Allergy & Asthma Center of Stamford

 

                                       Paul S. Lindner, MD, FACP   &   Ora Burstein, MD
                             1275 Summer St - Stamford, CT 06905    -    (203) 978-0072
   Home      Sublingual Immunotherapy

TYPES OF ALLERGY IMMUNOTHERAPY

ALLERGY SHOTS

The gold standard of allergy immunotherapy.  Allergy shots are administered in the allergist's office initially on a weekly basis and then gradually spaced out to monthly maintenance injections.  Initial doses are of low concentration and gradually build to a plateau.  Allergy shots have been studied extensively over half a century and have proven efficacy.  They are stronger than any type of sublingual therapy.  They are generally covered by most insurance plans as they are FDA approved and are the standard of care for allergies and asthma.  We offer allergy shots for an extensive panel of allergens to include dust mite, molds, grasses, weeds, tree pollen, cats, dogs and horses.

If a patient is unable to meet the time commitment for allergy shots or has a needle phobia, sublingual tablets may be an option.    


SUBLINGUAL ALLERGY TABLETS

The FDA recently approved 3 brands of sublingual allergy tablets.  The names are GASTEK, RAGWITEK and ORALAIR. These essentially contain a dried form of the allergy extracts that we use for allergy shots and are placed under the tongue until they dissolve.  The first dose is to be taken in our office and subsequent doses are taken daily at home.  They need to be started 4 months prior to the beginning of the season and then continued until the end of the season.  A good time to start the therapy would be in January or February.  These pills are prescribed for home administration and therefore would be covered under the prescription portion of insurance coverage.  As with all new prescription medication, you should check with your plan regarding coverage, copay, etc.

At this point in time, the sublingual tablets are only available for grass and ragweed pollen.  In terms of seasonality, these are the important pollens for late spring, summer and fall.  There are no sublingual tablets approved at this point in time for dust mite, dog, cat, molds or tree pollen.

SUBLINGUAL ALLERGY DROPS

Allergy drop therapy has been around for decades, however there has yet to be FDA approval for this technique.  Due to the lack of FDA approval, most insurance companies will not cover allergy drop therapy.  There is a lack of standardization of extract formulations for this product as well as a lack of approved protocols for administration.  Many practitioners providing allergy drop therapy use the extracts manufactured for allergy shot therapy (above) and just have patients put these drops under the tongue assuming the product gets absorbed into the systemic circulation in this fashion.  Side effects of sublingual allergy drops and tablets include oral itching, swelling and the potential for anaphylaxis.  Epipens are a must!


COMPARISON OF ALLERGY IMMUNOTHERAPY OPTIONS - SALIENT FEATURES

ALLERGY SHOTS


  • FDA approved
  • Covered by most insurance plans
  • Most efficacious of immunotherapy options
  • Most number of studies published through the decades
  • Initially given weekly, then gradually spaced out to monthly
  • Can be started any time of year
  • Shots available for all pollens, dust mite, molds, animal danders

 

SUBLINGUAL TABLETS


  • FDA approved
  • Covered by most insurance plans under prescription plan
  • Needs to be taken daily
  • Needs to be started at least 4 months prior to the season
  • Only available for ragweed and grass pollen
  • Does not help dust mite, tree pollen, molds or animal danders

ALLERGY DROPS


  • NOT FDA approved
  • Usually not covered by insurance plans
  • Not many studies published in reliable journals
  • Needs to be taken daily
  • Lacking uniformed manufacturing supply and published protocols