Allergy shots, tablets or drops: which one fits your life?

Sublingual tablets are FDA-licensed prescription tablets that dissolve under your tongue. Four are sold in the United States, and each treats one allergen family: Grastek for timothy grass, Oralair for a five-grass mix, Ragwitek for short ragweed, and Odactra for house dust mite. They are tested at the doses in their labeling, so many plans cover them when plan criteria are met. You take the first dose here in the office and every dose after that at home, so there are no weekly visits. Here is the other side. One tablet covers one allergen family, so a grass tablet will not fix your spring if you also react to dust mites and your cat. Tablets carry a labeled warning for severe allergic reactions, including anaphylaxis, so you are prescribed an epinephrine auto-injector and shown how to use it. Mouth itching, tongue tingling and throat irritation are common in the first few days. Tablets are not appropriate for people with severe or unstable asthma. And because you dose at home, they only work if you take them. Ask us which tablet, if any, fits your test results. The table below compares the other two routes, shots and drops.

Most people do not turn down immunotherapy because they doubt it. They turn it down because nobody tells them what three years means. Here it is. With shots, months 1 through 6 are the hard part. You come in once or twice a week, and each dose is a little stronger than the last. Each visit is a few minutes for the shot, then a 30-minute wait in our office. You will likely notice nothing yet except a sore, itchy arm, so do not judge the treatment in this stage. Miss doses or stretch the gaps too far and the dose has to be stepped back down. That is the main reason a build-up drags on. From month 6 to month 12, visits drop to about every 2 to 4 weeks. This is when many people first say their spring or fall was easier. Some notice nothing until year 2, and neither is unusual. Year 2 is the routine year at the same spacing, and it is usually when the difference is clear enough to judge. If you are not responding, that is when we tell you plainly. Year 3 is the decision year: stop, or keep going toward five years. Longer courses tend to hold up better after you stop, though nobody can tell you in advance how long your own relief will last. Tablets and drops trade almost all those visits for a dose you have to remember every day, roughly a thousand doses over three years. Shots fail when you stop coming. Home treatment fails when you stop taking it, usually a bottle left in a drawer. If you know you will not take something daily for three years, shots are the more honest choice, and we would rather have that conversation now than in month four.