Shots or Drops?

H. Farhadian, M.D., F.A.A.P., F.A.A.A.A.I.
Copyright© 2019, H. Farhadian, MD. All rights reserved.

In the past eighty years, allergists around the world have been treating patients who have been suffering from allergies and asthma by allergy shots or immunotherapy. This method of therapy is a type of vaccination. The substance that a person is allergic to is modified and injected under the skin so that the body becomes resistant to the allergen (offending allergic item). Therefore, upon exposure to the specific allergen, allergic symptoms will not longer bother the patient. For example, if an individual is allergic to cats, dogs, dust mite, trees, or grass pollen, giving him/her the same modified allergen will enable that person's body to become resistant to these substances.

Allergy shots or immunotherapy is effective and safe, but only if the test is done properly and the serum (vaccine) formula is appropriately administered under the care of an expert or qualified allergist. However, this method of therapy is sometimes performed by non-qualified physicians. Therefore, the results may be unsuccessful and, at times, even dangerous. As an alternative to allergy injections, recently in Europe, allergists have been treating allergies by oral route (under the tongue). This sublingual method has been fairly successful and seems to be attractive due to being painless and convenient. However, at the present time, the outcome is questionable for the following reasons:

1. Sublingual or under the tongue immunotherapy has not yet been approved in the United States.

2. Insurances have not recognized this procedure as an approved method and, therefore, will not compensate. Thus, patients must take full financial responsibility for this expensive treatment.

3. Thus far, this method has shown efficacy only for one substance at a time. Usually allergic patients have multiple allergies.

4. The amount of allergen by the sublingual method must be 350 to 750 times stronger than the amount used by injection. Otherwise this therapy is ineffective.

5. The question is, do children or adults prefer to tolerate almost painless minor injections or the taste of dust mites or cat drops under their tongue? In conclusion, at this time, we believe allergy immunotherapy by subcutaneous injection is more effective, conventional and safe. It is also covered by most insurances and is FDA approved. Of course, as I mentioned above, this treatment must be done under the care of a specialist. I do believe, however, in the future, after resolving these deficiencies, the sublingual method will be a positive addition to the treatment of allergic disease.