Is Immunotherapy Right for You? What to Expect from Allergy Shots and Drops
Is Immunotherapy Right for You? What to Expect from Allergy Shots and Drops
If you've been dealing with seasonal allergies for years, using antihistamines and nasal sprays, the same cycle every spring, you may have wondered whether there's something that actually changes the pattern rather than just managing it. There is. Allergen immunotherapy is the only medical treatment that can potentially improve or resolve allergic disease long term, rather than simply suppressing symptoms after the fact.
What Immunotherapy Actually Does
Allergy symptoms happen because your immune system has learned to treat a harmless substance — pollen, mold, pet dander, dust mites — as a threat. Every time you encounter it, it mounts a response.
Immunotherapy works by gradually retraining that response. Through repeated, carefully controlled exposure to the allergen at increasing doses, the immune system shifts from overreacting to tolerating. Over time, this reduces both symptom severity and the need for daily medications — and those changes can persist long after treatment ends.
Medications manage symptoms. Immunotherapy changes the immune system's relationship with the trigger — and for the right patient, that's a fundamentally better outcome.
Two Delivery Methods: Shots vs. Drops
Allergy Shots (Subcutaneous Immunotherapy — SCIT)
The traditional, most extensively studied form. A small amount of allergen is injected under the skin at regular intervals, in two phases:
Build-up phase: Weekly injections with gradually increasing doses, typically over 6–8 months.
Maintenance phase: Once the target dose is reached, monthly injections continue for 3–5 years.
Shots are always administered in a clinical setting where reactions can be monitored. Most people tolerate them well, and a brief observation period after each injection is standard protocol.
Allergy Drops (Sublingual Immunotherapy — SLIT)
Once we have information about your environmental allergies based on lab or skin testing, we can prescribe sublingual immunotherapy — delivered as custom drops or dissolving tablets held under the tongue for at least one minute. Absorption through the oral mucosa initiates the same immune retraining process as shots. Treatment follows a similar two-phase structure:
Initial phase: Treatment is started at least 3–4 months before the pollen season being treated. Your first dose is always taken in our office, with a 30-minute observation period to ensure there is no reaction.
Updosing phase: If a dose adjustment is needed, an additional in-office visit and observation may be required.
Maintenance phase: Daily drops or tablets are taken at home, at the same time each day, through the pollen season — and in some cases, year-round as recommended by your physician.
Consistency matters. Missing doses can reduce effectiveness and increase the risk of side effects. If you miss a dose, do not double up — contact the office so we can advise on any needed adjustments.
SLIT options include: Custom-compounded drops based on your specific allergen profile, which can address multiple allergens simultaneously, as well as FDA-approved dissolving tablets for specific allergens (dust mites, grass, or ragweed pollen). Note that each FDA-approved tablet treats only one allergen at a time; custom drops are used when broader or multi-allergen coverage is needed.
How Do They Compare?
Efficacy: Shots, tablets, and drops are all effective at retraining and desensitizing immune cells to reduce symptoms — and all three can meaningfully reduce allergy severity and improve symptom control. Shots have the most extensive long-term evidence and are highly effective across a broad range of environmental allergens. For insect venom allergy, allergy shots (SCIT) are the only appropriate form — sublingual drops or tablets are not used for venom treatment. FDA-approved tablets have been used safely for over 12 years and are as effective as allergy shots for the allergens they cover, though they treat only one allergen at a time and may take a little longer to achieve full symptom reduction. SLIT drops can address multiple allergens simultaneously and are well-suited for patients with broader sensitivities.
Convenience:
Drops offer more flexibility.
The bulk of allergy drop and tablet treatment is done at home, which fits more naturally into modern schedules than weekly office visits — especially for families with children.
Safety: Allergy shots must be given in the office so reactions can be monitored. The risk of severe allergic reactions, including anaphylaxis, is lower with allergy drops and tablets — making home administration appropriate for most patients. Self-injectable epinephrine should still be available at every SLIT dose as a precaution.
Insurance:
Shots are typically covered.
Custom sublingual drops generally are not, though FDA-approved tablets often are — worth clarifying during your evaluation.
Who Is and Isn't a Good Candidate?
SLIT is considered when nasal allergy symptoms are not adequately controlled by environmental measures and/or medications. It tends to be most beneficial when:
Symptoms are moderate to severe, or significantly affect quality of life
Symptoms occur for more than a few weeks per year
Multiple medications are needed for control
You want long-term relief, not just seasonal symptom management
You've had a serious insect sting reaction (venom immunotherapy — allergy shots only — is highly protective and the recommended treatment)
SLIT is not appropriate for everyone. It is contraindicated in patients who:
Have had anaphylaxis or a severe systemic reaction to immunotherapy (shots or a prior course of SLIT)
Have uncontrolled, severe, or unstable asthma
Have eosinophilic esophagitis
A thorough evaluation helps ensure the right approach for your individual health picture.
What to Expect: Side Effects and Safety
The most common reactions to SLIT — most likely in the first few days of treatment — are local and mild: throat irritation, mouth or tongue itching, ear itching, or mild abdominal discomfort.
If your asthma symptoms worsen at any point during treatment, notify us before continuing your sublingual medication. Worsening asthma is a signal to pause and reassess.
Timing: When to Start
Because treatment should begin at least 3–4 months before the relevant pollen season, timing your evaluation well ahead of your usual symptom window matters. Starting in the middle of a flare, when the immune system is already inflamed, is not the ideal moment to begin.
If spring is your hardest season, now is the right time to have the conversation. Building immune tolerance works best when we start before the season, not during it.
Our Approach at Holistic Allergy & Immunology
At Holistic Allergy & Immunology, immunotherapy is one part of a larger immune picture. As chair of the American College of Allergy, Asthma, and Immunology's Committee on Integrative Medicine, Dr. Atoosa brings an evidence-based and whole-person perspective to every treatment plan.
We offer both subcutaneous immunotherapy (SCIT) and sublingual immunotherapy, custom drops and FDA-approved tablets, tailored to your allergen profile, lifestyle, and overall immune health. For patients with food allergies, oral and sublingual food desensitization are also available.
If you've been managing symptoms year after year and are ready to ask whether there's a better long-term strategy, an evaluation is a good place to start.