Allergy Drops (Sublingual Immunotherapy) [SLIT]

107 NEWTOWN ROAD, SUITE 2A, DANBURY, CT 06810

131 KENT ROAD, SECOND FLOOR, NEW MILFORD, CT 06776

901 ETHAN ALLEN HIGHWAY, RIDGEFIELD, CT 06877

488 MAIN AVENUE, NORWALK, CT 06851

BEFORE PROCEEDING

Please read through this important information:

(NOTE: this link will also be emailed to you for later reference)

🔗 Allergy Drops (Sublingual Immunotherapy) at Advanced Specialty Care

Allergy Drops (Sublingual Immunotherapy):

(Note:  this information will also be emailed to you)

Sublingual Immunotherapy (Allergy Drops or SLIT ) is a home-based daily therapy applied under the tongue to treat allergic rhinitis and/or allergic asthma.  Your allergist has discussed this therapeutic option with you at length to help you understand the pros and cons of such treatment.

Sublingual Immunotherapy is an “off label” use of an FDA approved product. This allergy extract has been approved by the FDA for allergy shots. However, it is now being prescribed in another manner (drops under the tongue) that has not yet been specifically approved by the FDA. Using this allergy extract as allergy drops is generally not covered by insurance.

Sublingual Immunotherapy is often associated with minor local side effects such as itching and/or swelling of the lips/tongue/mouth, nausea or stomachache. These symptoms are usually mild and often resolve without treatment. If medication is needed, a quick onset oral antihistamine such as cetirizine (Zyrtec) or diphenhydramine (Benadryl) is generally sufficient to treat these symptoms.

There is a very small risk of a generalized systemic allergic reaction that theoretically could be life-threatening. Symptoms of such a reaction could include:

• Hives or itching of the entire body
• Flushing (redness) of the skin, with or without hives
• Swelling of the throat
• Cough, wheeze, chest tightness or chest discomfort
• Tearing, sneezing or nasal congestion
• Faintness, or generalized feeling of not being well
• Metallic taste
• Cramping of the uterus, stomach or intestines

For this reason, some physicians advise keeping an epinephrine auto-injector (such as EpiPen or Auvi-Q) available for emergency use.

Significant adverse reactions to Sublingual Immunotherapy are more likely to occur if the treatment is interrupted and not administered daily.  It is important to administer drops daily and keep scheduled follow-up appointments (usually every 3 months to monitor progress).

If you become pregnant while using Sublingual Immunotherapy (Allergy Drops), notify your Allergist prior to administering your next dose to discuss the options.   

Please notify the nursing staff if you start any new prescription medication. Certain medications such as “Beta blocker” medications (tablet or eye drops), often prescribed for high blood pressure, various heart problems, migraine headaches or glaucoma, may pose a safety risk while receiving Allergy Drops (or shots).

Signing the Allergy Drops/Sublingual Immunotherapy Authorization (provided on a later page) confirms your understanding of the above information.

Allergy Drops (Sublingual Immunotherapy) Patient Instructions

Please read these instructions carefully prior to starting Allergy Drop Immunotherapy

General information regarding Allergy Drops

• Your first dose of each vial will be administered by our trained nurses in our office. You will be asked to wait for 30 minutes in our office after administration of your allergy drops.  If 2 vials of SLIT are to be utilized, you will be monitored for 15 minutes after the first dose and if no adverse reaction occurs then the dose from the second vial will be administered and you will be monitored for another 30 minutes.
• Subsequent doses of allergy drops are self-administered in the comfort of your home. Please take your allergy drop dose at the same time each day, preferably in the morning, so that you can contact our office with any questions or concerns.
• Keep your vials refrigerated to maintain potency of the extracts. Avoid prolonged exposure to heat or freezing temperatures.
• It is very important that you take your allergy drop dose daily to achieve the best results and to minimize adverse reactions. However, please refrain from taking allergy drops the day of SLIT pickup, as you will receive a dose from your new vial in the office.
• There are no restrictions regarding eating or drinking before or after allergy drop treatment; however, the allergy extract should be the only thing in your mouth during the 2–3-minute treatment.
• Women who are or may become pregnant should not take allergy drops until they have consulted with their allergist
• Your asthma should be well controlled while taking allergy drops.  If your asthma is not well controlled, please inform your allergist immediately.           

Administration of Allergy Drops

• Administration should be done at the same time each day, preferably in the morning.
• Allergy drops should be placed under the tongue and held there for 2-3 minutes, then spit out or swallowed. (If significant stomach discomfort occurs, spit out the dose after 2 minutes; do not swallow.)
• Date each dose and record any adverse reactions in your dosing protocol chart. Be sure to bring this dosing chart to your follow-up appointment with your allergist.
• If you are unsure of your dose or if you have misplaced your dosing sheet, please do not guess your dose.  Instead, please call our office for instructions.
• Have a quick acting oral antihistamine (we recommend cetirizine/Zyrtec or Benadryl) available to treat mild reactions.  For some patients, your allergist will also ask you to keep an epinephrine auto-injector (such as Epipen or Auvi-Q) available.
  
