An allergy is a immune system disorder characterized by abnormal reaction to a substance that is not expected in the average person. The concept of allergy was first introduced and defined in 1906, by a pediatrician from Vienna named von Pirquet, describing abnormal reactions to food, pollen and dust.

The tendency to develop an allergy may have to do with genetics and to repeated exposure to a food or airborne substance. This can allow dander, dust mite dung, and pollen to induce an allergic response from your immune system. Research has implicated a malfunctioning FOXP3 gene, that can cause a lack of T regulatory cells (Treg). These cells induce tolerance to these foreign protein substances that are eaten or inhaled. The Treg cells also appear to be important in preventing damage from inflammation of respiratory tissue, such as in chronic asthma. Treg cells normally are produced in abundance when we eat or inhale substances; they send messages to the immune system to allow safe passage of foreign proteins. An abundance of Treg cells with properly functioning FOXP3 gene is present in those without allergies. It is hoped that further research on the FOXP3 gene will produce more functional Treg cells and thus a more tolerant immune system for the allergy sufferer.

An allergy can involve any part of the body. Any system. Any tissue. Most reactions involve the areas cared for by your Otolaryngologist, especially the nose, in both inhalant and delayed food allergy reactons. Foods tend to cause more nasal stuffiness when the patient is lying down. Except for house dust mite feces and body parts in the pillow, and the pet that loves to lick its fur often and spend time on or in the bed or couch, airborne allergies tend to be more of a problem when the patient is up and about. Some cases of fluctuating hearing loss, dizziness and / or buzzing in the ear (Menieres) have been associated with delayed food allergy. Symptoms from delayed food allergy reactions typically occur hours after ingestion, rarely up to a day or so. Sometimes symptoms, such as sneezing, occur before the meal is finished! Common symptoms from delayed food allergy or food sensitivity include: nighttime nasal blockage, persistent runny nose, repeated sneezing, itching of the nose, eyes, and sometimes the throat, throat clearing, general headache, migraine headache, dark circles under the eyes, lower eyelid wrinkles from congestion, sinus infections, middle ear fluid and infections, skin itching, hives, eczema, cough, wheezing, nasal polyps, hyperactivity, fatigue and trouble concentrating. Delayed food allergy is a prime cause for recurrent sinus and ear infections, as well as nasal polyps.

Special receptors of the floor of the mouth called “dendritic cells” detect the molecules present in the drop solution, and send messages to the immune system “T cells” to induce tolerance to these substances. These specialized T cells induce “down regulation” of the immune system, making the immune system more tolerant of the protein molecules in the allergy drop solution.

No. The FDA has not yet approved SLIT (sublingual immunotherapy). Clinical studies are underway in the US to gain FDA approval. The extracts commonly used in SLIT have long ago been approved, for skin testing and allergy shots. Allergy shots, or subcutaneous immunotherapy (SCIT), has had high efficacy, and has been safe for most patients, with few deaths reported annually in the US. Allergy shot mortalities led the United Kingdom to essentially outlaw allergy shots, by requiring that several hours following an allergy shot, the patient be observed in a hospital setting able to provide emergency treatment for reactions to the shots. Subsequently, there has been renewed interest in Europe for a safer modality of immunotherapy. SLIT is now widely utilized in Europe, where there have been no reports of deaths from sublingual allergy drop therapy. The FDA expects the medical practitioner to offer alternatives, after evaluating various modalities of treatment, including off-label (non FDA approved) therapy when it appears to be in the best interest of the patient. In fact, the World Health Organization has stated that SLIT is a viable alternative to allergy shots.

The FDA has approved allergy extracts given by injection, a route of administration that can result in anaphylactic allergic reaction and death. The government agency has not given approval for the sublingual route, a non-lethal delivery mode. Why? An extract manufacturer will need to spend millions of dollars over several years in order to add the oral route to labeled allergy extract indications. The FDA does not interfere with the right of the physician to provide “off label” use of FDA approved extracts when it is felt to be in the best interest of the patient. Many physicians agree with the World Health Organization, that allergy drops, sublingual immunotherapy (SLIT) should be offered as an alternative to allergy shots, subcutaneous immunotherapy (SCIT).

