The Top 7 Questions About Allergy Drops

Drops are one of the simplest, most effective allergy treatments. A few drops under the tongue each day teaches your immune system to ignore allergens so symptoms naturally fade away.

If you’ve been following the AllerVision blog and Facebook page, you know we’re enthusiastic about allergy drops (also known as sublingual immunotherapy or SLIT). Why? Lots of reasons, including the facts that they’re very easy to use, extremely effective, and suitable for allergy sufferers of all ages, to name just a few. Many people haven’t heard of allergy drops, though, and here are the top seven questions they ask when their doctor prescribes them.

1) How do they work? Once your doctor performs an allergy test and determines your allergy triggers, s/he prescribes drops based on those allergens that affect you. The drops contain low doses of those allergens (also known as antigens) — essentially, you put drops of pollen, dust, etc. under your tongue. Your immune system gradually begins to recognize that those particles are allies, not enemies, and stops trying to fight them off. As a result, allergy symptoms retreat and disappear.

2) How long does it take to work and how long do they last? Within the first six months of starting treatment — and often much sooner — your allergy symptoms will likely fall away dramatically. You’ll stay on the drops for about four years and probably will enjoy allergy relief for at least 10-15 years after you stop. For some, it will last significantly longer; relief varies from person to person.

3) What allergies do they “fix”? Drops can help resolve your allergies to inhaled allergens such as pollen, pet dander, dust and mold. Exciting new studies have shown success with peanut allergy as well, but that treatment is in its infancy and requires close monitoring by an allergy specialist.

4) Are they better than allergy shots? Drops and shots use the same antigens, so in principle they should work equally well. The clinical studies confirm that when used consistently, drops and shots have basically the same results. Drops seem to work better for some people, though. This may be because they’re much more convenient and you don’t have to stop them when you go on vacation, feel under the weather or can’t make it to the doctor’s office; therefore, patients are more likely to complete the full course of treatment. And kids, especially, prefer drops because there are no needles. For drops, you simply squeeze a little liquid under your tongue and hold it for two minutes each morning. For shots, you visit the doctor each week and stay for at least 30 minutes.

5) Why are the drops considered “off label” by the FDA? The FDA has approved individual antigens for use in injections, and a few some sublingual delivery but whenever antigens are combined for individualized treatment, the mix is considered off label. Both shots and drops are formulated off label to make sure they fit your exact needs. Nonetheless, every ingredient is FDA-approved and manufactured under the highest FDA standards. And drops are proven to be safer than injections.

6) What do they taste like? Because the antigens are suspended in glycerine, which is basically a sugar, the drops taste rather sweet. You place them under your tongue where you won’t taste much, but most patients usually enjoy what they do taste.

7) Will they interfere with medications or treatment of other conditions? It’s important to remember that drops are not medicine but are rather just little bits of tree, grass, weeds etc. that you already encounter in your environment, so they don’t interact with meds. For the same reason, they don’t cause side effects — like drowsiness, weight gain and increased blood pressure, common problems of many allergy medications — and have no effect on the treatment of other conditions. Also, drops are suitable for allergy sufferers of all ages, from young children to seniors.

For answers to other questions about drops, click here or ask your healthcare provider. In this world where allergies are only getting worse, drops are the safe, easy, and definitive solution to the allergy problem!

Drug Allergy: Essentials to Recognize in your Practice, Part 1

Miley Cyrus was reportedly hospitalized for a drug allergic reaction. Though I don’t know the facts of her case, I do know that drug allergy is probably over-reported by patients and possibly under-diagnosed by physicians. Confused? Let me explain.

An allergic reaction to a drug happens by the same mechanism as all other allergic reactions. It occurs when the hapten, the allergenic component of the drug, induces an immune reaction. This immune response can take place as any one of the four classic Gel-Coombs types of immune reactions. It is important to understand this concept because patient presentation can differ if it is an immediate IgE hypersensitivity reaction versus a delayed type reaction. The classic example is true penicillin allergy. A patient presents with a sore throat with white patches on the tonsils and is diagnosed with Strep pharyngitis. He is given a prescription for penicillin – which he has taken before without a problem – and on his first or second dose develops a urticarial rash and wheezing. This is an immediate type IgE immune reaction. The patient should be taken off the penicillin because continuing the antibiotic would potentially lead to life-threatening anaphylaxis. If this patient came to your office several years later with an infectious process, it would clearly be important to choose a non-penicillin-based antibiotic.

