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 PATIENT EDUCATION
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Which is better for me: allergy shots or allergy drops?
Reducing people’s sensitivity to certain allergens (e.g. pollens, animals, molds, venoms) has been possible for nearly 100 years in this country. Over the years, we have improved and refined the methods used. The “gold standard” method for the past 50 years has been subcutaneous (just under the skin) injections of purified allergens, also known as subcutaneous immunotherapy (SCIT). An alternative to injection therapy is now available. This method involves placing allergen liquids or dissolvable tablets under the tongue where the allergens are absorbed into the body through the oral mucous membranes. This method is referred to as sublingual immunotherapy (SLIT). SLIT offers two conveniences compared to SCIT that make this an exciting alternative to injection therapy: no needles and at-home therapy! This information sheet will explain more about each method to help you understand which method would be best for you.
How Do These Therapies Reduce Your Allergies?
Both methods reduce your allergy symptoms by altering your immune system’s reaction to naturally occurring allergens. Over time, with continued use, you can live comfortably with animals or pollens that now cause you allergic eye, nose or lung symptoms. Fewer symptoms mean fewer medicines and a much better quality of life! Medications used in allergy therapy (antihistamines, nasal steroids, eye drops, etc.) are like a Band-aid? on a toddler’s cut finger; when the Band-aid? hides the cut from the child’s eyes, he feels better. If the Band-aid? falls off later that day, the cut becomes visible again and the child panics. Another Band-aid? keeps things calm until the cut eventually heals. Allergy medications do not “cure” allergies; they simply reduce the symptom severity. Allergy immunotherapy, whether SCIT or SLIT, can actually “heal the cut” reducing medication needs in the future, sometimes to zero!
How Are These Therapies Administered to You?
Both methods rely upon frequent exposure to your allergens although the frequency and starting doses vary between the two methods. Both methods carry a slight risk of allergic reaction. The risk with SCIT is higher than with SLIT and requires in-clinic delivery with a 20 to 30-minute wait with each injection. We start SLIT in our clinic but quickly move to at-home use because of the reduced severe allergic reaction risk. The two methods are compared side-by-side on the reverse side of this paper.
| Method |
SCIT |
SLIT |
| Starting Dose |
Usually 1/10,000th the “maintenance” dose |
1/10th the “maintenance” dose |
| Dose frequency |
1-2 times a week for first 3-6 months, once a week for next 6 months and ultimately once every 2-4 weeks (Average patient…) Accelerated build-up schedules are available. |
Once daily, always! |
| Treatment Location |
Clinic |
Home after first 3 doses in clinic |
| Duration of Treatment |
3-5 years recommended |
Same as SCIT |
| Symptom Reduction Possible |
Up to 100% relief (without medicines!) |
40-60% relief (Higher in some cases) |
| Time to Initial Symptom Improvement |
4-9 months (average) |
2-6 months (average) |
| Number of Treated Allergens Possible |
Up to 30+ (pollens, molds, mites, animals, venoms) |
1-3 (cat, dog, mold, select pollens) |
| Adverse Reactions: Most common to least common |
Injection site swelling and itch. Hives, eye/nose allergy symptoms, breathing difficulty, full anaphylaxis are rare but possible. |
Oral itch and slight oral swelling. Nausea, vomiting, hives and breathing difficulty are very rare. |
| Insurance Coverage |
Yes, plan-dependent |
Not yet |
| Eligible Patient Age Range |
4-5 years and up |
2-3 years and up |
Which Method Is Best for You?
Subcutaneous therapy offers the greatest benefit potential to the largest percentage of our allergy patients. Use this if you have multiple pollen, mold and/or animal allergies or if you are insect venom allergic. At the moment, SCIT is the only option for venom-allergic patients. Use this method also if you are looking for “maximum” benefit.
If you are very afraid of needles, have only a few major allergens (dog, cat, grass or sagebrush pollens) or have a personal life schedule that prevents in-clinic treatment, SLIT may be the best choice for you! Children allergic to the family cat or dog can reverse their allergy symptoms using SLIT and avoid a “shot”! A hunter allergic to sagebrush pollen can finally find relief in the Fall hunting season with the convenience of in-home therapy!
Please talk about this choice with your allergist.
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