Sublingual (under the tongue) immunotherapy is a treatment for allergic rhinitis. It works by boosting a patient's tolerance to specific allergens thereby decreasing allergy symptoms, rather than simply suppressing symptoms. Here's what you need to know to determine if sublingual immunotherapy is right for you.
Who Can Benefit From Immunotherapy?
Adults and children who suffer from severe allergic rhinitis (overreaction of the immune system to an allergen) in more than a season or two each year may benefit from immunotherapy. Likewise, patients with severe symptoms who do not get significant relief from traditional allergy treatment may be candidates for immunotherapy. Immunotherapy is not typically used for patients with milder allergies or for those who suffer from allergy symptoms during a single season that can be controlled with medication.
Subcutaneous Vs. Sublingual Immunotherapy
There are two types of allergy immunotherapy. Subcutaneous immunotherapy involves injections of an allergen, given over a period of time in steadily increasing doses. These allergy shots are intended to gradually build a tolerance for the particular allergen and give the patient relief from symptoms. Patients typically must visit a doctor's office regularly to receive injections, and there is a small risk of anaphylaxis, a severe allergic reaction. Due to this risk, patients must carry an epinephrine self-injector (Epi-pen) in case of anaphylaxis after leaving the ENT's office.
Sublingual immunotherapy is an effective alternative to injections. It delivers an elixir of one or more allergens to the patient's body. However, it is given in the form of drops placed under the tongue, where the allergen is absorbed by lymphatic channels to interact with the immune system. Sublingual immunotherapy stimulates the same immunologic changes that lead to desensitization, without potentially painful shots and with dramatically lowered risk of anaphylaxis. In addition, a patient can administer these daily drops at home, so there is no need for weekly visits to the allergist.
The Facts About Sublingual Immunotherapy
The American Academy of Otolaryngic Allergy (AAOA) endorses sublingual immunotherapy, and it's used as the gold standard of care in many parts of Europe. However, it is currently considered an off-label use by the FDA. For this reason, many insurance companies do not cover it and patients typically pay out of pocket. Depending on your insurance co-pays, the expense of sub-lingual therapy may not be significantly different than the expense for subcutaneous. For those who opt for sublingual immunotherapy, symptom reduction often begins in as little as six months. Therapy usually lasts about three to five years but can provide several years of symptom improvement.
Before immunotherapy can be prescribed for you, you will need to be evaluated by an ENT and undergo allergy testing.