• How common are allergies?
• Do allergies run in families?
• Can I develop allergies as an adult if I didn't have them as a child?
• Why does the body make allergic reactions?
• What are allergens?
• What's going on in my body when I have an allergic reaction?
• What role does histamine play in allergic reactions?
• Is it true that I can't be allergic to something the very first time I'm exposed to it?
• I don't have a fever when my allergies are bothering me, so why is it called “hay fever”?
• Can allergies make me tired?
• What kinds of things cause allergic reactions?
• What's the story on dust mites?
• What about food allergies?
• What is the oral allergy syndrome?
• Is a rash from poison oak an allergic reaction?
• If my nose is always stuffy or I sneeze a lot, does that mean I have allergies?
• What are some non-allergic conditions that simulate nasal allergy?
• Is it true that nose drops can be bad for my nose?
• How can I tell the difference between a cold and an allergy?
• How does an allergist arrive at an accurate diagnosis?
• What can you learn about my allergies from my medical history?
• What does an allergist look for on a physical exam?
• What laboratory and special studies are helpful in evaluating allergies?
• What is allergy skin testing?
• How do you treat allergies?
• What is meant by “avoidance of allergens”?
• What medications are used to treat allergies?
• Don't antihistamines help stuffiness?
• Is it okay for everyone to take decongestants?
• Are there nasal sprays that are safe for allergies?
• What medications are used to treat asthma?
• Aren't steroid sprays and inhalers dangerous?
• What are “mast cell stabilizers”?
• How do allergy injections work?
• How effective are allergy injections?
• What are the details of getting allergy injections?
• How long does it take for allergy injections to work?
• How long are allergy injections needed?
• Can allergy injections be taken with other medications?
• What are allergy drops?
• What is in the allergy drops?
• How do allergy drops compare with traditional allergy injections?
• Are allergy drops going to replace injections?
• How are allergy drops taken?
• How long to I have to wait after taking allergy drops before eating?
• What do allergy drops taste like?
• Can I travel with allergy drops?
• Do allergy drops have to be refrigerated?
• Are allergy injections or allergy drops homeopathic therapies?
• What does it mean that allergy drops are "off-label"?
• I heard about an under-the-tongue tablet that may soon be available. Is that similar to allergy drops?
• How do you know which therapy is right for me?

How common are allergies?

More people are troubled by allergies than any other medical condition. They affect about 25% of the population. No other health problem--high blood pressure, diabetes, high cholesterol, cancer, etc.--affects one-fourth of all people.

Allergies are responsible for more time lost from work and school, and for more limitations on social and athletic activities, than any other condition. Unfortunately, however, allergy problems all too often get overlooked, misdiagnosed, or simply regarded as nuisances not worthy of proper evaluation and treatment. The consequences are unnecessary discomfort, inappropriate treatment and avoidable complications.


Do allergies run in families?

Yes.

The tendency to develop most kinds of allergies is genetically inherited. A child with one allergic parent has about a 40% chance of having allergies; the odds double to about 80% for people who have inherited the tendency for allergies from both parents.

But the particular pattern of allergic responses and the substances responsible can vary a lot from one family member to the next.

For example, mom might have nasal allergy while son has skin or lung problems. And dad might be allergic to tree and weed pollens while daughter is allergic only to mold spores or particular foods.

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Can I develop allergies as an adult if I didn't have them as a child?

Yes.

If you have inherited the tendency to develop allergies you might experience their initial onset at any age. It isn't necessary to have had allergies during childhood to have them as an adult.

And even if you are predisposed toward developing allergies, you might never experience their onset.

Although there is a lot of conjecturing, at this time we don't know much about why susceptible people begin to have allergy problems at any particular age.


Why does the body make allergic reactions?

You tell me and we'll share the Nobel Prize!

Nobody knows exactly why we develop allergies. In fact, I like to refer to allergies as an “immunological mistake.”

The same substances that are allergens for people with allergies typically don't cause problems for people without allergies. Non-allergic people can breathe in the same microscopic bits of organic matter and eat the same foods to which allergic people react and have no problems.

It certainly seems that people with allergies would be better off if their immune systems would just ignore the substances to which they are allergic.

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What are allergens?

First, let's describe antigens.

An antigen is any substance that is capable of causing your body's immune system to produce antibodies (or sometimes certain types of cells). Antibodies are gamma globulins in your blood.

When you are subsequently exposed to the same antigen, the antigen and antibodies interact, which can result in various outcomes depending upon the nature of the antigen and antibodies.

Allergens are a special category of antigens. Like other antigens, they elicit antibody production. But only people with allergic tendencies respond to them by producing “allergic antibodies,” which are gamma globulins of the “Immunoglobulin E” (or “IgE”) class.

