There are so many treatment options for patients with allergic rhinitis that understanding all of the options can sometimes be confusing. When treating hay fever or allergic rhinitis, asthma and sometimes eczema, there are three main treatment options to consider. First, you should always try to avoid any offending allergy triggers. Second, there are several varieties of medications, many of which are now available over-the-counter, that may be effective. But when avoidance and medications fail, allergen immunotherapy, commonly known as allergy drops or allergy shots, may be the answer.
Allergen immunotherapy is the only option that truly addresses the underlying medical condition. Rather than reducing symptoms after they have started, allergen immunotherapy helps your body develop resistance to the pollen particles so that your symptoms are significantly reduced and much less severe.
When someone is allergic, his or her immune system makes an allergic antibody to a pollen, dander or mold. When this antibody (IgE) is exposed to the allergen again in the future, it starts a reaction which triggers the symptoms of hay fever such as a runny nose, nasal congestion, or watery itchy eyes. It can also trigger the symptoms of asthma such as coughing or wheezing. This allergic reaction actually represents an over-active immune system. Allergen immunotherapy (allergy drops or allergy shots) works by readjusting or rebalancing the immune system so that it will stop reacting to allergy triggers and calm down this over-active immune response.
A board-certified allergist will complete allergy testing so the patient will know exactly which allergens they are most allergic to. An allergist will then prepare allergy immunotherapy serum or allergy extract, which should be unique and customized to each patient. Certain allergens cannot be mixed together in the same prescription, or they degrade each other and will be less effective. So while some patients will receive immunotherapy from one vial of extract, others may require two. Patients then take a regular dose of their extract and advance through build up dilutions to reach their maintenance dose. But are allergy drops or allergy shots the better option?
While allergy shots are the most widely used immunotherapy treatment in the United States, finding time for weekly allergy shots can be difficult. Allergy drops however, offer “a safe and effective alternative to weekly injections.” Allergy drops, more properly known as sublingual immunotherapy (SLIT), are a form of allergen immunotherapy originally developed in Europe. Sublingual immunotherapy (SLIT) is the “new frontier” for allergen immunotherapy treatments in the U.S. Patients take a daily dose of their allergy drop extract and advance through build up dilutions to reach their maintenance dose in just one month. Allergy drops have been refined in Europe over the past 25 years and have shown excellent benefit when used in patients who are most affected by a limited number of allergens, perhaps 10-15 relevant sensitivities.
Although there is still some risk for adverse reactions related to allergy drops, these risks are significantly less than those associated with allergy shots. Systemic reactions (anaphylaxis) can still occur with allergy drops. Therefore, care still has to be taken when allergy drops are started and advanced. Local reactions in the mouth, throat and stomach can also occur. For these reasons, allergy drop immunotherapy should be prescribed and administered under proper supervision by a physician specifically trained in allergy and immunology.
While the allergen extracts used in allergy drops are the same ones that are used in allergy shots, their use in oral form has not yet been approved by the FDA. Studies are underway here in the U.S. to obtain FDA approval and this will likely occur within the next few years. But this means that for the time being, neither insurance companies nor Medicare will reimburse for the cost of allergy drops. However, many patients are able to use health savings accounts or flexible spending accounts to help cover the cost of their allergy drops.
In Central Texas, allergy drops offer a safe, convenient and effective option for patients who suffer with allergic symptoms from a variety of pollen, mold, animal dander or dust allergens and who have not responded sufficiently to avoidance measures or over-the-counter medications.
San Antonio allergist Dr. Jeffrey Hallett has been offering his patients the more effective, high-dose European protocol allergy drops since 2009.