Sublingual Immunotherapy (SLIT) is an allergy treatment that targets the actual cause of your allergies. The treatment is designed to re-educate your immune system, so it does not react so aggressively to harmless things like pet dander and pollen.

Your healthcare provider will speak with you about your allergies and may have you take an allergy test. Your provider will then coordinate with the pharmacy to formulate a treatment specific to your allergy triggers and ship the therapy to your home. You will take the allergy drops by using a bottle with a metered pump to deliver a few drops of the allergen mix under your tongue every day.  Over time, your body will begin to develop tolerance to those allergens.

After your allergy evaluation, you will be provided with a few subscription options to begin your allergy treatment. You may be surprised that SLIT is an affordable treatment, and the average daily cost of allergy drops is probably less than your favorite Starbucks order!

Some insurance plans may cover the cost of the test; however, most insurance plans do not cover the cost of SLIT. There may be certain plans that will allow a pre-authorized reimbursement for the test and/or treatment, but in most cases, SLIT is a cash only option for the patient. 

Your healthcare provider may perform an easy in-office allergy test or order a simple at-home allergy test to be shipped to your home. The test kit instructs you how to prick your finger and capture a few drops of blood on a small collection card. The card is then shipped to a special lab that will determine if you are sensitized to specific allergens.

A report will be sent to you or your healthcare team to let you know what has been making you miserable all these years. Unfortunately, the lab does not currently offer allergy testing for foods, drugs, dyes, or chemicals. In those cases, avoidance is still your best option. Your provider may have options for these allergens through other tests.

If you have test results from another company or healthcare provider, these can be used to create a prescription for allergy drops. If the results are more than 2 years old, it is often best to be re-tested since your primary allergy triggers may change over time.

Both allergy shots and allergy drops are designed to reduce your sensitivity to allergens, so you no longer experience allergy symptoms. Allergy shots are usually administered in an allergist’s office every week, and there is a 30-minute wait after each injection in case you have a severe reaction, not to mention the time required to drive to and from the office.  

On the other hand, Allergy drops (SLIT) can be taken at home each day and have a far lower risk of severe reactions. The shots and the drops are both formulated with the same allergenic extracts.

The “drug” used in the allergy drops is a mixture of one or more allergenic extracts, which are solutions that are manufactured from the actual allergen sources like pollen, pet dander, mold, or dust mites.

The allergenic extracts are manufactured by an FDA-licensed supplier, and these products undergo many quality control steps before being made available for treatment. The patient-specific SLIT prescriptions are dispensed at a licensed compounding pharmacy that has expertise in allergy immunotherapy.

Your SLIT prescription will arrive with a capped SLIT bottle containing a 90-day supply of the allergen mix. The treatment kit also includes a metered pump. Simply unscrew the cap from the bottle and screw on the metered pump (be sure to tighten the pump on securely but do not excessively overtighten).

Next, you will prime the SLIT bottle by pressing down on the pump a few times to make sure 1 drop is produced with each pump (preferably over a sink).  You can now apply your drops by placing the tip of the nozzle over your bottom teeth so the drops land under your tongue.  Apply the number of drops according to your dosing protocol (1 pump = 1 drop).  In most cases, you will apply a maximum of 3 drops daily. You should hold the solution under your tongue for 2 minutes and then spit out the solution in the sink. Do not rinse, drink or eat for at least 5 minutes after taking your drops.

There is no need to prime the bottle again unless the bottle is accidentally dropped, shaken or inverted and air gets into the pump’s tubing. If this happens, simply re-prime the bottle like before and continue dosing according to your schedule.

The allergens in your SLIT bottle will remain stable at room temperature so you can leave your bottle somewhere convenient like on a bathroom or kitchen counter.  If you have more than 1 bottle in your kit, it is a good idea to keep any unused bottles in the refrigerator until needed.

Most people who are taking allergy drops do not need to carry an epinephrine autoinjector (e.g., EpiPen). Your healthcare team will speak with you about any specific risks when taking allergy drops.

Patients on allergy drops will often notice their symptoms improving after only a few weeks, but in some cases, it may take several months.  It really depends on the types of allergens that are your worst triggers and what times of year you have the most exposure to those allergens. 

For things like cat hair or dust mites, the effects from SLIT may appear very quickly after starting the drops, but for seasonal allergens like ragweed or grass pollen, the benefits from SLIT may not be noticeable until the peak pollen season arrives.

No matter what you’re allergic to, it is important to continue taking your drops even when you feel better since the effects of SLIT continually build over time.

Most allergy experts agree that 3 to 5 years of immunotherapy (shots or drops) will produce the best chance at life-long relief from allergy symptoms. Some patients experience significant improvement in just a year or two, while others may need to continue drops for longer to get the full long-term benefits of SLIT.

SLIT is an incredibly safe treatment. Some patients report mild reactions in the mouth including some itching or tingling of the tongue, gums or lips.  These reactions usually last only a few days and most reactions resolve with continued treatment. If you experience these types of reactions and they do not resolve quickly, please consult with your healthcare team.

Less common side effects include ulcers in the mouth and cramping or aching of the stomach or abdomen. Please consult with your healthcare team if you experience any of these reactions. You may be advised to discontinue treatment for a short time.

There have been very rare reports of more serious reactions like swelling of the mouth or lips, difficulty speaking or swallowing, asthma, hives, and even anaphylaxis. If you experience any of these reactions, please seek immediate medical care and stop taking the allergy drops until you have spoken to your healthcare provider.

The allergenic extracts for foods are approved for diagnostic use only. If you have a known food allergy, it is best to speak with an allergy specialist about avoidance and treatment options.

Both adults and children can be treated with allergy drops. It is advised that very young children (~up to 5yo) are not treated with allergy drops since the child must be able to follow the dosing instructions and communicate clearly if there are any problems or reactions.

Yes, you can travel with your allergy drops. If travelling by plane, it is a good idea to place the SLIT bottle in a leak-proof container or Ziplock baggie and pack it with your other medications or toiletries. It is also advised to carry a copy of the prescription information from your healthcare provider or the pharmacy.

It is important to take your allergy drops every day but missing a few days here or there is not horrible. If you miss up to 14 days (about 2 weeks) of treatment you may continue the drops without any changes.  If you miss up to 28 days (about 4 weeks) of treatment, you can perform a brief 5-day build-up with your current SLIT bottle (1 drop, 1 drop, 2 drops, 2drops ,3 drops per day).  If you have missed more than 1 month of treatment, please consult with your healthcare provider about options, including re-starting treatment.

Your healthcare team will send a prescription refill reminder when it is time to order a refill of your allergy drops.  If you are getting close to finishing your SLIT bottle you can contact your healthcare team.

It is best to try and take your allergy drops in the morning or during normal business hours. This will allow you to contact your healthcare provider in the event you experience any problems.

Your SLIT prescription will remain stable when exposed to a wide range of temperatures, even over several days. However, please contact your healthcare team if you believe that your SLIT bottle may have frozen or if the bottle was exposed to very high temperatures (>100°F) for longer than 12 hours. In those cases, your allergy drops may need to be replaced.

It is best to skip your scheduled SLIT dose on the day of your Dentist appointment if the visit is for a regular cleaning/check-up. If you have any other dental work performed that leaves wounds or cuts in your mouth, you should discontinue the drops until your mouth is fully healed.