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Sublingual Immunotherapy

At Exton Allergy & Asthma Associates we have been offering subcutaneous (injection) immunotherapy, which is still the predominant way of administering allergen immunotherapy in the US. There is growing evidence that sublingual immunotherapy is effective, when administered properly. In head-to-head clinical trials; however, it has been less efficacious than subcutaneous immunotherapy, even in those European research centers that have become specialized in sublingual immunotherapy, where it has evolved and developed into its current state. Clearly, sublingual immunotherapy offers certain advantages, and can be a suitable alternative to allergy shots for some individuals. We aim to provide the most appropriate treatment that will not only address our patients' medical needs, but also accommodates their choices and preferences.


In April 2014 the FDA approved dissolvable tablets for sublingual immunotherapy of seasonal nasal allergy (hay fever) caused by grass pollen and ragweed. The FDA approved this form of treatment for allergy to dust mites in March 2017. Most allergic individuals are sensitized to more than one allergen, but sublingual immunotherapy can only treat one allergy at a time as opposed to allergy shots that can treat multiple allergens and usually aim to eliminate all relevant allergies identified in an individual. At present we offer sublingual immunotherapy with the FDA approved dissolvable tablets to our patients for allergy to dust mites(Odactra in persons 18 through 65 years), grass allergy (Grastek in persons 5 through 65 years of age or Oralair for ages 10 to 65 years), and ragweed allergy (Ragwitek in persons 18 through 65 years), who are allergic only to dust mite, grass or ragweed pollen, or whose allergic symptoms are predominantly due to dust mite allergy, or allergy to grass or ragweed pollen. We will be offering sublingual immunotherapy for other allergens as soon as they are approved by the FDA and become available in the US.


Other forms of sublingual immunotherapy that use allergy drops are still considered "experimental" since allergenic extracts used for this treatment have not been approved by the FDA for sublingual immunotherapy in routine patient care. For that reason there is currently no appropriate CPT code that could be submitted to 3rd party payers, i.e. to your health insurance provider for reimbursement. Practices that prescribe sublingual allergy drops use material that is designated for injection immunotherapy, which may or may not be adequate for sublingual immunotherapy. This makes any prediction of effectiveness of the treatment with sublingual allergy drops impossible. Since no health insurance plan provides coverage for sublingual allergy drops, it can easily become a lucrative "cash only business", which could be used to generate revenue at the expense of poorly informed patients or their parents. That is unfortunately yet another reason to approach sublingual allergy drops with due caution.


We encourage you to inform yourself about allergen immunotherapy to the extent possible before you decide whether you wish to proceed, and would be glad to provide our advice, if you wish to discuss this subject further with us.

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