Sublingual immunotherapy is a treatment option that has been discussed for many years. This is a treatment that was pioneered in Europe as an alternative to subcutaneous or injected immunotherapy (allergy shots). Living within the United States, we now have three new products that are available for Sublingual Immunotherapy which are all FDA approved, but two of these are for the treatments of grass allergy, and one is for the treatment of ragweed allergy. Limitations of this therapy include cost of therapy (there are coupons that help with this). There has been recent criticism (from Danilo Di Bona and colleagues, JAMA Internal Medicine, June 29, 2015) that sublingual tablets may not be much more helpful than placebo in many patients. Overall, sublingual allergy tablets are considered safe and are FDA approved as well. Although there have been documented cases of anaphylaxis requiring injectable epinephrine (EpiPen).

Another form of Sublingual Immunotherapy is “allergy drops.” This typically involves mixes of allergen, similar to what is used in “allergy shots,” but for oral/sublingual use. As with the sublingual allergy tablets, this treatment is done daily with the exception of initial doses, which is administered at home. While FDA-approaved allergen extracts are used in this therapy, allergy drops themselves are not FDA-approved. As such, insurance typically does not cover this treatment option which causes allergy drops to be typically more expensive than allergy injections (which are typically covered quite well by insurance).

Fr the most part, allergic individuals benefit from injected “allergy shots” called “Subcutaneous Allergen Immunotherapy.” Allergy shots are typically given in the arm and are administered in a doctor’s office (not at home as the allergy drops or sublingual tablets are). They are typically quite convenient and are effective for most. Overall, the goal with immunotherapy is to make a person “less allergic” or “less sensitive”, in other words, ‘more tolerant to environmental allergens.’ This is a treatment that doesn’t just mask symptoms but is the closest thing to a “cure” that is available.