Discover the “magic” of allergy drops!!!

Nearly ten years ago, Clarity Allergy Center began offering sublingual allergy drops as a way to desensitize a person to their environmental allergies. The results were simply stunning for many patients. Symptoms literally disappeared within days of starting treatment. Over the last ten years- Clarity Allergy Center has developed an expertise in sublingual immunotherapy that is second to none in the Chicago land area. In the new era of high insurance deductibles and chaotic work/life schedules, allergy drops will likely become a common alternative to traditional allergy shots.

With fear of the corona virus spreading, allergy drops are the perfect option to treat environmental allergies. Only one or two visits are required to start treatment. The allergy drops can be taken at home without the need for weekly visits for allergy shots.

Sublingual allergy drops are a fast and convenient way to reduce a person’s allergy burden. It has been used extensively in Europe, Asia, and Australia to treat allergic respiratory disorders for decades, and is becoming more popular in the U.S. as well. It is currently endorsed by the World Health Organization (WHO) as an alternative to allergy shots.

Immunotherapy is the process by which a person is desensitized to their environmental allergies. This has traditionally been accomplished via allergy shots, with patients receiving in-office allergy injections over a 3-5 year period. Sublingual allergy drops, however, can be conveniently taken at home.

Clarity Allergy Center has been a pioneer in the use of sublingual allergy drops in the Chicagoland area for the last 10 years, having treated hundreds of patients over that time. We have expertise in both allergy drops and allergy shots and are in a unique position to be able to consult patients regarding either option.

Below is a series of Question & Answers for the commonly asked questions.This is based on treating hundreds of patients with allergy drops over the last 10 years.

The results obtained from allergy drops can be astonishing. Many patients find it hard to believe how well they work. The response depends on the type of allergens being treated. We have broken down the response rates based on the common environmental allergies treated. Not everyone will have such dramatic results, but the majority of patients experience substantial benefits as outlined below. We have included a comments section for those that benefited from allergy drops at our practice.

Cat dander

• Approximately 75% of people report a significant improvement with cat allergy drops. In those people that do respond, the symptom improvement ranges from 60-90%. A smaller number of people have a more modest treatment response.

  Many patients report a life changing response to their cat allergies and significant improvement can be seen within 2 weeks.

  Allergic reactions to cat allergy drops are very rare and are well tolerated in the overwhelming majority of patients.

Dog dander

• Approximately 50% of people report a significant improvement with dog allergy drops. In those that do respond, the symptom improvement ranges from 50-80%. Again- many patients have reported a “magical” improvement in their dog allergy symptoms in as soon as 2 weeks. However, the response rate is lower for those receiving allergy drops to dogs vs. those with cat allergies. This likely reflects a somewhat lower potency of dog allergen extracts compared to those for cats. Short of not having any dog exposure, however, there is no other treatment option as convenient as allergy drops that has the potential to be so effective. Systemic allergic reactions are very uncommon.
• We have started a trial program in which patients can receive a 3-month supply of allergy drops for their pet allergies for only $75. This is a sufficient time period to assess how well the allergy drops are working without taking a significant financial risk.

Tree/Ragweed/Grass pollen

• The response to pollen allergies can be dramatic with allergy drops. Approximately 75-85% respond significantly to treatment with the drops. The improvement ranges from 60-95% and can occur in as little as 2 weeks. Allergic reactions are still rare, but occur slightly more frequently following administration of allergy drops with pollen allergens. Many patients report an improvement in their seasonal allergies within days of starting treatment. Allergy drops are the fastest and most effective way to dramatically reduce all of the allergy symptoms associated with seasonal allergies.

Dust mites

• The response to dust mite allergies is very good. Approximately 60-80% of patients respond to dust mite allergy drops. The response for each patient ranges from 55-85%. Dust mite allergies can be considered in those people with year-round allergy symptoms. Like pet allergy drops, we offer an introductory trial for $75.

Mold 

• Mold allergies can certainly respond to allergy drops. The response rate is more variable for mold allergies then other environmental allergies. This is because the extracts used for mold allergy drops are not as potent as for some of the other allergens. Also, there are many mold allergens and allergen extract manufacturers have difficulty producing the full range of mold extracts.

