Sublingual allergy drops (SLIT)

How allergy drops work

The tissue under your tongue is rich in immune cells that tend to encourage tolerance rather than inflammation. When small amounts of allergen are held there every day, the immune system gradually learns to react less. The idea is the same as allergy shots, delivered by mouth instead of by injection.

You hold the drops under your tongue for about 1 to 2 minutes, then swallow. The dose rises over the first weeks according to a written schedule, then stays steady for the rest of treatment.

What goes into your drops depends on your testing and on what actually sets off your symptoms, whether that is a spring tree season, a summer of grass pollen or a cat at home. Allergens that tested positive but never cause you trouble are usually left out.

Custom drops versus tablets

There are two forms of sublingual immunotherapy in the US. FDA-approved tablets are available for grass pollen, ragweed and dust mite allergy. Each tablet type treats one allergen, and tablets may be covered by your pharmacy plan. Grass and ragweed tablets are usually started a few months before the season, while dust mite tablets are taken all year.

Custom drops are mixed for you and can combine several allergens in one bottle, such as mountain cedar, oak, Texas grasses, cat and dust mite. In the US, these drops are prescribed off-label, meaning the extracts are FDA-approved but not specifically for use under the tongue. Because of that, they are usually not covered by insurance and are paid for out of pocket.

Tablets make sense when one allergen drives most of your symptoms. Custom drops tend to suit people with several overlapping triggers, which is common here. We will review both with you and explain the costs before you decide.

May be a good fit if…

• Testing shows you are allergic to pollen, dust mites or pet dander
• Antihistamines and nasal sprays only partly control your symptoms
• You or your child would rather not get regular injections
• Weekly clinic visits are hard to fit around school, work or travel
• You can stick with a daily routine for several years

Starting treatment and dosing at home

Your first dose is given at our Arlington, Keller or Mansfield clinic, and we observe you for about half an hour afterward. Starting here means any early reaction happens where we can treat it, and you go home knowing what normal feels like. During that visit, we also show you how to measure each dose, what side effects to expect and when to hold a dose.

From then on, you take your drops once a day at home, ideally at the same time each day. Most people tie their dose to a daily habit, like brushing teeth in the morning. Store your drops as directed, usually in the refrigerator, and pack them when you travel.

Your usual allergy and asthma medicines stay in place at the start. If the drops help as hoped, you and your provider can scale those medicines back later.

Who tends to choose drops

Drops are a strong option when frequent clinic visits would be hard to keep up. With no waiting room time after each home dose, they can save many hours over the course of treatment. They are often a good match for these patients:

• Children who get upset about needles or shots
• Parents juggling school, sports and work calendars
• Families on the outer edges of DFW who face a long drive to any clinic
• College students and frequent travelers who need a portable routine
• Adults with mild to moderate nasal allergies who want to depend less on daily medicines

What to expect over time

Allergy drops are a multi-year commitment. Many people begin to notice fewer symptoms within the first season or year, and treatment usually continues for about 3 to 5 years.

Follow-up visits let us check your progress, adjust your mix and keep your supply on schedule. Severe or poorly controlled asthma can make drops unsafe, so we make sure your breathing is stable before you start and at each check-in.

When to stop is a shared decision. Many people who complete a full course continue to feel some benefit after stopping, though this varies from person to person.

What to expect, step by step

1. Testing and consultation

   We confirm your allergies, review your asthma and health history, and compare drops, tablets and shots with you.

2. Your drops are prepared

   Your drops are mixed from the allergens that matter for you and come with a written dosing schedule.

3. First dose in the clinic

   You take your first dose with us, practice the technique and stay for observation before heading home.

4. Daily dosing at home

   Take your drops once a day, keep a simple log, and call us with any questions or side effects.

5. Regular check-ins

   Follow-up visits track how you’re doing, fine-tune the plan and decide how long to continue.

Before your visit

• Bring a list of all your medicines, including inhalers and any heart or blood pressure pills.
• Make sure your asthma is under control, and reschedule if you are wheezing or recovering from a flare.
• Tell us about mouth sores, recent dental work or anything else that makes your mouth sore.
• Plan to stay about an hour for your first-dose visit.

Safety

Mild side effects are common in the first weeks, such as an itchy or tingling mouth, slight lip swelling or an upset stomach, and they usually fade as your body adjusts. Serious reactions are uncommon. We review warning signs with you, explain when to hold a dose, for example during mouth sores or an asthma flare, and may prescribe an epinephrine auto-injector to keep at home.