Are your allergy shots aimed properly? If not, can you try sublingual drops?

By Dan Dalan, MD Board Certified Allergist.

Yes, you can try sublingual drops. They are still fairly new but are now more available in allergy clinics. If you wish to try this new way to treat allergy, I can help you decide.

There are many options of treatment for allergy and asthma. They include pollen, dust mite, and pet exposure avoidance. Medications include anti-histamines, and inhalers for the nose and lungs. Specialists also use immunotherapy or allergy shots, and now drops.

Before you start shots or drops, please consult with an allergy expert. Shots or drops should never be given for food or drug allergy, as there are no good studies that show safety and efficacy. 

Tests to diagnose allergy and asthma are an important step in the treatment process. Medical studies show that the skin prick test is best. A CT scan of a patient’s sinuses helps us to diagnose and treat immediately, which is important, for example, in the case of a sinus infection related to allergy. Specialized breathing tests for allergy are often needed because hay fever often occurs with asthma. State-of-the-art breathing tests, methacholine challenge, and exhaled nitric oxide are other common testing procedures. I rarely do blood tests, but if they are done, I make sure they are for allergy proteins called IgE and from certified laboratories.

Diagnosing asthma is especially important, and allergy shots have been shown to prevent asthma or decrease its symptoms.

Some of my patients are not on shots or drops. Instead, they avoid the allergy as best they can and are content in their use of antihistamines and nasal corticosteroids. Surveys show that these treatments are effective at 10 and 50 per cent, respectively.

But for most people, this is not enough. When is it not enough? You are the only person who knows the answer. 

I still prefer allergy shots. They have the best track record, backed up by decades of studies.

But allergy shots will not work if they're “not aimed properly.” The most common reason for shots not being aimed properly is a dose that’s not high enough. Studies show that the proper strength of allergy serum is necessary for success, and low or homeopathic doses fail. Up to 80 per cent of patients are improved with shots. This means that even with the best therapy, shots may not work for everyone. 

Most allergy sufferers I see, but not all, benefit from immunotherapy. We have been studying various forms of immunotherapy for years in our clinic. Standard shots, which can be administered for up to five years and are effective for several years thereafter, are still considered the best. I am currently studying a form of immunotherapy sublingual pills that melt in your mouth. The best dose, formulation, and schedule remain to be determined.

In summary, if your allergy shots are not working, make sure the diagnosis is correct. Insure the proper dose is being used. Some allergy sufferers do just fine with pills or nasal sprays. Standard allergy shots are still the best. But if you want to try sublingual allergy drops, they are now available in increasing number of board certified allergy clinics.

updated July 4, 2008.