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Mon, Dec 22, 2014

Dr. Kestner: Some allergy specialists foregoing needle for drops

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If you know anyone that has undergone medical treatment for allergies, you know that they have likely made repeated weekly visits to the doctor’s office for a year or more to receive injections.

The injections are intended to desensitize the body to the offending allergens. The shots are uncomfortable, and the weekly clinic visits are often inconvenient. The costs for such treatment can be substantial.

This has been the time-tested technique that many allergy doctors have preferred for several decades. The shots are approved by the FDA and are often covered by insurance plans.

During the last 10 years an alternative approach has been slowly gaining popularity among patients and doctors alike. The treatment involves administering liquid drops under the tongue instead of the hypodermic injections. Needless to say, this approach is welcome to anyone that has ever been treated with the injection protocol.

The treatment is known as sublingual immunotherapy, or S.L.I.T. It may also be simply called allergy drops.

S.L.I.T. has been used in Europe for a while longer than here in the United States. Although some allergy specialists have used the approach since the 1980’s, many are just now considering it.

Dr. John Shea, who received his allergy treatment training at the University of Texas, has been successfully using allergy drops since 1982. He initially became interested in using allergy drops instead of shots after hearing about successful trials during allergy society meetings in 1979. On his Web site, he has posted a number of in-house trials that have shown the relatively significant positive response rate of the treatment protocol for a variety of allergy related conditions.

Sandra Lin, M.D., at the Johns Hopkins Sinus Center in Baltimore also offers the allergy drops treatment option for patients with allergies and asthma. She is very positive about the effectiveness and safety of the practice. In many cases, the patient is able to administer most of the treatment at home.

During my research in preparing this column, I came across a large number of papers dealing with the use of allergy drops. Most were overwhelmingly positive about the effectiveness and safety of the approach. The World Health Organization published a position paper about the practice in 1999 that endorsed its use and further development of the products.

At this point, the FDA has not approved the drops for allergy treatment, but physicians have the option to use them. FDA approval for a product can take years and millions of dollars of research to accomplish.

The use of liquid allergy drops by physicians is somewhat similar to the use of homeopathic drops for treatment of allergies that has been around for more than 100 years. This approach was developed by German physician Samuel Hahnemann in the early 1800s.

Homeopathy uses an extremely diluted form of a substance that would normally cause an allergic reaction to stimulate a positive effect on the body’s immune system to eliminate the allergic response.

Today, consumers can obtain homeopathic treatment remedies at health food stores, pharmacies and various health care providers easily and inexpensively. I have used this approach successfully with patients seeking relief from seasonal allergies, and even tried it myself with excellent results.

At this point, the medical use of allergy drops as an alternative to injections is still fairly new.

Not all allergy specialists are embracing the technique. Not surprisingly since the approach is innovative and so unlike the traditional medical approach of repeated weekly injections, there are some allergy specialists that are adamantly opposed to even considering it.

S.L.I.T. may or may not be available at allergy specialists in your area.

The safety profile appears to be very good and increasing evidence for effectiveness is emerging.

Although the research is promising, some allergy specialists resist further development of the treatment. Their attitude might not be totally related to patient outcomes, however. According to a 2004 newsletter of the American College of Allergy, Asthma, and Immunology, “50 percent of readers (allergy specialists) responding say high-dose SLIT immunotherapy will cause allergists to lose patients due to other physicians easily being able to prescribe this treatment.”

Next week: Foods that may make allergies worse.

Dr. Mark Kestner
mkestner@DrKestner.com
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