How to Get Allergy Shots Without Needles
Sublingual immunotherapy is available for several allergens, including dust mites, ragweed, and grass pollen. Could it work for you?
For those with allergies who are uncomfortable with needles, you may have another option if over-the-counter medications or steroid nasal sprays don’t relieve your symptoms. Sublingual immunotherapy (SLIT) is approved for certain allergies. Instead of getting an injection, this treatment involves placing a tablet under your tongue.
According to the American College of Asthma, Allergy, and Immunology, the prescription treatment offers an alternative to traditional immunotherapy—otherwise called allergy shots or subcutaneous immunotherapy (SCIT). That involves injecting increasing amounts of allergens over three to five years to raise your tolerance.
How Is Sublingual Immunotherapy Administered?
It involves letting a tablet dissolve under your tongue for a few minutes a day, one that contains purified extracts of the offending allergens.
An allergist will initially administer the treatment in his or her office to ensure that you don’t experience significant side effects such as anaphylaxis, a potentially deadly allergic reaction.
After that, you should be able to take the tablets yourself at home. (Allergy shot injections are always given under medical supervision.)
Is Sublingual Immunotherapy Right for You?
You might consider the under-the-tongue approach if you have frequent, bothersome dust mite, grass, or ragweed allergy symptoms that don’t respond sufficiently to allergy medications such as steroid nasal sprays and you don’t want to use traditional immunotherapy.
Currently, four FDA-approved SLIT treatments are available. The newest is Odactra, the first approved for house dust mite allergies, a year-round problem for millions of Americans. The others are Oralair, for five different grass pollens; Grastek, for Timothy grass allergies; and Ragwitek, for ragweed allergies.
All are only for those ages 65 and younger. Depending on the specific SLIT treatment, younger people may start at age 5 (for Grastek), 10 (Oralair), or 18 (Odactra and Ragwitek).
Some doctors prescribe sublingual drops instead of tablets and recommend them for a wider range of allergens, including cat dander. But that approach is still being studied and is “off-label”—legal but not a use that’s officially approved by the FDA.
For grass and ragweed, it’s wise to begin treatment three to four months before the allergy season gets underway, says Mark S. Dykewicz, MD, the Raymond and Alberta Slavin Endowed Professor in Allergy & Immunology at the Saint Louis University School of Medicine in Missouri.
That way, by the time grass and ragweed are in full bloom, you’ll have built up a tolerance to the allergens and your reaction to them should be significantly diminished. (Ragweed season tends to be late summer to early fall; grass pollen is prevalent in late spring or in warmer areas all year.)
For dust mite allergies, according to The Medical Letter, a nonprofit periodical for healthcare providers, it can take up to 14 weeks of Odactra use for symptoms to ease. Clinical trials have found that it reduced allergy symptoms and the need for allergy medication by 16 to 18 percent compared with a placebo.
SLIT may cause mild side effects such as an itchy or irritated mouth and throat and nausea or abdominal discomfort. Severe reactions such as anaphylaxis appear to be quite rare.
But guidelines released by the American Academy of Allergy, Asthma, and Immunology and the American College of Allergy, Asthma, and Immunology recommend that people using SLIT have a prescription for an epinephrine auto-injector—and know how to use it—just in case.
Is Sublingual Immunotherapy Better Than Allergy Shots?
Only a few small clinical trials have directly compared the effectiveness of allergy shots with SLIT, but so far the shots appear to have a slight edge, according to Wolters Kluwer’s UpToDate.
In addition, Dykewicz says, “Patients who are allergic to multiple allergens would be better candidates for SCIT, which can be used to treat multiple allergens. Administration of several different types of SLIT tablets together has not been well-studied.”
And while the risk of a serious allergic reaction with SLIT is far lower than it is with allergy shots (which is why the injections are always given in a medical setting), the sublingual approach isn’t for everyone, he says.
For example, you shouldn’t use it if you have conditions such as severe, unstable, or uncontrolled asthma; eosinophilic esophagitis (EOE), an immune disorder that can make swallowing food difficult; or a history of a severe reaction to immunotherapy. If you’re considering the therapy, be sure your doctor has your full medical history.
