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Frequently Asked Questions about Allergy Drops
(Sublingual Immunotherapy)
What are Allergy Drops?
The medical term for “Allergy Drops” is Sublingual Immunotherapy or SLIT, for short. Allergy Drops are a treatment for nasal, eye, and respiratory allergies, which is similar in its mechanism of action to traditional allergy shots. However, instead of injections that have to be performed in a physician’s office, Allergy Drops are done by patients at home, placing a few drops under the tongue each day, taking only a few seconds. For more information, see the handouts: What About Allergy Shots? and Allergy Drops (Sublingual Immunotherapy).
What is in the Allergy Drops?
Allergy Drops, like traditional allergy shots, contain extracts of allergens to which you are allergic (such as specific tree pollens, grass pollens, weed pollens, pet dander, dust mite extracts, etc.). The drops are tailored to your specific allergic sensitivities, based on the testing performed by your Allergist, just as would be done for allergy shots. This is not a “one-size-fits-all” treatment; each patient’s treatment is made specifically to treat his or her own identified allergies.
How do Allergy Drops (sublingual immunotherapy) compare with traditional Allergy Shots?
The main advantages to Allergy Drops are convenience and safety. Unlike allergy shots, which have to be done at a physician’s office, drops can be done by patients at home, and take just a few seconds each day. Traveling to the physician’s office in the middle of the day, receiving an injection, and waiting a half hour or so are no longer necessary. The trade-off is that in some studies, they may not be quite as effective as the injections, and are presently not covered by most insurance plans, although the cost is comparable, if not favorable for the drops. For further comparison, see: Comparison of Allergy Shots with Allergy Drops.
Are Allergy Drops going to replace shots?
No. Allergy shots are still considered the “gold standard” route for administration of immunotherapy. In some head-to-head studies, shots appear to be more effective than drops. Also, shots are still the only “FDA approved” route of administration, and covered by most insurance plans and Medicare. So for many patients, shots will still be the most effective treatment option.
There are many people, however, who simply cannot receive shots, either because their school or work schedules prevent them from being able to come in to the clinic regularly for shots, or who travel for long periods, or who live too far away to reasonably make it in on a regular basis for shots, or who are not comfortable receiving injections. For these people, Allergy Drops may be an excellent alternative since they are done quickly at home, are safer, travel easily, and are painless.
How are Allergy Drops taken?
Allergy Drops are self administered, at home, under the tongue. (For young children, parents administer the drops.) They are provided in a clear dropper-vial, which you hold up to your mouth and squeeze so that the drops “land” under the tongue. The liquid is held under the tongue for approximately 1 minute before being swallowed. Applying the drops takes only a few seconds, and the entire procedure takes a little more than a minute.
How long do I have to wait after taking the Drops before eating?
Typically, we ask patients to wait at least 5 minutes before eating, just to allow for additional absorption time for the drops.
What do the Drops taste like?
The drops have a slightly sweet taste, because they contain glycerin. Most adults and children find them quite tolerable and even pleasant.
Can I travel with the Drops?
Yes. In fact, that is one of the main ADVANTAGES of drops. They are very easy to travel with and can go anywhere you can go. The dropper vials have a small enough volume to be carried on to any airline. Since taking the drops is only a few seconds out of your day, it is very easy to continue your treatment no matter where you are, or how long you’re there.
Do the Drops have to be refrigerated?
No, Allergy Drops do NOT need to be refrigerated. This is because the concentration of protein is higher in Allergy Drops (compared to the extracts used in allergy shots), the dropper vials are consumed relatively quickly, and the extracts are all glycerinated, so potency is maintained without refrigeration. Many people take advantage of this by keeping their drops on the bathroom countertop as a reminder to take them every morning. If you anticipate more than three months will pass until a dropper vial is used (such as if you order several months’ supply for extended travel), then you may choose to refrigerate (NOT freeze) the vials that are not actively being used; this is not required, however.
Are Allergy Shots or Allergy Drops homeopathic therapies?
No. Properly administered allergy shots and Allergy Drops are established traditional medical therapies, with numerous clinical studies supporting their significant benefit in treating allergic diseases. They are sometimes confused with homeopathic therapies because they are “all-natural” since the extracts are derived from the pollens and pet dander, etc., that people are actually allergic to. They contain no drugs, which has a significant appeal for many people. For more information, see What About Allergy Shots? and Allergy Drops (Sublingual Immunotherapy).
What does it mean that Allergy Drops are “off-label”? I thought that the extracts were the same as in Allergy Shots which have been FDA-approved for many years?
The extracts that are used in preparing Allergy Drops are indeed the same extracts that are used in skin testing and traditional allergy shots. These extracts are approved and monitored by the United States Food and Drug Administration (FDA) and approved for use in injected immunotherapy (allergy shots), but not specifically for administration sublingually (under the tongue). Therefore, since the under-tongue route of administration is not specifically a labeled indication, it is considered “off-label” use.
Off-label use of therapies is extremely common in traditional medical care. Several studies indicate that about 1 in 4 of ALL prescriptions written by physicians are for off-label indications, and in many studies such as with children, 50% or more medications are given off-label. This is because a drug company or manufacturer has to spend a significant amount of money and go through a lengthy process to get a “labeled-indication,” which may not be practical (as with pregnant women or children) or financially advantageous. Not only is off-label use common, but it can even be considered in some cases the standard-of-care—meaning that to NOT use the medicine off-label would be considered “bad medical care.” There are several examples, especially in ophthalmology (eye disorders), cancer therapy, pregnancy, and treating children, where off-label use of medications is frequent.
The fact that Allergy Drops (sublingual immunotherapy) have proven safe and effective in numerous studies and meta-analyses (groups of studies looked at altogether) may well eventually lead to one or more allergy extract manufacturers obtaining an FDA- labeled indication for sublingual immunotherapy in the future, either for traditional allergy extracts or for derivatives (see Allergy Tablet, next question below).
I heard about an under-the-tongue tablet that may soon be available. Is that similar to Allergy Drops?
Yes, there is currently a treatment in phase III clinical trials as an under-the-tongue tablet, which works very similarly to Allergy Drops, only in tablet form. The tablet is called grazax®, produced by Alk-Abello, which has been approved and used in Europe and likely will also soon be available in the U.S. Unfortunately, however, as the name implies, the tablet contains ONLY grass pollens; and very few people are allergic ONLY to grass pollen. Most are allergic to several types of allergens, including tree pollens, weed pollens, pet dander, etc. So for the group of individuals who are primarily grass-pollen allergic, grazax® may be an option once it becomes available. However, for the majority of allergy sufferers who have several different types of allergens that trigger their symptoms, tailor-made Allergy Drops or shots are likely to remain a superior treatment.
How do you know which therapy is right for me?
At the Northern Nevada Allergy Clinic, our aim is to get your symptoms under the best control possible, with the least amount of medication necessary. We aren’t “pushing” one treatment option or another whether it’s allergy drops, shots, pills, creams, sprays, puffers/inhalers, or other therapies. You will have a complete and thorough evaluation by a fellowship-trained, board-certified Allergist, after which we will discuss the management options for your condition(s) and the relative benefits and risks of each. Working together, we will arrive at a management plan that is right for you.
For over 36 years, the Northern Nevada Allergy Clinic has been serving our community with knowledge and caring to bring you the best subspecialty allergy care possible. So if you or someone you love is suffering with nasal or eye allergies, asthma, chronic sinusitis, chronic cough, food allergy, or an allergic skin condition, call for an appointment today: (775) 826-4900.