• Allergy drops for cats and dogs (even horses!) are a great option. The main caveat for those taking dog allergy drops is that they work in about 50% of patients (vs about 75% for cat allergy drops). But as mentioned above, it can be magical for those that do respond. The improvement can be so impressive that a trial of pet allergy drops should be considered in any pet allergic patient with significant exposure. We have made the trial offer hard to resist so that as many people can have a chance to start this potentially life changing therapy as possible. Pet ownership has skyrocketed in recent years and can be hard to avoid socially. Allergy drops can be a great option for those with short term pet exposure (visiting family or friends with pets). We cannot guarantee that other allergy medications will not be needed. Some patients are sufficiently controlled without additional medications and others become very well controlled with the combination of allergy drops and allergy medications (as opposed to still being poorly controlled on just allergy medications alone). There are 3 response groups we typically see in those taking allergy drops:
  • Great response in which no other medications are needed (45-55% of those taking cat drops; 25% of those taking dog drops.
  • Good response but additional allergy medications may be required to control the allergy symptoms (vs. minimal symptom improvement on allergy medications prior to taking the allergy drops); 20-30% of those taking cat drops; 25% for those taking dog drops
  • Minimal response to allergy drops (25% of taking cat drops; 50% taking dog drops)

There are two forms of sublingual immunotherapy (SLIT)

• FDA-approved sublingual allergy tablets
  • Out of the approximately 45 different allergens that are used for traditional immunotherapy with allergy shots, there are FDA- approved sublingual allergy tablets for three different allergens- dust mite, ragweed, and grass. These three commercially available products underwent the same FDA approval process that all traditional medications must go through and are prescribed and filled through traditional pharmacies.
• Sublingual allergy drops
  • Many allergy practices (like ours) offer sublingual allergy drops. The vaccines for the allergy drops are made in the lab of the individual allergy practices. We use the same FDA-approved allergy extracts that we use for the allergy shot vaccines. In this case, the route of administration of the allergy drops (under the tongue) is what is not FDA approved. The allergen extracts we use go through the standard FDA manufacturing approval process. Unlike the FDA-approved allergen tablets, we can use all of the environmental allergens needed to treat the full spectrum of environmental allergies.

• Are the FDA- approved allergy tablets widely used?

  No. Sales for the allergy tablets have been a big disappointment for the pharmaceutical industry and have not gained traction in clinical practice. The primary reason for this likely relates to the lack of real world utility. Only three allergens have been FDA approved. The vast majority of people have allergies to a wide range of environmental allergens and these FDA approved tablets are simply not practical for most people.

  Will there be more environmental allergens approved by the FDA?

  This is very doubtful. The clinical studies required to attain FDA approval are time consuming and very expensive. Given the disappointment of the commercially available FDA-approved allergen tablets, it is highly unlikely that pharmaceutical companies will be willing to undertake any further financial commitment in this space.

• There are many reasons for this
  • Perhaps the most likely reason is a lack of familiarity with allergy drops. Prior to offering allergy drops to patients almost ten years ago, we invested considerable time researching the safety and efficacy of sublingual immunotherapy. Over the last ten years, we have developed state of the art knowledge and expertise- which is second-to-none in the Chicagoland area.
  • Allergy shots generate significantly more revenue than allergy drops- on a per patient basis. Unfortunately, profit can be a driving factor for many in the health care industry. From a financial perspective, allergists have historically had little reason to offer allergy drops to their patients. To see what we mean- call a local allergy practice and ask how much allergy shots cost per year and then compare that to the prices listed below for allergy drops.

• We recognized the potential that allergy drops offered many years ago. With sky rocketing health care deductibles, many people do not want to pay for the significant out of pocket expenses of allergy shots. We strive to make allergy drops affordable for as many people as possible.
• Often times, a person’s schedule is not conducive to weekly in-office allergy injections.
• Offering both allergy drops and allergy shots gives our patients more flexibility in choosing a customized treatment plan. We have expertise in both and can advise patients on which options would be better for them. We will discuss the pros and cons of each, helping patients implement a customized treatment plan that works within their budget and their schedule.

• Patients will have an allergy consultation and allergy skin testing at the initial visit. Based on those results, we will make a customized allergy vaccine in our in-house lab. Patients then follow up to receive their first dose of the allergy drops in the office. Although allergic reactions to allergy drops are very rare, it is prudent to administer the first dose in the office. Allergy drops are continued daily for a period of 3-5 years. There are also options for less lengthy treatment protocols depending on a person’s individual circumstances. The magic of allergy drops is that dramatic symptom improvement can occur within days to several weeks. Continued improvement is typically seen over the next several months. Although patients typically experience significant improvement quickly, it takes at least 3 years to have the permanent results associated with immunotherapy. (In other words- those that continue allergy drops for less than the 3 years may lose the benefits after stopping the allergy drops).