Yes. The cosmetic use of Botox is an example. Botox was originally approved by the FDA for treatment of muscle spasm. But its “off label” cosmetic use for treating facial wrinkles was commonplace, prior to its final approval by the FDA on April 15, 2002.

No. Each individual receives specific treatment depending upon history and clinical evaluation. In the case of the inhalant allergy vial, results from skin testing are used to determine safe starting doses of the various pollens, molds, animal danders, and house dust mite. For example, a weak dilution of grass pollen would be used if there has been a strong reaction to the grass skin test. A stronger solution would be given for a weak test response. In the case of the chronic food allergy, a detailed history and sublingual evaluation is done to determine which particular food solutions are used.

No. Allergy drops are not used for anaphylactic reactions to foods, just as shots are not normally recommended for this problem. If there is a history of severe, sudden anaphylactic reaction to a specific food, with symptoms such as sudden extensive hives, life-threatening asthma, and/or swelling of a part of the body, such as swelling of the mouth, tongue, or throat, then allergy drops would not be provided. The patient with a history of a sudden reaction to a known food, must strictly avoid that food, and be prepared to discover these reactions early so prompt medical attention can be delivered. It may be helpful to join one of the online food allergy networks. It is very important to inform your personal health care provider if there is a history of sudden severe food reaction, or if such reactions develop in the future, and keep up with management guidelines from the office of your healthcare provider.

Allergy drops provide significant relief of symptoms in the majority of our patients, and result in less need for medications and associated medication side effects.

You can avoid some allergens, medicate to reduce symptoms or treat the immune system. Avoidance - some allergens such as grass can be avoided by giving the lawn mowing job to someone else. Avoiding common foods such as corn can be challenging, as corn is pervasive in our diet. High fructose corn syrup, for example is common in most soft drinks, and has become a common contributor to chronic food allergy symptoms. Medication – steroid nasal sprays, antihistamines and antileukotrienes can used prior to airborne allergen exposure. Medications have had a limited effect upon chronic delayed food reactions. Immunotherapy – allergy shots, called subcutaneous immunotherapy or SCIT and allergy drops, called sublingual immunotherapy or SLIT, can be very effective. Omalizumab, an anti-IgE antibody, has been given on monthly intervals to treat very severe Immunoglobulin E (IgE) mediated allergies.

During and after your allergy drop treatment course, avoidance is a key factor in how fast, how well and how long your symptoms will be controlled.

As symptoms are relieved, you may taper off of these medications. Oral steroid such as Prednisone should be slowly tapered down, following instructions from your prescribing doctor. Prescribed and over the counter allergy medications approved by your doctor can be continued if you find you can prevent or relieve allergy problems; they will not alter the effectiveness of the allergy drop solution.

There is no miracle “cure” for allergies at this time. The allergy drop therapy is used for up to 5 years or longer, depending upon your ability to avoid allergens in the air and in the diet, as well as your ability to take the drops regularly.

Yes. As stated in the text “Otolaryngic Allergy”, regarding patients diagnosed with vasomotor rhinitis, “Attention should be directed toward delayed-onset food allergy…” Patients are commonly told they have vasomotor rhinitis when there is no evidence for Gell and Combs Type I IgE mediated allergy, or “atopy”. Most delayed food allergy reactions are associated with Type IV cellular immune reactions. There is currently no good skin or blood test for these delayed food allergies. Diet changes and sublingual evaluation for food sensitivities can be effective, however. Diet changes should at least be considered to see if symptoms improve before taking long term decongestant medications, and before considering nasal surgery.

Airborne allergy symptoms may be reduced a by starting allergy drops at least three months before onset of the allergy season. For example, in north central Texas, starting allergy drop therapy in early January may be sufficient to reduce springtime allergy problems. Receiving the allergy drop solution throughout the year is more effective, and is recommended for the multi-season inhalant allergy patient. Consider alternative treatment, including medication and allergy shots (SCIT), if an 80% or better reduction in symptoms does not occur during the first year of treatment. Symptoms from delayed food allergens may begin to be relieved as soon as the first several days of treatment. As with the airborne allergens, continued regular use of the drops can result in steady symptom improvement.

