From Ah-Choo! to Ahhhhh: Managing Seasonal Allergies

/FAPProviderImages/_0011MJ43K.jpg​​​​​​​With spring in the air, if you have seasonal allergies, your sneezing and runny nose will appear soon—if they haven't already. That means it's time to find an effective treatment to reduce your symptoms and improve your quality of life.

If over-the-counter medications don't work for you, sublingual allergy immunotherapy drops may be the answer you're looking for, says Esther Cheng, MD, an otolaryngologist with The Christ Hospital Physicians - Ear, Nose and Throat. This new therapy can potentially give you long-term allergy relief.

“If the regular allergy medicines or treatments your primary care physician recommends aren't working and your symptoms are persistent, you need to seek specialty care," she says. “Sublingual allergy immunotherapy drops are an alternative to classic allergy shots. They offer symptom relief with more comfort and convenience."  

What are sublingual allergy immunotherapy drops?

Sublingual drops deliver allergy medication directly under your tongue. They are the latest form of allergy immunotherapy, a personalized treatment option that provides lasting allergy symptom relief.

Allergy immunotherapy introduces you to small doses of an allergen—a substance like grass or pet dander that triggers your over-active immune response. Over several weeks, the drops expose you to increasingly larger doses to help you build up tolerance. The goal is to limit how much you rely on over-the-counter medication like antihistamines or decongestants to improve your breathing and control your itchy eyes or runny nose.

“By getting more and more exposure to these allergens, you build up enough antibodies so your immune system can fight off the allergen," Dr. Cheng says. “Eventually, you don't develop symptoms when exposed to the allergen in the future."

What to expect from sublingual drops

Sublingual drop therapy can be a daily or twice-weekly treatment. You place several drops under your tongue for two minutes and then swallow. Your ENT doctor delivers the first few therapy rounds in the office to make sure you don't experience a severe allergic reaction called anaphylaxis. After that, you self-administer the drops at home. Some mild side effects, such as swelling, irritation and burning under your tongue, are possible with each treatment.

It takes roughly three to five years to build up an immunity to an allergen. Dr. Cheng says. Once you have that immunity, you can stop using drops. For many people, immunity can last for up to 10 years. The therapy is best suited for patients who don't get symptom relief from traditional allergy treatments. However, you shouldn't use drops if you're taking medication for high blood pressure.

“If you're on a beta blocker, you should avoid allergy drops and shots," Dr. Cheng says. “If you have an anaphylactic shock to one of your allergy treatments, beta blockers will blunt your response to epinephrine, the life-saving medication we use to counteract severe allergic reactions."

Creating your allergy-specific treatment

Sublingual drops are a personalized therapy. As a first step, your doctor will conduct an allergy skin or blood test to identify every allergen that triggers your immune system. Dr. Cheng says your doctor will use those test results to determine the formula and dose of your drops.

“We create drops for patients based on their number of different allergies. With some exceptions, we can sometimes put medication for all their various allergies into one vial," she said. “It's a much easier way to administer the medication since patients get everything they need all at once."

Sublingual drops versus tablets and allergy shots

Sublingual drops are just one type of allergy immunotherapy. Sublingual tablets and allergy shots are also available. Each therapy reduces your symptoms, but they do have differences.

Drops: Sublingual drops are not yet approved by the Food and Drug Administration (FDA). But they present a lower risk of anaphylactic shock because your body absorbs the medication slowly. Drops also deliver medicine for the widest variety of allergens, including:

  • Cats and dogs
  • Dust mites
  • Feathers
  • Grasses
  • Molds
  • Trees
  • Weeds

Tablets: Like drops, you dissolve tablets under your tongue once a day or twice weekly. However, each tablet can only fight one allergen, and they are only FDA-approved to treat:

  • Dust mites
  • Grasses
  • Short ragweed pollen

Shots: Allergy shots have been FDA-approved for many years. They're effective but inconvenient. Your doctor must deliver your weekly injections because shots present a higher risk of anaphylactic shock. Additionally, each shot can only target one allergen.

The challenge to using sublingual drops

Sublingual drops are effective, but cost is a significant challenge when using them for regular allergy therapy. Because they don't yet have FDA approval, they aren't covered by insurance. You will pay out-of-pocket for treatment.

Dr. Cheng says the cost of sublingual drops depends on how many medications your mixture includes. So, the price tag can range from several hundred to over a thousand dollars.

Still, she says, sublingual drops may offer you a more convenient, easy-to-tolerate allergy treatment plan.

“Even with the associated cost, sublingual drops can be an attractive therapy option," she says. “It presents less risk and is generally better tolerated than shots. And it may be worth it for patients who would rather put a few drops under their tongue every few days than get poked with a needle once a week."

​ ​​

Contact The Christ Hospital Physicians – Ear, Nose & Throat to learn more about sublingual allergy immunotherapy drops. You can schedule an appointment by calling 513-421-5558.


Esther Cheng, MD

Esther Cheng, MD, holds several professional memberships such as the American Academy of Otolaryngology – Head and Neck Surgery, the American Head and Neck Society, the American Academy of Facial Plastic and Reconstructive Surgery, and the Triological Society. Her areas of interest include head and neck cancer, transoral robotic surgery, head and neck reconstruction, thyroid surgery, nasal/sinus disorders and surgery, and salivary gland tumors.