  DO NOT TAKE ALLERGY DROPS if you have:
• A fever (temperature >100.4 degrees)
• Wheezing or if your asthma is not well-controlled (if monitoring, peak flow <80% of your personal best)
• Open sores in your mouth
• Dental procedure completed that day
• Viral respiratory infection
• Nausea, vomiting
• Strep throat

Women who become pregnant should inform our office immediately. If you become pregnant, please do not take allergy drops until you have spoken with your allergist.

Side Effects

Allergy drops are generally considered a very safe method of treating allergies, and that is why this therapy can be administered at home.  Most side effects of allergy drop treatment are mild and disappear within two weeks.  Some patients report mouth tingling or itching, but this reaction is usually limited to the initial weeks of therapy.

Possible Reactions/Recommended Treatment

• Mouth itching: Take an oral antihistamine.
• Swelling of lips/tongue: Take an oral antihistamine. Decrease to last tolerated dose for the next 2 allergy drop administrations, then continue protocol as scheduled. If swelling of the tongue and/or throat occurs and interferes with breathing or swallowing, you must use your epinephrine auto-injector, call 911 and take Benadryl or Zyrtec/cetirizine.
• Nausea or cramping: Take an oral antihistamine. Call our office before taking further doses. If symptoms worsen or persist, administer epinephrine and call 911.
• A few hives: Take an oral antihistamine. If symptoms persist or worsen, administer epinephrine and call 911. Do not take any more doses of allergy drops until you speak with your allergist.
• Anaphylactic reaction: Symptoms include wheezing, throat tightness, progressive itching (nose, throat, eyes, skin, palms, soles of feet, groin, etc.), sneezing, coughing, nasal congestion, runny nose, vomiting, abdominal cramping, diarrhea, generalized hives, lightheadedness, and fainting. If anaphylaxis occurs, administer epinephrine auto-injector and call 911. Take an oral antihistamine. After the reaction has resolved, call our office to arrange a follow up visit before taking any more allergy drops.         

Missed Doses

• If you miss between 1-7 days: No adjustment is needed. Continue advancing the dose as instructed or take your regular maintenance dose.
• If you miss between 8-14 days: Decrease by 1 drop in the current bottle(s), then increase per protocol.
• If you miss between 15-21 days: Decrease by 2 drops in the current bottle(s), then increase dose per protocol.
• If you miss between 22-28 days: Decrease by 3 drops in the current bottle(s), then increase per protocol.
• If you miss more than 28 days, please contact your allergist for instructions. 

Renewal Policy

• Your first Allergy Drop extract will be provided as a 90-day supply. However, you will need to schedule a follow-up appointment with your allergist after the first 30 days of allergy drop therapy.
• The next follow-up appointment will be 90 days from the date you start allergy drops.
• While on allergy drops, you will need follow-up appointments with your allergist every 90 days.  At each 90-day visit you will be given your next 90-day supply of extract. You will follow the same procedure as you did for the initial SLIT pick up and have the same monitoring period.  Failure to keep these appointments will result in delay of your allergy drop extract vial(s) distribution.
• It can take 1-2 weeks to obtain new allergy drop extract vials; therefore, please plan accordingly and contact our office at least 2 weeks prior to running out of your current vials.

Results/Duration of Allergy Drop Treatment

• Response to allergy drop therapy varies by individual. Some patients experience improvement in as little as three months, while others note improvement sometime during the first year. There may be some patients who do not notice a significant clinical benefit.  Proper follow up will ensure that the best decisions and plans are made for each patient.
• To achieve the best results, patients should expect to be on allergy drops for 3-5 years depending on their response to therapy.

Questions? Call (203) 748-7433

Allergy Drops (Sublingual Immunotherapy) Authorization

I request that my allergist prepare sublingual immunotherapy extract (Allergy Drops - SLIT) for me/my child. I acknowledge that I have received the attachments above regarding the pros and cons, as well as the potential risks associated with receiving Sublingual Immunotherapy (Allergy Drops).

I have read and understood all of this information. The pros and cons of initiating Allergy drops (Sublingual Immunotherapy) have been discussed thoroughly with my allergist. The opportunity has been provided for me to ask questions regarding the potential risks and benefits of this treatment, and these questions have been answered to my satisfaction.

I understand that extract(s) for Allergy Drops (Sublingual Immunotherapy) are prepared for me based on my allergy test results and are not usable by anyone else.  Since these drops are generally not covered by insurance, I agree to provide payment in advance of preparation of the allergy drops for my specific treatment, or I give permission to Advanced Allergy and Asthma Care to charge my credit card for the preparation of my extract.

PAYMENT AGREEMENT

I understand that my allergy immunotherapy drops will be refilled automatically every three months for a charge of $340 per vial.

I authorize Advanced Specialty Care to charge my credit/debit charge for my SLIT immunotherapy refill.