• Allergy drops are not covered by most health insurance plans. The actual price depends on the number of allergens used in the formulation. The yearly cost will range from $450 for single allergen allergy drops up to $1100 for the entire allergen panel. Our goal is to make allergy drops as affordable as possible. For that reason, we offer a starter program that allows patients to have a trial period of the allergy drops for 3 months. This is a sufficient time period to see how well the allergy drops work. The starter trial begins at $75 for single allergen treatment plans (such as a cat or dog). These prices do not include the initial evaluation or allergen skin testing.

• Studies have, in fact, shown that allergy drops (like allergy shots), can reduce the likelihood of developing asthma. Immunotherapy (via shots or drops) can induce immunological changes that prevent the development of asthma and additional environmental allergies. The earlier the onset of treatment, the better the chance of preventing the progression of allergies and asthma.

• Allergy drops are very safe. Systemic allergic reactions are rare, occurring in less than 1% of patients. Additionally, a fatality from allergy drops has never been reported. In our practice, patients are given the first dose of the allergy drops in the office. To date, no one that did not have a severe allergic reaction during the in-office challenge has had a significant reaction to the drops at home. Mild allergic reactions to the drops occur with increased frequency. Approximately 5% of patients will experience mild itching or swelling of the mouth and/or mild abdominal discomfort for several minutes after administering the drops. These mild reactions typically resolve within several weeks of starting treatment and usually do not require stopping the drops. In the unlikely event that there is a more severe allergic reaction at home, it is recommended that patients have an Epipen and Benadryl available. We will be adding another blog post soon that takes a deeper dive into the safety of allergy drops.

• The actual age is a case by case situation. However, 7 years of age is typically the age we start offering allergy drops

• Patients with severe, uncontrolled asthma should not be started on allergy drops. Patients with well controlled mild to moderate asthma can be started on allergy drops.
• An allergic inflammatory condition of the esophagus called Eosinophilic Esophagitis is a contraindication to allergy drops. If you notice worsening abdominal pain, difficulty swallowing, or other GI symptoms while on the allergy drops, please stop the allergy drops and notify the prescribing doctor
• Allergy drops should not be started or continued in those with open sores or ulcers in the mouth. These patients may be more susceptible to an anaphylactic reaction (severe allergic reaction) to the allergy drops. It is important to stop the allergy drops until the sores or ulcers resolve.
• Patients should stop taking their allergy drops if they have a history of asthma and develop worsening asthma symptoms

Allergy drops can decrease the full range of environmental allergy symptoms- including eye, nasal symptoms and asthma symptoms. Allergy drops can prevent or reduce the need for multiple medications (allergy eye drops, anti-histamines, nasal sprays, and inhalers).

Allergy drops can change the natural course of a persons’ allergies, inducing a state of long term tolerance to their allergies long after stopping the allergy drops.

In contrast, allergy medications can treat the allergy symptoms but will not alter the natural course of a person’s allergies.

• If we had to pick one- allergy shots can be more effective than allergy drops. As described above, it does depend on the allergies being treated. Based on our experience, about 30-40% of patients will respond equally well to allergy shots compared to allergy drops. Another 30-40% will still have a good response to the allergy drops but not quite as well as the allergy shots. Approximately 10-20% of patients will not have a significant response to allergy drops but will respond to allergy shots. The one exception, as mentioned, are those receiving allergy drops to dogs- in which about half do not have a significant response to the dog allergy drops. In contrast, almost all patients receiving allergy shots to dog dander respond to one degree or another.

We have included a link to the position paper released by the World Allergy Organization on sublingual immunotherapy. The organization is comprised of experts in the field of Allergy and Immunology throughout the world. I will also include some of the pertinent highlights from the position paper:

• Sublingual immunotherapy (SLIT) has been shown to induce long-term remission after discontinuation and may prevent new sensitizations, features consistent with the induction of tolerance
• Several large “definitive” trials have confirmed the efficacy and safety for allergies in both children and adults.
• 77 randomized controlled trials with SLIT have sown clinical success in those with nasal and eye allergies, as well as asthma.
• Some studies suggest that SLIT is as effective as allergy shots
• SLIT has fewer complications than allergy shots and is better tolerated
• The majority of SLIT reactions are local (itching of the mouth) that occur during the beginning of treatment and resolve within a few days or weeks of treatment
• SLIT reduces the risk of asthma in children with nasal allergies

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3983904/

A recent study from Ohio State University, published in the Annals of Allergy, Asthma & Immunology, has found that stress can exacerbate allergy flare ups. The study observed 179 participants over a 12-week period and found that 39% experienced more than one flare up. That group that experienced the flare up was also found to have higher stress levels.   More Allergy Information...