Then when you are subsequently exposed to the same antigen (allergen), interactions between the allergen and allergic antibodies initiate allergic reactions.


What's going on in my body when I have an allergic reaction?

When you start making IgE allergic antibodies to something, we say that you have become “sensitized” to that substance. And once you are sensitized to something, you will experience allergic reactions when you are subsequently exposed to it.

Some of your allergic antibodies attach themselves to the surface of certain cells (particularly mast cells). Then when the allergen that caused the production of those allergic antibodies again enters your system, the allergens and their corresponding allergic antibodies link together on those cells. That causes an infinitesimal distortion of the cell surface. And that distortion initiates a cascade of events inside the cell that culminates in the release of histamine and other chemicals.

Histamine and the other chemicals are known as “allergic mediators.” They diffuse away and exert powerful effects upon susceptible tissues.

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What role does histamine play in allergic reactions?

Histamine and the other allergic mediations have many effects.

The ones that are easiest to recognize are:

• Stimulation of mucous glands, contributing to runny nose, postnasal drainage and increased phlegm
• Dilatation of blood vessels, contributing to nasal congestion, chest heaviness and red eyes
• Contraction of smooth muscles, contributing to wheezing and shortness of breath and even puffiness beneath the eyes
• Leakage of fluid from capillaries, contributing to hives, itchiness and sneezing

Organs that are particularly rich in the cells that release allergic mediators are the eyes, nose and sinuses, mouth and throat, lungs, intestinal tract and the skin. That's why most allergic reactions affect those areas, although other organs can also be involved.


Is it true that I can't be allergic to something the very first time I'm exposed to it?

Yes.

Your immune system does not make allergic antibodies to something it has never encountered. It needs at least one exposure to a substance to trigger the production of allergic antibodies against it. Once it does start producing allergic antibodies against it, that substance becomes one of your allergens. Then, upon subsequent exposures, it can trigger allergy symptoms.

Actually, for inhaled allergens, it usually takes many exposures to something before your immune system produces enough antibodies against it to cause you noticeable symptoms.

But sometimes people develop allergies quite quickly, especially to insect stings, some medications and some foods. And confusion can result from unrecognized encounters. For instance, patients who experience an allergic reaction to penicillin from their first-ever injection may have unknowingly ingested the antibiotic in milk that came from cows being treated with it.

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I don't have a fever when my allergies are bothering me, so why is it called “hay fever”?

“Hay fever” is a misnomer. Not only is fever not part of the problem, but hay is seldom to blame. Another inappropriate name used to be “rose fever”--it's not caused by roses either!

The medical term for “hay fever” is seasonal allergic rhinitis if it is present only during certain seasons and perennial allergic rhinitis if it is present year-round.

Rhin- refers to the nose and -itis means inflammation.

The name reflects the important point that the basic underlying mechanism of all allergic reactions is inflammation. That doesn't mean inflammation to the point of causing pain or fever, but inflammation of the tissues and organs involved in allergy nonetheless.


Can allergies make me tired?

Absolutely!

Allergies can be responsible for, or contribute to, fatigue, irritability, poor concentration and sleep disturbance. Bad enough for adults, for children those problems lead to restlessness, inattentiveness and moodiness.

Allergic children sometimes fidget, rub their nose and eyes and make clucking sounds in their throat to the point that they distract other kids in the classroom. And that doesn't exactly endear them to their teachers. Worse yet, their study habits can suffer, dooming them to an unsuccessful academic career. Sometimes their allergies even lead to a misdiagnosis of attention deficit-hyperactivity syndrome.

For more, click on “Allergies and the Quality of Life” in the Patient Literature section.

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What kinds of things cause allergic reactions?

Common allergens include components of pollens, animal products, dust mites, mold spores, foods, insect venoms and medications. Inhaled allergens from pollens, animals, dust mites and mold spores are responsible for most problems.


What's the story on dust mites?

Dust mites are found by the billions in pillows, mattresses, stuffed furniture and carpeting. They are already present when the items are manufactured, then increase in number as they feed on human skin scales. People develop allergies to the mites' waste matter and to the dried up bodies of the mites themselves.

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What about food allergies?

Foods are often blamed for presumed allergy symptoms, but in actual fact they affect only about 8% of infants and 2% of adults. Most food allergy in children is due to eggs, fish, milk, peanuts, soy and wheat. Most adult food allergy problems are due to fish, nuts, peanuts and shellfish.

