Sublingual immunotherapy, often called allergy drops, works like allergy shots by gradually helping your body build tolerance to the antigens or substance(s) that cause your allergies. The difference is that the antigen is placed under your tongue in a customized liquid form. See how allergy drops work.
At Allergychoices, we advocate for custom sublingual immunotherapy that is based on your specific allergens, and at your level of sensitivity — matching your allergic fingerprint. The La Crosse Method™ Protocol follows this philosophy. Treatment is matched to your test results, and gradually becomes stronger based on how you respond to treatment — it does not follow a “one size fits all” formula that doesn’t take your individual response, lifestyle, and medical history into account. This precise approach helps ensure your treatment isn’t higher or lower than needed for your body to respond. You can ask your provider if their approach follows this philosophy of treatment to be sure it is customized for you.
Anyone interested in treating the cause of their allergic disease, instead of just temporarily managing symptoms, can consider allergy drops. Although most allergy sufferers can benefit from allergy drops, they’re especially ideal for people who can’t tolerate or don’t respond to allergy shots, as well as those who are unable to commit to other therapies and long-term medication use. These people include:
* Allergy drops have proven especially helpful for children with eczema and recurrent ear infections, which often have underlying allergic causes. Research shows that many children with untreated eczema and allergies often develop asthma and other chronic conditions later in life, so treating them early can have life-long benefits and may prevent development of other allergies and asthma.
More providers across the country are beginning to offer allergy drops to their patients. If you’re interested in finding someone close to you, we can help you find a provider nearby who is trained in offering custom sublingual immunotherapy. Or, we’re happy to assist providers in adding this option.
Allergy drops are prescriptions, so a licensed prescriber must order and will monitor your treatment progress and dose based on your progress. Contact your provider to order your prescription, or we can help you find a provider who offers treatment using the La Crosse Method Protocol.
In addition to being a viable option for people of all ages and conditions, there are more advantages:
Lower cost, fewer clinic visits. Compared to shots and many medications, allergy drops typically cost less over time. Most patients receiving allergy drops need only a few clinic visits the first year, and then once every 6-12 months thereafter until visits are no longer needed. That can also mean a lot less time away from work or school.
More convenient. You can take allergy drops at home or wherever you are, making it much easier to stay with your treatment.
Less medication. Our patients report, and research confirms, that they typically need less medication to control symptoms after beginning allergy drops.
Enjoy healthier days. The end benefit of taking drops consistently? Feeling better, more productive and better able to enjoy life and activities that allergies once made it hard to enjoy.
Allergy drops have been used around the world for more than 100 years, and numerous studies validate both the safety and effectiveness. The World Health Organization has endorsed sublingual immunotherapy as a viable alternative to allergy shots. The Cochrane Collaboration, the world’s most-trusted international organization dedicated to reviewing healthcare treatments, concluded that allergy drop immunotherapy significantly reduced allergy symptoms and the use of allergy medications.
In addition, La Crosse Method Protocol outcomes have been validated through the Validation Institute, an independent team of population health scientists and bio-statisticians who provide objective review to validate performance in healthcare.
See our bibliography for more information about research studies.
Most patients do not report side effects, but some may report minor mouth itching or stomach upset—especially when beginning treatment or as prescription strength increases. Most reactions resolve themselves on their own, or with antihistamines. Report symptoms lasting more than an hour to your doctor.
Rarely, generalized reactions may occur, including:
Mild to moderate urticaria (hives) with rash, swelling or itching on more than one part of the body. This typically occurs within minutes of taking a dose.
Angioedema has not been reported using this protocol, but has been reported rarely with other protocols. Symptoms include swelling of the ears, tongue, lips, throat, intestines, hands, and feet – alone or in any combination. This may occasionally be accompanied by asthma symptoms and may progress to anaphylactic shock. The primary danger lies in suffocation from airway swelling. Angioedema may occur within minutes of taking a dose and requires immediate medical attention.
