I hurt people to make them feel better. Such is the life of an allergy nurse. Subcutaneous Immunotherapy (SCIT), more commonly known as allergy shots, has been the gold standard for relief from allergy misery for years, but hopefully, relief from needles, too, may be on the horizon for select patients. SCIT involves injecting the offending allergen extracts into the tissue under the skin towards the back of the upper arms, beginning with a low strength allergen extract and gradually increasing the dose and strength over a period of about 4-6 months until the highest dose ordered by the physician or tolerated by the patient has been attained. In the beginning shots are given 1-2x/wk, gradually being reduced to anywhere from every one to four weeks for a maintenance dose. Although this method has been definitively proven to be highly effective by a success rate of anywhere from 80-90 % of patients, depending on the source, it has it’s drawbacks. Factors such as discomfort, the risk of serious side effects, time commitment, and cost prevent some people who could benefit from allergy immunotherapy from seeking help.
Hopefully in the next several years some allergy sufferers will have an alternative to shots in the United States. Since as early as the 1900’s some doctors were placing pollen antigen extracts under patients tongues to alter immune systems and lesson seasonal allergy symptoms. Since then, numerous studies and trials have proven the safety and efficacy of this method, known as Sublingual Immunotherapy, or SLIT. The drops are made from the same allergen extracts as allergy serum for injection, but formulated for use under the tongue. There are also tablets available for this route of administration. Although the method has been approved for use in Europe for many years, it has yet to be approved by the FDA for use in the United States. Due to factors such as differences in allergens in the air and patient sensitivities to allergens between the United States and Europe, trial results have been different, and the FDA is not satisfied enough with the results we have seen here in the US to give it its stamp of approval.
Even though it is not FDA approved, SLIT is being used off label in some doctor’s offices. Off label drug use means that the medication has been approved by the FDA, but not for the use for which the doctor is prescribing it. That doesn’t mean that the drug is bad, it means that not enough data has been compiled to merit a declaration of safety and effectiveness for that particular use. Off label use by physicians is not illegal, but professional organizations, although optimistic about SLIT, will not endorse it until it has FDA approval. The downside to this is that insurance companies do not cover drugs for off label use, shifting the entire cost of the therapy to the patient.
From my research into SLIT, I am encouraged that some day soon the necessity of injections for the treatment of moderate to severe allergies will be drastically reduced or maybe even eliminated completely for some people, so if you are an allergy sufferer who has an aversion to needles, keep an eye on the allergy treatment news.