Yes, it does matter. The receptors of the floor of the mouth should be “primed” by avoiding chewing gum, mints, drinks, or having other food prior to placing the allergy drop solution under the tongue. You should use the drops three times a day: just after awakening from sleep, the middle of the day, and upon lying down in bed prior to going to sleep.

Pure glycerin from a plant source is present in the vial, as a preservative.

Yes, it can. Some people are sensitive to glycerin, which is a common ingredient in most toothpaste, soaps and lotions. Commercially made glycerin can come from animal (beef or pork) and / or vegetable sources. Vegans and people of certain religions cannot have glycerin made from animal sources. The glycerin used in the allergy drop solution is derived totally from plant sources, and not from any animal. If you know you react to glycerin-containing products, you may not be able to receive allergy drops. However, a weak allergy drop solution of glycerin can sometimes be used to treat glycerin reactions. Most people that are glycerin sensitive are aware of this because they react to almost all toothpaste, soaps, hair softeners, and lotions.

There has never been a report of death from use of allergy drops. Deaths from severe, anaphylactic allergy reaction to allergy shots do occur. Furthermore, in a 15 year literature review of allergy drop use, reported in 2007 by Dr. Leatherman from Southwestern Medical School in Dallas, there have been no life-threatening reactions reported. Millions of allergy drops have been given safely to thousands of patients.

The reactions from allergy drops have typically been limited to mouth itching / swelling, tiredness, headache, eye / nose itching, nasal blockage, abdominal discomfort, nausea, hives, cough and wheezing. These uncommon symptoms may occur during the first few days of starting immunotherapy. Symptoms that occur after being established on the allergy drops are likely related to other causes, and it is best to keep a record of what was eaten and of airborne exposures prior to developing the symptom. An example of symptoms developing after being established on allergy drops, is an adult patient sensitive to onion that was doing well on the allergy drop solution two months. She was given a 5 pound bag of Vidalia onions, a treat she could not resist. She ate onion several times a day for several days. Until the onions were gone, she experienced exacerbation of runny nose and throat clearing. An example of symptoms developing during the first few days of starting allergy drops, is a teenage girl with recurrent migraine headache, who experienced a recurrence of her migraine headache the same day she started her allergy drop solution, or sublingual immunotherapy (SLIT). She stopped the drops, and received another sublingual evaluation of her food sensitivities. The allergy drop solution was adjusted, and resumed. She has remained free of headaches since.

If symptoms develop within an hour of receiving an allergy drop, Benadryl and, if available, Singulair is taken. The allergy drops are stopped, and the office notified to make an appointment for repeat evaluation.

Yes. Know the symptoms that can occur. For example, should nasal blockage occur within an hour of each drop received, then consider that the symptom is very likely associated with the allergy drop. Children should be especially monitored, as they may not report symptoms unless asked. They should be monitored for mouth breathing, especially at night; watch for change in snoring. It is very easy to ignore these symptoms, as they may have been chronic for years!

If there is a history of severe asthma and / or recurrent hives, there is increased risk for a severe reaction called anaphylaxis, with or without use of allergy drops. If there is a history of severe asthma, chronic hives or anaphylactic allergy reaction, allergy drop therapy is not recommended.

Yes. Stop the drops if you develop a sudden severe illness, such as pneumonia, or become hospitalized for an illness or injury.

Regular evaluations are required every 6 months, sooner as needed.

Even though the drops are not covered by insurance companies, the majority of patients find that the overall cost of allergy drops is less than for allergy shots, and less than medications used for symptomatic relief. Contact the office for current allergy drop charges.

Contact the office. Your vials will be ready within two business days, ready to be picked up, or mailed. If a trip is planned, order vials early. At the time of your six month visit, vials may be reordered as well.

Certain foods, when eaten during your allergy season, can make your allergies worse.

	Concomitant Foods
Elm	milk, mint
Ragweed	milk, mint, melosn, banana
Marsh Elder	wheat
Pigweed	pork, black pepper
Posion Ivy/Oak/Shumac	pork, black pepper
Cedar	beef, yeast
Grass	apple, carrot, celery, potato
Oak	egg, apple
Cottonwood	lettuce
Pecan	corn, banana
Mesquite	cane sugar, orange
Molds	cheese, mushrooms, candida, ground molds