This patient’s case is straightforward. But many patients give a nebulous history of a penicillin-allergic reaction. Typically they say, “I was told as a child by my mother I was allergic to penicillin” or, “I may have had some type of rash, but no one really remembers.” Often what actually happened was that the child had a typical rash-causing viral infection. The parent took the child to the doctor before the viral rash developed, and he put the patient on penicillin for presumed bacterial pharyngitis or otitis. When the inevitable rash appeared, the antibiotic was blamed. The problem with this common scenario is that penicillin and its derivatives are safe, useful, and inexpensive, and they are often the best choice for first-line antibiotics. Lacking a clear history, but possessing the patient’s report of “allergy,” you feel obligated to avoid the penicillins.

The other problem with the penicillin allergy diagnosis is the 10% incidence of cephalosporin allergy in true penicillin-allergic patients. As a result, many doctors refuse to prescribe cephalosporins in reportedly penicillin-allergic patients. This is the conundrum in private practice: patients over-diagnose themselves with penicillin allergy and we as physicians are left with limited antibiotic choices despite the fact that many of these patients are not truly allergic.

The signs of an immediate allergic reaction to any drug are: urticarial (hives), angioedema (swelling), dyspnea (shortness of breath) and gastrointestinal distress (vomiting or bloody diarrhea). You may see just one symptom or a combination, which can indicate the potential for a dangerous drug-allergic reaction. I recommend that you carefully document the patient’s history of drug reaction(s) to ensure that true drug allergy is identified but he or she is not erroneously labeled “penicillin-allergic.” For definitive diagnosis, talk to your AllerVision Allergy Care Consultant about the Pre-Pen test for penicillin allergy.

In part 2 of this series I will discuss the serious delayed reactions that occur with different drug allergies.

– Dr. Dean Mitchell

Treating Allergies With Tablets or Drops: What Every Allergy Patient and Doctor Should Know

Sublingual allergy drops have been available for a while. New sublingual tablets by pharmaceutical companies are poised to bring FDA approval to sublingual treatment. There are important differences between drops and tablets.

Last week, the FDA advisory committee reviewed two sublingual allergy tablets. Both tablets gained acceptance by the advisory committee, meaning that they will be recommended for approval by the FDA. While the tablets will be new to the U.S. market, they have been available in Europe and Canada for some time. The Sublingual method is an exciting alternative for allergy sufferers who have been waiting for decades for a definitive but shot-free solution to their allergies. Though the tablets present a new answer to that dilemma, physicians in the United States have long been successful in utilizing sublingual immunotherapy drops to help reverse their patients’ allergies. The drops are generally composed of FDA approved antigen in an “off label” route of administration.

While most physicians prescribe “off label” many times per day as part of their regular practice (such as offering a Beta Blocker for performance anxiety, or prescribing Albuterol for young children), FDA approval of the new tablets will provide physicians and patients an added level of comfort with sublingual route. Like many ENTs and several other allergists, I have been prescribing sublingual immunotherapy to treat my patients’ allergic disease for 15 years. In my book, Dr. Dean Mitchell’s Allergy and Asthma Solution, I dedicate a full chapter to discussing numerous medical studies which show that sublingual allergy drops reverse allergies and asthma and prevent future allergies from developing. Most of those studies are available for your review on the AllerVision website http://www.AllerVision.com.

There’s a Big Difference Between Tablets and Drops

The question patients and their doctors will be asking is “What’s the difference between these new sublingual tablets made by the pharmaceutical companies, and the liquid drops I get from my physician?” The answer: there is a big difference. The new sublingual tablets developed my Merck and Stallergenes are high dose allergy tablets covering only a single allergen or allergen category—grass. And, in fact, they only cover the grass(es) for a specific region of the country. The new tablets are clearly effective for patients in those regions who are allergic to only grasses. I have a concern, however, about side-effects with such a concentrated tablet which is taken at full dose from day 1 as opposed to utilizing the build-up phase that defines true immunotherapy. There will be many patients who are highly sensitive to grass pollen and the tablet may cause itching in the throat, rashes or difficulty breathing. In contrast, the sublingual drops available through AllerVision-affiliated providers, are custom-made for each patient to cover the categories affecting that specific patient. The treatment program includes a progressive ramp-up phase. This is important for several reasons…

First, the customized liquid drops enable you to treat multiple allergens simultaneously; most allergy patients suffer from several airborne allergens in multiple categories (most are poly-sensitized.) Interestingly, the cost might be more favorable with the drops compared to the pharmaceutical tablets, which will likely command a third-tier copay when they arrive on the market. Second, proper allergy desensitization protocol dictates starting with a low dose of allergen and carefully building the strength up over time while monitoring patient response. This is the way allergy desensitization has been practiced for decades, and the process accomplishes the goal of modulating the immune system by easing the body into acceptance.

Allergy treatment with the sublingual method may never have been as easy or as effective as it is today; and certainly it is fast becoming more widely available. Remember, not all sublingual options are equal. As always, it is important to do your research and educate yourself so you can rest assured that you are making the right choice.

– Dr. Dean Mitchell