Food-related problems that might have to be differentiated from true food allergy include:

• Food intolerances due to enzyme deficiencies
• Naturally-occurring food chemical reactions
• Reactions to synthetic food additive chemicals
• Food poisoning
• Interactions between foods and medications
• Stimulatory and depressant effects of certain ingestants

For additional information see “Food Related Headaches” and “Lactose Intolerance” in the Patient Literature section.


What is the oral allergy syndrome?

People with the oral allergy syndrome experience itching and swelling of their lips, tongue and throat when they eat certain fresh fruits and vegetables. The symptoms are due to cross-reactions between antigens in pollens and foods, and are most likely to occur when certain trees and weeds are pollinating.

Symptoms are usually limited to annoying itching, tingling, and/or swelling of the lips, tongue and palate. But there is also the possibility of developing enough swelling of the throat to cause asphyxiation.

Click on “Oral Allergy Syndrome” in the Patient Information section for a fuller description.

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Is a rash from poison oak an allergic reaction?

Yes.

The resin from poison oak, ivy and sumac contains substances that cause allergic skin reactions in most people. Similar skin allergies can be caused by contact with a number of other substances. These include some metals like nickel and chromium, some medications like neomycin, some preservatives found in skin care products, and a variety of other chemicals.

The rash caused by contact with these substances is called allergic contact dermatitis.

Even people without other types of allergies are susceptible to developing allergic contact dermatitis because it is due to a cellular (lymphocyte) reaction that is different from IgE allergic antibody reactions.


If my nose is always stuffy or I sneeze a lot, does that mean I have allergies?

Not necessarily.

Although allergic rhinitis, or hay fever, is the most common cause of chronic nasal symptoms, some people have nasal problems that simulate allergy, but they don't have allergies.

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What are some non-allergic conditions that simulate nasal allergy?

There are quite a few.

One is vasomotor rhinitis, which is due to excessive changes in the caliber of blood vessels in the nose. “Vasomotor” refers to the “tone,” or tension, of the blood vessels. Year-round symptoms that may include nasal congestion, runny nose and headaches are brought on by changes in temperature, humidity and barometric pressure, and exposure to pungent odors. To emphatically distinguish this condition from allergy, we often use the term non-allergic vasomotor rhinitis, or NAVMR.

A common variant is gustatory rhinitis. You've probably had the experience of your nose running when you've had hot soup. People with gustatory rhinitis have the same problem when they eat anything.

Other causes of conditions confused with nasal allergy range from hormone imbalances to side effects from certain medications.


Is it true that nose drops can be bad for my nose?

Yes.

Overuse of decongestant nasal sprays and drops leads to “rebound congestion.” The nasal tissues actually become more congested after the decongestant wears off than they were before. That leads to a vicious cycle of ever-increasing congestion and use of the decongestant. This unhappy situation is called rhinitis medicamentosa.

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How can I tell the difference between a cold and an allergy?

A good rule of thumb is that if you feel like you have a cold more than three or four times a year you probably have allergies. And, of course, colds are of limited duration, whereas allergies usually cause prolonged symptoms.

To help differentiate between colds, the flu, and allergies, click on the “Cold, Flu, or Allergy?” button.


How does an allergist arrive at an accurate diagnosis?

By following the same steps that physicians use for other problems, including obtaining the pertinent medical history, examining the affected parts of the body, and getting laboratory and special studies as indicated.

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What can you learn about my allergies from my medical history?

The medical history orients the physician to the patient's problems. It can lend support for diagnoses. Or it can dissuade consideration of certain diagnoses if they don't seem to be well supported. In clinical jargon, it helps to “rule in” or “rule out” causes for the patient's symptoms.

Obtaining an in-depth personal medical history is also likely to uncover complicating and exacerbating factors, the possibility of unrecognized adverse drug reactions, a familial predisposition to medical problems, environmental, social and occupational exposures, and much more.


What does an allergist look for on a physical exam?

Allergic individuals might have any number of physical signs of allergy. I'll just hit upon some high points.

The eyes might be mildly to strikingly bloodshot. They might also be watery. There might be swelling of the eyelids. The area beneath the eyes might be puffy and dark.

Structures inside the nose might be enlarged. The nasal lining might be swollen and discolored. Copious amounts of mucus might be present. There may be pus in the nose if the sinuses are infected. Fresh or dried blood might be present. And nasal polyps are a possibility.

Prolonged nasal congestion can contribute to buckteeth. Similarly, the hard palate might be highly arched. A “geographic tongue” (surface features resembling continents) can be a tip-off to food allergies. Post-nasal drainage is indicative of sinusitis.

Poor air movement and wheezing might be heard when listening to the lungs of an asthmatic. And asthma can lead to an increased front-to-back diameter of the chest.

