Why Does Sublingual Immunotherapy Work?

 

Why Does Sublingual Immunotherapy Work?

 

 

Drops under the tongue? How is that is going to help my allergies? I used to hear this daily from my patients and now there seems to be a seismic shift in what patients know about sublingual immunotherapy, or allergy drops, and their success in allergy treatment.

Sublingual immunotherapy involves more than the gradual increasing doses of allergen placed under the tongue to build tolerance. Tolerance is the most accurate term used to describe the permanent change to the allergic immune response induced by sublingual immunotherapy.

We have found that that delivering immunotherapy under the tongue balances the best of safety and efficacy. This area under the tongue is rich in dendritic cells — cells which help induce tolerance, and it’s poor in mast and other effector cells such as basophils and eosinophils which can trigger allergic reactions. “…The mucosal surface has to deal with regular exposure to a wide range of innocuous material and its default response is set to nonresponse.The sublingual area also has the highest permeability compared to any other easily accessible mucosal surface — which explains why fast-acting medications and highly effective vaccines have used this oral mucosal route for over a century, and not surprisingly, is increasingly becoming a popular route to deliver therapies today.

Not all patients with a given allergy are equally reactive to the allergen(s) in question nor are allergen batches produced by the same manufacturer equal to each other, therefore we use titrated dosing for more accurate results. Likewise, custom dosing based on the specific patient’s reactivity eliminates the need for unnecessarily high doses that can increase both risk of reaction and cost without providing incremental benefit to the patient.

 

Frequent Administration

“Allergen persistence in the oral mucosa may be a far more relevant factor for gaining efficacy than allergen concentration. A number of studies have shown that allergen administration to the sublingual mucosa is retained for a period of up to 48 hours.  Daily doses provide continuous, uninterrupted supply of antigens to the body and slowly immune tolerance is developed.

Sublingual immunotherapy has been an effective tool for aeroallergies with great success.  Our experience and research has demonstrated thatcustomized sublingual immunotherapy allergy drops is a safe and effective allergy treatment.