Immunotherapy is widely used by allergy specialists because it treats the underlying cause of allergic reactions instead of temporarily relieving symptoms. Immunotherapy is designed to gradually desensitize the immune system to substances to which a person is allergic. Patients receive small doses of specific allergy-causing substances – not enough to cause a full-blown allergic reaction, but enough to build up a tolerance. Immunotherapy can potentially lead to lessening of allergy symptoms, even after discontinuing treatment. SLIT (sublingual or under the tongue therapy) is now available in tablet form for ragweed, grass pollen and dust mite allergy

Sublingual vs. Subcutaneous Immunotherapy

There are two ways to administer immunotherapy: subcutaneously (via allergy shots) and sublingually (via tablets applied underneath the tongue). Sublingual immunotherapy (SLIT) is advantageous for a number of reasons:

  • Tablets are more convenient to administer.
  • Tablets do not require a physician to administer them. Because sublingual immunotherapy can be administered at home, patients save money on injection co-pays and other charges (travel time and time taken off work) that can add up over the course of treatment.
  • Tablets  are well-tolerated with very few side effects.  Some serious reactions have been reported and it is recommended that patients receiving allergy tablets have autoinjectable epinephrine at home to treat a serious reaction.
  • SLIT is the preferred form of immunotherapy throughout most of Europe.

Allergy Tablets – Sublingual Immunotherapy Dosing Protocols

Some Sublingual Immunotherapy (SLIT) treatment regimens  involve a build-up phase and a maintenance phase. The FDA approved sublingual tablets are started at maintenance dose except a 3 day buildup phase in children for grass tablets. Pollen tablets should be started 3 months prior to the pollen season and continued through the season.  Ragweed tablets should be taken daily from June 1st to November 1st.  Grass tablets should be taken from January 1st through July 1st.  Dust mite tablets should be administered year round.  Some patients are able to achieve a lasting reduction of allergy symptoms upon completing a full course of sublingual immunotherapy.

NOTE: A universally accepted dosing schedule for SLIT with allergy drops is not known at this time. Except for grass/ragweed/dust mite tablets, the use of sublingual immunotherapy in the United States is considered to be an off-label use of an FDA-approved allergen extract. As SLIT with drops is considered off-label use and is not FDA approved, treatment is not covered by insurance. The optimal dosing ranges for individual antigens have not been determined. SLIT with allergy tablets may be covered by insurance, the tablets are a prescription filled at a pharmacy.  it is recommended that patients taking SLIT have an epinephrine autoinjector at home in the rare event of a serious allergic reaction to the tablets.