The skin might show rashes of allergic eczema, hives or related conditions. It might also reveal marks from vigorous scratching of itchy skin.

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What laboratory and special studies are helpful in evaluating allergies?

Common laboratory tests in allergy diagnosis include microscopic examination of nasal mucus, pulmonary function studies, and blood tests to determine, among other things, amounts of allergic antibodies and other gamma globulins and “allergy cells.”

Chest x-rays are sometimes indicated. More often, computerized tomography (CT scan) of the sinuses is of value.

And of course, allergy skin testing is probably the single most important special study done by allergists.


What is allergy skin testing?

Allergy skin testing is a diagnostic tool that can be done to find out for sure if you have allergies, and, if you do, to discover what you are allergic to. Although it is also possible to do blood tests for allergies, the most reliable testing for allergies is done by introducing extracts of tiny amounts of substances to which you might be allergic into the surface of your skin.

If your immune system has produced allergic antibodies, some of them will be attached to so-called “mast cells” in your skin. And even if your allergies don't cause rashes or hives, localized reactions similar to mosquito bites will appear where your skin is pricked with extracts of substances to which you are allergic.

A number of extracts are usually used and those to which you react are your particular allergens. Extracts of substances to which you are not allergic won't cause a significant reaction on your skin.

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How do you treat allergies?

At the present time we are not able to literally cure allergies--and the same can be said for other chronic medical conditions, such as high blood pressure, arthritis, diabetes, and many others. But, like other chronic conditions, allergies can certainly be successfully treated. And, as with other ailments, allergies will probably eventually yield to gene therapy for actual cure.

There are three basic approaches to the treatment of allergy. They are:

• Avoidance of allergens
• The use of various medications
• Allergy injections

Each of the approaches has different objectives and modes of actions. The best results are often obtained by combining all three methods.


What is meant by “avoidance of allergens”?

If you can completely avoid the things to which you are allergic, you cannot experience an allergic reaction.

A person with allergies makes allergic antibodies to certain allergens; then, upon subsequent exposure to those allergens, they experience allergy symptoms. So if you can always avoid your allergens--including any substances to which you develop new allergies--you will not have allergy problems.

But completely avoiding your allergens is usually not easy.

For instance, if your lips swell and your throat itches when you eat shrimp, you probably choose to avoid it. And if you think you're allergic to penicillin, I'm sure you would tell your doctor to not prescribe it for you. But the things that cause most allergies are submicroscopic components of invisible inhaled particles, so they're pretty hard to avoid.

But there are any number of “partial avoidance” measures you can do to at least reduce, if not completely avoid, inhaled allergens. Partially avoiding, or minimizing your exposures to your allergens might be as easy as not letting the dog in your bedroom, or wearing a special paper mask that filters out dusts and pollens when gardening or sweeping out the garage.

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What medications are used to treat allergies?

Antihistamines are the most widely used. They block histamine's attachment to cells, thereby lessening a lot of symptoms, but they have no direct effect on stuffiness.

New “second generation” antihistamines are mostly free of side effects, but you should always be aware of the possibility of drowsiness or slowed reaction time when you take antihistamines.


Don't antihistamines help stuffiness?

No.

Decongestants, not antihistamines, are used to shrink engorged tissues, decreasing stuffiness.

Oral decongestants include pseudoephedrine (Sudafed® and other brands), which is available by itself and combined with antihistamines and other medications, and phenylpropanolamine, which is found combined with other ingredients in some allergy remedies.

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Is it okay for everyone to take decongestants?

Although safe for many people, oral decongestants have the potential to adversely affect high blood pressure, heart conditions, diabetes, thyroid disorders, glaucoma and prostate problems. They can also cause jitteriness, sleep disturbance and palpitations.

Decongestant nasal sprays and drops include oxymetazoline (Afrin® and other brands) and phenylephrine (Neo-Synephrine® and other brands). I advise patients against using decongestant nasal sprays for longer than three consecutive days because they can cause “rebound congestion,” resulting in ever-worsening nasal stuffiness and dependency upon the medication. This condition is called rhinitis medicamentosa.


Are there nasal sprays that are safe for allergies?

Yes.

The anti-inflammatory steroid nasal sprays are largely free of side effects when used properly and can be very effective if used regularly.

There is also an antihistamine spray that also has anti-inflammatory effects.

There is also a nasal spray that has a drying effect that can be use to advantage for excessive runny nose.

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What medications are used to treat asthma?

