Sublingual Immunotherapy

General Information

Sublingual immunotherapy (SLIT / Allergy Drops) is the name given to allergy vaccines that are administered orally. The vaccine, rather than being administered by an injection, is administered as oral allergy drops that are placed under the tongue ("sublingual"), held there for a short period of time, and then swallowed. Some medical authors call this route of administration the "sublingual-swallow mode" of immunotherapy. Sublingual immunotherapy is a unique immunotherapy modality that combines safety and convenience with excellent benefit. Popular in Europe for many years, sublingual immunotherapy is now being introduced into the United States and is gaining in popularity. Capitol ENT is pleased to be able to offer this treatment to select patients who suffer from allergic respiratory diseases.

Advantages of sublingual immunotherapy include a safety profile that allows the treatment to be administered at home, saving the patient travel time and expense, as well as clinic visits. The lack of injections makes sublingual immunotherapy easier for children ( and many adults ) to tolerate the treatment. And, it is an ideal treatment for patients who travel frequently or who live a long distance from the allergists office.

The primary disadvantages of sublingual immunotherapy center around two facts:

1. Although SLIT accounts for almost half of all allergen immunotherapy administered in Europe, it is currently considered "investigational" and "off-label" in the United States. Even though the allergen extracts that are used for subcutaneous (injection) immunotherapy (SCIT) and for sublingual immunotherapy (SLIT) are the same and are licensed for use in the United States for SCIT, the FDA has not yet approved the extracts for SLIT, and there is no current CPT billing code for the SLIT treatments.
2. Because of this "off-label" status for sublingual immunotherapy, insurance companies are not currently reimbursing this form of treatment, making the expense "out-of-pocket." Nevertheless, the overall cost of SLIT is significantly less than a lifetime of allergy medications and office visits for allergy-related illnesses and is comparable to the overall cost of receiving subcutaneous (injection) immunotherapy. We anticipate that this insurance reimbursement issue will improve in coming years, as the FDA is currently looking at several oral allergy vaccine products for potential approval.

Patients often ask if all allergy drop procedures are equal, and the answer is a definitive NO! There are many clinics in North Carolina that are offering oral immunotherapy as prescribed by "non-allergists" that are essentially placebo treatments. Our clinic offers full-dose oral immunotherapy treatments, designed in accordance with well-established European protocols that have been shown to offer excellent benefit. The current studies still emphasize that injection immunotherapy is the most efficacious, but oral immunotherapy offers substantial benefits without many of the problems associated with injection immunotherapy.

Once you have completed your allergy testing, your Capitol ENT doctor will discuss the various immunotherapy protocols with you and help you decide which treatment procedure will best meet your needs.

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