Research summary: Allergy drops

February 12, 2008 7:11:50 PM PST

Mitchell C. Sollod, M.D.
CPMC Allergist and Pediatrician
595 Buckingham Way, #355
San Francisco, California 94132
Phone: (415) 566-2727

Suzette Mikula, M.D.
Ear, Nose and Throat Surgeon
Georgetown University Hospital
Washington, D.C.
Georgetown Health Care Referral:
(202) 342-2400

BACKGROUND: The American Academy of Allergy, Asthma and Immunology estimates allergies affect more than 50 million people in the United States. While not all of these sufferers need to seek medical help for their reactions, a great many of them use allergy shots to suppress symptoms. Typically, patients with allergies to mold, pollen, dust and pets benefit from allergy shots. Once problem allergens have been identified, immunologists create a customized shot containing those allergens to desensitize the patient. Regimens begin with shots twice a week and can decrease in frequency, depending on the severity of the allergy. However, some patients have reactions to shots, while others may not be able to commit to the frequent office visits. For these patients, a new type of allergy treatment could be the answer.

ALLERGY DROPS: Sublingual immunotherapy, or SLIT, is an allergy shot in a drop. Suzette Mikula, M.D., an Ear, Nose and Throat surgeon at Georgetown University Hospital in Washington, D.C. prescribes the drops to patients. Just like allergy shots, Dr. Mikula says the mixes are custom-made for each patient. The mixture comes in a dropper bottle and is administered under the tongue. Patients can do it themselves, eliminating weekly doctor's office visits. The drops are to be given three times a day for the first week, then twice a day after that. The bottles do not have to be refrigerated to keep the mixture safe, but they shouldn't be left sitting in high temperatures. Dr. Mikula says patients have to visit their doctors every three to six months to monitor progress, but complete immunity is usually achieved within two years to three years. This is a longer immunity time than with traditional allergy shots, but many patients feel the benefits of the drops outweigh the time delay.

"Using the drops has many benefits," Dr. Mikula says. "They're easier for the patient who can administer their own drops at home instead of making a weekly doctor's appointment for a shot. It's a great alternative for adults and children who are afraid of needles, and for those who are highly reactive to shots."

Depending on the allergy, the drops cost between $30 and $150 a month and are sometimes covered by insurance. Dr. Mikula says the cost-benefit of the drops increases when patients eliminate doctor's visits, a co-pay, time off of work, parking and the cost of allergy shots themselves. The drops are mixed with a glycerin solution, so they may taste sweet.

Allergy drops have been used in Europe for more than 40 years and are beginning to gain support by doctors and allergists in the United States. In 1998, SLIT was endorsed by the World Health Organization as a viable alternative to allergy injections. Patients still need to see a doctor or allergist to determine the best plan of action to treat allergies. Not all allergies warrant immunology or allergy drops. Oftentimes, the itchy, watery eyes many people suffer with in the Spring and Fall can be treated with over-the-counter medications.