Sublingual Immunotherapy

[Kay Henderson]

Has anyone tried sublingual immunotherapy? (This is an alternative to allergy shots and is used more in Europe than North America. The extract is delivered in drops or a tablet held under the tongue for a brief period of time.)

If you have tried this, how successful was it in reducing allergy symptoms?

Kay

[JHolcomb]

If anyone has tried it, do you still have to go to the doctor's office twice a week for a month, then each week for 6 months, then every month for 3 yrs? That was the dealbreaker for me with the shots. I just couldn't keep that up for something that might or might not work.

Paying the price this week, though. I can't even get out of bed to go to work...sinuses are so bad that my equilibrium is off just enough to make it hard for me to walk. Damned oak trees.

[JHaris]

I tried it a few years ago. I kept the "serum" at home in the fridge and did my own dosing. I wanted to see if I could do without shots. I really don't think it worked that well. You are supposed to "hold" the drops under your tongue for a required amount of time. Sorry, I don't remember how long it was, BUT the major problem, at least for me, was the minute I put the drops under the tongue, my saliva glands started to work overtime. Guess they sensed a foreign substance in the mouth and they were "off and running." I felt I was probably swallowing the drops before they were absorbed. i.e., got diluted with saliva.

I was, however, seriously considering trying it again since I go for my "new" batch of allergy serum on Monday, meaning shots. Maybe the sublingual system has changed and is more effective now. I will ask. It certainly was a lot easier than going to the Dr.'s office every two to three weeks for the shots. I've gotten a bit blase about shots over the years since I have had so many...it was the convenience. Basically, I monitored my self. Also, had to remember to use the drops on a regular schedule...going to the Dr.'s office made me more aware of a schedule.

As far as sinus problems, ouch! Not too bad this week. I don't have that big a problem outside, but molds which are a big problem do me in..i.e., rainy days.

[Mlasley]

I worked in an office that offered this method and patients were given their serum to take home and dose as directed. I am not aware whether or not the effectiveness varies from traditional allergy shots. You may want to try to research on medline. You can get free access with registration (free)via medscape.com.

[JHolcomb]

Do you mind if I ask you where in NC you worked? I'm more than willing to give this a try in the name of science if I can find someone in Raleigh/Durham/Chapel Hill that will administer. And if my insurance will pay. I should check on that...

[Mlasley]

I PM'ed you.

[Kay Henderson]

Thanks to those of you who replied.

Background: My shot-phobic DH and I are working to find the cause of some severe allergic reactions he has experienced in recent months.

I had read in two popular magazines about sublingual immunotherapy (SLIT). When we met with the very experienced allergist to whom we were referred, I asked about SLIT. His comment was that it didn't work. At that point, I decided to do a bit of research.

I found out these things:

1. This therapy has been used in Europe quite extensively during the last decade.

2. There are a number of fairly small (> 100 participants) studies showing good success. There is a dearth of larger studies and head-to-head studies comparing SLIT to allergy shots (SCIT, e.g. subcutaneous immunotherapy).

3. In the United States, less than 1% of allergists use SLIT. The most experience appears to have been compiled in a practice in upper Midwest. These folks have also trained physicians in other parts of the country.

4. In Europe, the drops or tablets are generally taken at home. In the U.S., they are sometimes taken at home and sometimes in a doctor's office.

5. Dosage varies widely from 20 times the amount used in shots to 300 times. (The protein molecules in the extract are big guys and not all make it past the skin barrier even in the mouth.) This is significant because some American allergists are worried about safety in using such large doses. It is interesting that in the summary study (#4 below) of 22 trials, NONE of the participants suffered any systemic reactions. (With shots, patients are required to stick around for a half hour because a small number of people have reactions severe enough as to require treatment.)

Here are five of the more interesting references I came across:

1. An article in Scientific American.
http://www.sciam.com/article.cfm?articleID=000EF6AF-F176-1CCE-B4A8809EC588EEDF&sc=I100322

2. An article from a Wisconsin alumni magazine describing the work of a graduate who has used this method extensively.
http://www.uwalumni.com/onwisconsin/Fall00/drop3.html


3. Allergy Choices. A Wisconsin company interested in this therapy. They have a list of physicians they have trained in other regions.
http://www.allergychoices.com/g5-bin/client.cgi?G5genie=1

I'm something of a research nut, so I loved the last two.

4. A British study (a "meta-analysis")of 22 double-blind, placebo-controlled clinical trials. Results showed significant reduction of symptoms and medication requirements using SLIT with no systemic side effects.
http://www.allergychoices.com/images/files/b9_file2_38561.pdf

5. This Copenhagen study was great. Participants were randomly divided into three groups -- 1)active SLIT, placebo SCIT, 2) active SCIT, placebo SLIT, 3) placebo SCIT, placebo SLIT. Both treatments were effective compared to a placebo, and there was no significant difference between them.
http://www.allergychoices.com/images/files/b9_file1_35851.pdf

Even with all this, I know that not all therapies work for all patients, so I really appreciate any personal experience you can share.

Thanks!

Kay

[mbrogier]

I'm taking shots because I'm allergic to cats. (I have two) I hadn't heard of SLIT, but I'm allergic to some pretty strange stuff...I wonder if they'd even let me try it. :rolleyes: The shots don't bother me. I don't even feel them...the needles are teeny tiny. The skin test was worse. I would be suprised if insurance would cover it because its so new--in this country.

[Kay Henderson]

I came across a couple of sites of insurance agencies which did not cover SLIT -- their reasoning was that it was still "investigative."

Kay

[mst]

I am literally the biggest baby ever. HUGE BABY. I get allergy shots. And, seriously, if I can commit to them, anyone can. The shots only hurt for a quick second, and once you get enough, you will know how you like them. (I like my shots quick, rather than slow and drawn out.)

If you allergies are that bad, shots are not as bad as the sinus pain was for me!

Feel free to PM me with any questions. But really, I doubt that ANYONE can be a bigger baby than me.

Oh- I call myself the drama queen at the office, and I always have to have a bottle of water with me too. I find that it helps me be less dramatic with the shots!