Review

I used to have severe environmental allergies to cats, dogs, and the outdoors. As I kid, I woke up crying most mornings because of my allergies, and I would occasionally wake up with croup and difficulty breathing. I even had to be taken the hospital once.

Anyways, I cried enough that my mother found and enrolled me in a study for an experimental treatment called sublingual immunotherapy (SLIT). For the next two years I took under-the-tongue drops, and I presume the drops were formulated with small amounts of the allergens I was reactive to.

My allergies have been nearly non-existent since then.

I’m sharing this post because I keep telling people about sublingual immunotherapy and they’re very surprised. No one seems to know about this treatment! I’m mad about this.

Maybe my improvement was unusual? I don’t know. A few random studies. Please share additional information in the comments.

To be clear, I still have a few mild symptoms:

  • If I pet a dog and then rub my eyes, my eyes get slightly itchy.
  • If a dog licks me, I get mild hives in that area.

But that’s all! (And I haven’t observed any side effects, either.)

FWIW, I might also go back on sublingual immunotherapy at some point so I can pet dogs without worry. (Because maybe my treatment was stopped too soon?)

Other details:

  • My mother says the particular drops I took costed $25 a week. They weren’t FDA approved, but they were still available for purchase.
  • From a quick brief search, I found a few that sell sublingual immunotherapy in the US: Wyndly, Curex, and Quello. I looked a few months ago and I couldn’t find any significant reason to prefer one brand over the others. Please comment you have a recommendation.
    • Note: SLIT has been available for longer in Europe than in the US, so the European brands might be better if you have access to them.
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Also, this page on the Johns Hopkins Medicine website says:

The cost of a one-year supply of allergy drops ranges from one thousand to several thousand dollars, depending on the number of things to which you are allergic.

The medical consensus is that sublingual immunotherapy is inferior to the injected immunotherapy that has been used for a century. Did you try that as a kid? If there's reason to believe sublingual is better, that's good to know, but it sounds like you just don't know about injections.

Sublingual immunotherapy has an obvious advantage because people don't like shots. And it doesn't require a prescription. Indeed, one should be suspicious of a conflict of interest in the medical consensus. But injected doses are more precisely controlled, so there is good reason to believe they work better. And the doses are smaller, so the material cost is smaller.

Compliance to the schedule may be the main obstacle. It is not obvious whether doctor appointments make this better or worse. This probably varies between people.

I was under the presumption that injected immunotherapy doesn't last?

https://my.clevelandclinic.org/health/treatments/25194-allergy-shots

Once you reach the maintenance phase, an allergy shot lasts about one month. The maintenance phase may last up to five years or longer until you no longer need to receive allergy shots.

hmmm

That sounds pretty similar to sublingual therapy. I think it is likely that sublingual therapy is better because of the denser dosing (weekly vs monthly), but the difference is small enough that it can only be assessed with a head-to-head trial. (If the difference is compliance, it would be difficult to measure, though potentially very large.)

The headline that environmental allergies are curable is a decades old. If this news has not spread, it is good that you promote it, but we should ponder why it is not common knowledge.

I was allergic to acarids when I was a child, and this caused me a severe asthma crisis when I was around 10. I live in France, and I got prescribed SLIT by the first allergy specialist my mother found, so I guess it's quite a common treatment there. I took it for more than 5 years, and now 8 years later I don't ever have any symptoms of allergy.

My understanding (based on watching some YouTube lectures and talking to my allergists) is that SCIT (aka allergy shots) and SLIT are equally effective but (at least in the US) SLIT is not covered by insurance so SCIT ends up being a lot cheaper for most people. The main problem with SCIT is that it requires going to the allergy clinic every week for a while, then every month for a while over a period of about 3 years (but it is possible to speed things up quite a bit by doing cluster shots or double shots). I tried doing SCIT last year but my chronic illness made it too difficult to go to the clinic each week so I eventually had to stop (I imagine this won't be a problem for most other people). My allergy clinic gave me an estimate that SLIT would cost roughly $7000 total over 3 years, whereas SCIT for me was free with my insurance.

How were you getting SLIT for $25/week, how much did SLIT cost in total for you, and were the doses tailored to your particular allergies based on tests?

oh this would make a lot more sense if true.

How were you getting SLIT for $25/week

I don't know, but the online shops that sell it are still $100/mo today.

how much did SLIT cost in total for you

$25/wk * 2 years

were the doses tailored to your particular allergies based on tests?

yes, there were several allergens in there, just the ones i was allergic to

Interesting, I don't know anything about the quality of different SLIT manufacturers, but $2600 sounds a lot more affordable than $7000. I'll try to remember to ask my allergist about this if I ever see them again.

How long has it been since the treatment, in your case? A quick perusal of the top search hits for this treatment suggests that it (often? usually? sometimes? not clear) wears off after several years.

14 years