The Journal of the American Medical Association published a review of the effectiveness of sublingual immunotherapy (allergy drops) in the March 27, 2013 issue. The review analyzed several databases of medical literature through December 2012. They found 63 studies that could be analyzed, and found moderate grade evidence the sublingual immunotherapy decreases nasal and ocular symptoms by more than 40%. Efficacy in asthma was found as well. The conclusion was that the studies analyzed do support the effectiveness of sublingual immunotherapy, but that high quality studies are needed to answer questions regarding optimal dosing.

An important point made is that there are no sublingual forms of immunotherapy extracts approved for use in the United States. Because of this, sublingual immunotherapy performed in this country is NOT FDA APPROVED. Extracts used in Europe for sublingual immunotherapy are higher dose than those used for injection immunotherapy, other studies have found that the doses required for sublingual immunotherapy are 50-300 times higher than those given by injection. The studies analyzed in this summary used these higher doses, and lower doses have been found in other studies to be ineffective.

Since there are no extracts approved for sublingual immunotherapy, providers offering this in the US use the injectable extracts that are far weaker than required for sublingual immunotherapy. The resulting doses have been shown to have minimal or no effectiveness, far less effective than the doses used in Europe. Unfortunately, some practitioners continue to offer this form of therapy with inadequate doses, which as unapproved therapy is not covered by insurance and can cost upwards of $1500/year.

High dose sublingual immunotherapy is likely effective, though some studies have shown it is not as effective as injection immunotherapy. When adequate strength extracts are approved and available in the United States, Allergy & Asthma Care will be happy to offer this therapy to our patients. Until then, we will not offer unproven therapy with inadequate doses simply because some other, less scrupulous practitioners do so. The only extracts currently available in the United States are not adequate for effective sublingual immunotherapy. We continue to offer injection immunotherapy for appropriate patients. There are also many other options for controlling allergy symptoms. Our office can be reached at (203)259-7070.