The most common prescription medications for day-to-day control are:

• Inhaled anti-inflammatory steroids are presently considered the first choice for patients who experience asthma symptoms more than twice a week. They do for the lungs what the nasal anti-inflammatory sprays do for the nose: they reduce inflammation - which is the underlying cause of allergic and asthmatic reactions - and they do so by working on the inner surface of the lungs, not deep within the body. If begun early enough, they can reverse tissue changes in the lungs known as “remodeling.”
• Bronchodilators dilate the bronchioles, or air passageways, by relaxing the strands of smooth muscle that constrict them. Although bronchodilators are mostly used by inhalation, oral and injectable forms are also available.
• There are other types of inhalers that can be helpful for some asthma patients.
• The most recently developed category of medications for the treatment of asthma are the anti-leukotrienes.
• Theophylline has been used to treat asthma for years but has been largely supplanted by newer medications.

Asthma exacerbations may require oral or intravenous steroids and/or injected epinephrine.


Aren't steroid sprays and inhalers dangerous?

Some patients are apprehensive about steroid side effects. But there is little reason to be overly concerned with the modern-day steroid sprays and inhalers being used for allergies and asthma.

For details click on “Steroid Medication for Allergies and Asthma” in the Patient Literature section.

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What are “mast cell stabilizers”?

IgE allergic antibodies attach to the surface of “mast cells.” When the allergens corresponding to those antibodies are present, the allergens and IgE antibodies link up, initiating events inside the mast cell that culminate in the release of histamine and other chemicals that diffuse away and exert effects upon susceptible tissues.

Mast cell stabilizers, available as inhalers for asthma, a nasal spray, and eye drops, decrease the amount of histamine and other “allergic mediator” chemicals liberated.

How do allergy injections work?

Allergy injections immunize you against things you are allergic to. In fact, the proper term for them is "allergen immunotherapy". It is the only form of allergy treatment capable of modifying the immunologic abnormalities that are responsible for symptoms.

Allergen immunotherapy works in several ways, one of which is to direct your immune system to produce ever-increasing amounts of “blocking antibodies” that hamper a step in allergic reactions.

Careful allergy testing reveals the patient's particular pattern of reactions. Treatment vaccines can then be custom-formulated based upon the individual's specific patterns of reactions, the allergens to which they are usually exposed, and other factors.

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How effective are allergy injections?

Properly conducted, allergen immunotherapy is usually very effective. A January 1997 World Health Organization Position Paper confirmed their value for hay fever and allergic asthma.

Important factors for maximally effective allergen immunotherapy, in addition to allergy testing that has been properly conducted and interpreted, include skillful vaccine preparation and the know-how to personalize treatment programs.


What are the details of getting allergy injections?

A course of allergen immunotherapy is begun with an extremely small dose of vaccine. The volume and concentration are then very gradually increased every several days, aiming for an effective “maintenance dosage” and duration between the injections is gradually lengthened.

Tiny needles, only about four one-hundredths of an inch in diameter, are used to give the injections in the upper arm. The injections usually cause some mild localized redness and itching about the size of a quarter.

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How long does it take for allergy injections to work?

A lot depends upon the rapidity of the progression schedule used and other factors, but many patients notice marked benefits within the first few months. Nevertheless, it is important to not regard allergen immunotherapy as an instantaneous “cure all” because some patients experience more gradual improvement over many months.


How long are allergy injections needed?

For the best likelihood that improvement will last for a long time, they should be received for about three to six years. Some patients prefer to remain on treatment longer to help ensure continued freedom of symptoms.

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Can allergy injections be taken with other medications?

Yes.

In general, they can be taken along with medications for any condition, allergic or otherwise, but it might be advisable to not take some medications within several hours of an injection. And they have no adverse effects on any medical problems.


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 injections. 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.

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What is in the allergy drops?

Allergy drops, like traditional allergy injections, 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 injections.  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 compare with traditional allergy injections?

The main advantages to allergy drops are convenience and safety.  Unlike allergy injections, 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.

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Are allergy drops going to replace injections?

No.

Allergy injections are still considered the “gold standard” route for administration of immunotherapy.  In some head-to-head studies, injections appear to be more effective than drops.   Also, injections are still the only “FDA approved” route of administration, and covered by most insurance plans and Medicare.  So for many patients, injections will still be the most effective treatment option. 

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.

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How long do I have to wait after taking allergy 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 allergy 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.

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Can I travel with allergy 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 allergy 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.

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Are allergy injections or allergy drops homeopathic therapies?

No.

Properly administered allergy injections 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.


What does it mean that allergy drops are "off-label"?

The extracts that are used in preparing allergy drops are the same extracts that are used in skin testing and traditional allergy injections.  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.

The fact that allergy drops 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). 

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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, injections, 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.

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