Immunology Services
Treatment Options That Address The Underlying Immune Dysfunction
Sublingual Allergy Immunotherapy (SLIT)
An alternative to subcutaneous allergy immunotherapy injections (SCIT), sublingual immunotherapy (SLIT) is helpful managing conditions such as allergic rhinitis, allergic conjunctivitis, and shows benefits in asthmatic patients.
SLIT is an option for patients who cannot get to the office for allergy injections due to work schedules or travel. It is also a wonderful alternative to pediatric patients as there are no shots or adults who are unable to tolerate injections.
SLIT introduces small liquid or tablet doses of allergens under the tongue daily. Over time, this causes a decrease in the body’s production of specific allergic antibody, called IgE, and teaches your immune system to tolerate exposure to allergens in the environment. Just as with allergy shots, your body is able to tolerate more allergen exposures with less symptoms as your immune system is “re-wired” toward a non-allergic response.
SLIT is offered in two forms: tablets and drops. SLIT tablets are FDA approved prescription medications that treat specific allergens – grass pollen, ragweed pollen, and dust mites. Sublingual drops are custom formulated by David J Friedman MD PC and may contain allergens relevant to your environment and your clinical profile.
Common Side Effects
SLIT is generally very well tolerated, with generally mild and local side effects. Some patients describe a bitter taste due to glycerin (a plant-based fatty acid) content. Glycerin helps preserve the potency of the extracts.
Side effects rarely reported include an itchy mouth, itchy tongue, and mild oral swelling.
In very rare circumstances, more severe symptoms such as anaphylaxis have been reported. SLIT is safe enough to take daily at home, but patients should have access to an epinephrine pen or nasal epinephrine (newly approved in 2024) when taking SLIT due to the very small risk of anaphylaxis.
Subcutaneous Allergy Immunotherapy (SCIT)
Allergy shots (also called subcutaneous allergy immunotherapy, or SCIT) are one of the best ways to address the root cause of the inappropriate allergy response to allergens. This is because allergy shots modulate the way your immunity’s reactions to the environment. In an allergic process, your immune system overreacts to otherwise benign triggers in your daily life, such as plant pollens, pet dander, mold spores, and dust mites. Arizona has very low to non-existent dust mite levels, but patients who are allergic will see them in just about any other place in the world. Unlike medications that treat or cover up allergy symptoms, SCIT stimulates the immune system to start behaving like a non-allergic person’s response to the allergens. By gradually introducing ever greater quantities of the allergen, allergy shots (SCIT) can increase the threshold of allergen exposures that activate the allergy response. In many cases, if done long enough, SCIT can provide disease-modifying effects from the formation of non-allergic immune memory cells that can stick around after stopping therapy. This type of long-term disease-modifying effect is not seen with just medications. This is why allergy shots are the cornerstone of allergy treatment for board-certified allergists. SCIT has been around for over 100 years with a publication in The Lancet in 1911 with grass immunotherapy improving allergic conjunctivitis symptoms.
Innovations in allergy shots over the last few decades include injecting lymph nodes with even smaller amounts that are injected into the subcutaneous or fatty layer just beneath the skin. While not FDA-approved to deliver this way, some allergy clinics have offered this type of delivery.
Another way of delivering allergy injections is placing the allergy vaccines just into the skin layers which is known as intradermal delivery. Intradermal is also used as a method of testing whether someone is allergic to an allergen. This is like how TB skin tests are performed. There are several infectious vaccines that are given intradermally as well while influenza shots are given in the muscle fiber. David J Friedman MD PC offers intradermal allergy immunotherapy as it may represent a better way to stimulate the immune system to change its tune away from the allergic response. There are several studies to support this route of delivery. Injecting the skin layers can cause local discomfort like stinging and itching similar to the subcutaneous route.
Most reactions to any kind of allergy immunotherapy injections are localized and appear as redness, pain, or swelling at the injection site. This typically is transient and occurs within a couple of hours.
Systemic reactions are much less common than local, but may include symptoms such as itching, sneezing, congestion, hives, cough, or wheezing, all of which will be monitored during your visit. While severe reactions are uncommon, they can occur, which is why allergy shots must be given under medical supervision with post-injection monitoring for 30 minutes. Fatal reactions to allergy shots have been reported over the years with an approximate incidence of 1 fatality per 4 million injections given. Severe reactions are more common in uncontrolled asthmatics and patients with a history of allergic reactions to multiple substances.
Take Control of Your Health Today
Our specialized immunology services are here to help you achieve a strong immune system. Take control of your health and experience the benefits of personalized care. Call Dr.Friedman today at 520.492.3271.
