allergy drops are administered the first time in a physician’s office, thereafter, they are taken at home.
  • Currently, SLIT is not covered by many insurance providers. SCIT is commonly covered by health insurance.
For those who suffer chronic seasonal allergies, or mild asthma, ASI has numerous advantages that include:

  • Better, more comfortable quality of life
  • Reduction of symptoms related to allergic rhinitis and allergic asthma
  • Decreased reliance on medications like antihistamines, decongestants, and nasal sprays

How Does Immunotherapy Work?

Allergen-specific immunotherapy works by desensitizing your system to the allergens that causes your symptoms and discomfort.

As part of the immunotherapy process, you undergo testing, using skin-prick tests or lab work, to identify the specific allergens causing your allergic response. Unlike medications aimed at managing general allergy symptoms, testing focuses on finding the cause.

Creating a clinical history is part of ASI, to ensure you are a good candidate for treatment. We can discuss the advisability and safety of allergen immunotherapy under conditions such as:

  • A patient under five years of age
  • Pregnancy, or potential pregnancy
  • Presence of severe allergies, strong allergic reactions, or average to severe asthma
  • Underlying medical conditions, or taking certain medications

The Sublingual Immunotherapy Process

Whether you receive injections, or take tablets or drops, you receive small amounts of the allergens causing your symptoms. It may sound backward, but it works. Here is the process:

  • After placing a tablet or drops under your tongue, the extract dissolves and is absorbed through the mucous membrane in your mouth, with few side effects. Any residue of a tablet is swallowed and makes its way to the small intestine.
  • Throughout the duration of treatment, the daily dose of allergens causes changes in cellular activity to reduce local inflammatory reaction to the allergen, and blunt the build-up of symptoms during active exposure (allergy season).
Sublingual immunotherapy and allergy shots work similarly to achieve the same goal. Because the delivery mechanisms are different, so is your experience. Consider these differences:

  • Delivery: Subcutaneous injections – allergy shots -- are usually given weekly, and require a visit to the doctor’s office for at least the first year. With sublingual immunotherapy, the initial dose is given at the doctor’s office, but thereafter, once a day at home. Over time, the amount of allergen in each dose is increased to reach a target or maintenance level dose.
  • Duration: Treatment by injection or extract is generally given over a three to five-year period. Improvement in symptoms may occur within, or after the first year of treatment. Many patients drop out of treatment before it is concluded. With the relatively convenient, painless delivery of sublingual immunotherapy, busy patients can maintain their health—on their own schedule.
  • Side effects and safety: Side effects of allergy shots may be similar to the allergy itself—coughing, headache, fatigue, sneezing, and redness, pain, or itch at the site of injection. Sublingual immunotherapy can cause throat irritation or mild itching or swelling in the mouth.
  • Effect and benefits: Both allergy shots and sublingual immunotherapy are considered effective. At present, research studies do not find either treatment more effective than the other. Long term benefits of allergen-specific immunotherapy include cessation or reduction of symptoms, potential avoidance of onset of allergic asthma, or more serious allergic reactions.
If you have questions about sublingual immunotherapy, contact my office for more information.