It’s All in Your Head: Allergy Shots vs Drops

After completing my formal residency training in Otolaryngology (ENT) in 1983 I later completed a fellowship in Allergy in 1989.  At that time all patients who tested positive for allergies were treated with desensitization therapy via injections “allergy shots”.

The technique of shot immunotherapy had changed very little since the 1930s.  The injections were administered in a doctor’s office, usually once a week though that schedule might vary.

In Europe in the 1970s and 1980s allergists started treating patients with extracts of allergy causing pollen administered under the tongue.  They found this to be an effective form of allergy desensitization.  After multiple training courses in seminars I incorporated allergy drops, referred to as sublingual immunotherapy (SLIT) in the year 2000.

I am frequently asked, which is better shots or drops.  Like so many areas and medicine this has been researched on multiple occasions through large studies performed mainly at universities or other large medical centers.  And the answer seems to be that as far as achieving desensitization from allergies both types of therapy are equally effective.

I consider myself to be a science-based physician analyzing evidence.  However, after being in practice for over 35 years I realize that the practice of medicine is also an art.  Just because scientific papers state that the shots and the drops are equal in effectiveness does not mean that in an individual patient they are the same.

I have personally switched patients from shots to drops or vice versa and seen improved results using a different form of therapy.  I still believe that in many patients injection therapy with conventional allergy drops done in a safe and standardized manner provides excellent relief of allergy symptoms, usually within 6 months or less of starting the treatment. But I also know drops will do that also.

Additionally, there is the issue of cost to the patient.  Even though oral allergy drop therapy is recognized throughout the world to be effective and safe, the United States FDA has not approved it officially.  The bottom line of this decision is that neither commercial medical insurance companies or Medicare will pay the cost of the drops.  The cost is therefore up to the patient to pay.

In my office allergy injection shots are provided in a clean, sanitized setting by an experienced technician.  Since the outbreak of coronavirus we have taken extra measures to maintain cleanliness and distancing between patients.

So the question of which is better to relieve your allergies, traditional shots or more modern drops under the tongue is answered on an individual patient by patient basis only after discussing the options fully.