From Ah-Choo! to Ahhhhh: Managing Seasonal Allergies Spring in Cincinnati. You might not see all the pollen, but it can really wreak havoc on your respiratory system! Ear, Nose & Throat specialist Dr. Esther Cheng has some newer solutions for allergy relief.

/FAPProviderImages/_0011MJ43K.jpg​​​​​​​With spring in the air, if you have seasonal allergies, your sneezing and runny nose will appear soon—if they haven't already. That means it's time to find an effective treatment to reduce your symptoms and improve your quality of life.

If over-the-counter medications don't work for you, sublingual allergy immunotherapy drops may be the answer you're looking for, says Esther Cheng, MD, an otolaryngologist with The Christ Hospital Physicians - Ear, Nose and Throat. This new therapy can potentially give you long-term allergy relief.

“If the regular allergy medicines or treatments your primary care physician recommends aren't working and your symptoms are persistent, you need to seek specialty care," she says. “Sublingual allergy immunotherapy drops are an alternative to classic allergy shots. They offer symptom relief with more comfort and convenience."  

What are sublingual allergy immunotherapy drops?

Sublingual drops deliver allergy medication directly under your tongue. They are the latest form of allergy immunotherapy, a personalized treatment option that provides lasting allergy symptom relief.

Allergy immunotherapy introduces you to small doses of an allergen—a substance like grass or pet dander that triggers your over-active immune response. Over several weeks, the drops expose you to increasingly larger doses to help you build up tolerance. The goal is to limit how much you rely on over-the-counter medication like antihistamines or decongestants to improve your breathing and control your itchy eyes or runny nose.

“By getting more and more exposure to these allergens, you build up enough antibodies so your immune system can fight off the allergen," Dr. Cheng says. “Eventually, you don't develop symptoms when exposed to the allergen in the future."

What to expect from sublingual drops

Sublingual drop therapy can be a daily or twice-weekly treatment. You place several drops under your tongue for two minutes and then swallow. Your ENT doctor delivers the first few therapy rounds in the office to make sure you don't experience a severe allergic reaction called anaphylaxis. After that, you self-administer the drops at home. Some mild side effects, such as swelling, irritation and burning under your tongue, are possible with each treatment.

It takes roughly three to five years to build up an immunity to an allergen. Dr. Cheng says. Once you have that immunity, you can stop using drops. For many people, immunity can last for up to 10 years. The therapy is best suited for patients who don't get symptom relief from traditional allergy treatments. However, you shouldn't use drops if you're taking medication for high blood pressure.

“If you're on a beta blocker, you should avoid allergy drops and shots," Dr. Cheng says. “If you have an anaphylactic shock to one of your allergy treatments, beta blockers will blunt your response to epinephrine, the life-saving medication we use to counteract severe allergic reactions."

Creating your allergy-specific treatment

Sublingual drops are a personalized therapy. As a first step, your doctor will conduct an allergy skin or blood test to identify every allergen that triggers your immune system. Dr. Cheng says your doctor will use those test results to determine the formula and dose of your drops.

“We create drops for patients based on their number of different allergies. With some exceptions, we can sometimes put medication for all their various allergies into one vial," she said. “It's a much easier way to administer the medication since patients get everything they need all at once."

Sublingual drops versus tablets and allergy shots

Sublingual drops are just one type of allergy immunotherapy. Sublingual tablets and allergy shots are also available. Each therapy reduces your symptoms, but they do have differences.

Drops: Sublingual drops are not yet approved by the Food and Drug Administration (FDA). But they present a lower risk of anaphylactic shock because your body absorbs the medication slowly. Drops also deliver medicine for the widest variety of allergens, including:

  • Cats and dogs
  • Dust mites
  • Feathers
  • Grasses
  • Molds
  • Trees
  • Weeds

Tablets: Like drops, you dissolve tablets under your tongue once a day or twice weekly. However, each tablet can only fight one allergen, and they are only FDA-approved to treat:

  • Dust mites
  • Grasses
  • Short ragweed pollen

Shots: Allergy shots have been FDA-approved for many years. They're effective but inconvenient. Your doctor must deliver your weekly injections because shots present a higher risk of anaphylactic shock. Additionally, each shot can only target one allergen.

The challenge to using sublingual drops

Sublingual drops are effective, but cost is a significant challenge when using them for regular allergy therapy. Because they don't yet have FDA approval, they aren't covered by insurance. You will pay out-of-pocket for treatment.

Dr. Cheng says the cost of sublingual drops depends on how many medications your mixture includes. So, the price tag can range from several hundred to over a thousand dollars.

Still, she says, sublingual drops may offer you a more convenient, easy-to-tolerate allergy treatment plan.

“Even with the associated cost, sublingual drops can be an attractive therapy option," she says. “It presents less risk and is generally better tolerated than shots. And it may be worth it for patients who would rather put a few drops under their tongue every few days than get poked with a needle once a week."

​ ​​

Contact The Christ Hospital Physicians – Ear, Nose & Throat to learn more about sublingual allergy immunotherapy drops. You can schedule an appointment by calling 513-421-5558.


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