Anaphylactic shock, the rarest complication, has not been reported using this protocol but has rarely occurred using other protocols. Symptoms include acute asthma, low blood pressure, unconsciousness, and potentially death. If you have a history of these reactions, you are required to have an epinephrine injector available when taking your drops.
Yes, you can convert from allergy shot to allergy drop treatment. Our clinical team can work with your provider to review your current treatment and adjust your dosing and delivery so you can safely take your treatment at home.
Insurance companies may cover the cost of office visits and diagnostic testing. Because allergy drops are an off-label use of FDA-approved antigens, they are not typically covered by insurance. Check with your carrier first.
Allergy drops do qualify for Health Savings Account or Flex Spending reimbursement. Even without insurance coverage, most patients find treatment affordable and comparable to other medication or visit co-pays. Most patients agree that the temporary investment in allergy drops is well worth the lasting results and improvement in their quality of life.
It’s important to understand that the antigens used in allergy drops are the same FDA-approved antigens used in allergy shots. They’re also prepared in the same way as allergy shots. The difference is the route of delivery — a dispenser that delivers a precise drop of antigen under the tongue versus a syringe injecting antigen into tissue. The FDA approves products, not therapies, so it’s unlikely that it will ever “approve” custom, multi-antigen sublingual immunotherapy.
Antigens are labeled by the FDA for single use through injections and some for sublingual immunotherapy. A number of FDA-approved biologics are considered off label use when delivered via sublingual immunotherapy, which is both legal and highly common. Most physicians prescribe drugs in an off-label manner today, for example, the use of blood pressure medications for migraines, montelukasts for COPD, or arthritis drugs to treat shingles. Multiple antigen therapies for both injection and sublingual use are an off-label use of FDA-approved biologics.
Allergy drops are widely accepted as an effective treatment throughout the world. As more U.S. doctors and patients become aware of their benefits, acceptance grows. Allergychoices has proudly led the way in helping more providers and allergy sufferers understand the benefits and options for custom, precise disease-modifying allergy treatment
Each prescription is a custom solution for each patient according to the type and severity of his or her allergy. Drop prescriptions contain custom amounts of the allergen the patient is found to be allergic to upon testing. Antigens are put into a glycerin solution for stability. There are no other preservatives added in the prescription formulation.
Most patients take allergy drops three times daily for 3-5 years, but it varies according to the severity of the allergies, seasonality, and how adherent they are to treatment. Many patients see symptoms improve within a few weeks to months, but need to keep using the drops through the full course of therapy to get long-term benefit. For some patients with complex health conditions or severe allergy, treatment length may vary.
Treatment doses are adjusted over time based on your specific test results and response (your allergic fingerprint) rather than a one-size-fits-all treatment approach. This custom way of matching your dose — uniquely to you — helps you build tolerance without unnecessarily increasing your risk of reactions.
A benefit of immunotherapy (shots and drops), is that it can actually change the course of allergic disease by treating the root cause, not just the symptoms. Once tolerance is built, it can be permanent for many patients.
But even the best treatments won’t work if you don’t stay with them. Like allergy shot treatment, it’s important to stay with allergy drop treatment until your provider has determined it can be discontinued to give you the best chance of long-term effectiveness.
While many long-term studies of patients on sublingual immunotherapy have shown a decrease in specific IgE in some groups, not everyone’s IgE decreases. It is important to reinforce that IgE is only one measure of allergic response.
Just as IgE can be used to indicate allergic sensitivity, it can also be a late indicator of tolerance to allergens. Immunotherapy induces the regulatory T cell, the immune cell that regulates allergic inflammation. The T cells direct the cells that make immunoglobulin, B-cells, to make protective antibodies such as IgA and IgG4. With all of this immune stimulation, the IgE may actually increase in the first year of sublingual immunotherapy treatment before it decreases. Sometimes a ratio of IgE to IgG4 is used to indicate whether immune tolerance is developing.