Q: What factors should I consider when deciding which immunotherapy option – allergy shots or under-the-tongue tablets – is best for me? 

Bobby Q. Lanier, MD: For most people with environmental allergies, over-the-counter or prescription medications are sufficient to control symptoms. However, medications do not address the root cause of allergies. Confronted with a lifetime of daily allergy medication needs, many people – particularly those with severe symptoms – seek therapy for long-term remission or perhaps a cure.

Enter allergy immunotherapy – also called vaccinations – to help the body build tolerance to allergens. Symptoms must be at least moderate to severe for immunotherapy to be considered.

The traditional method of immunotherapy is allergy shots, or subcutaneous immunotherapy (SCIT). Allergy shots are administered weekly in the doctor’s office, with alterations to the treatment schedule typically made at six months, depending on the results.

As an alternative to shots, under-the-tongue immunotherapy tablets, also called sublingual immunotherapy (SLIT), are available for cool weather grass pollen and ragweed. Recently approved by the U.S. Food & Drug Administration (FDA), the tablets can be taken at home. They must be taken daily before and during the patient’s allergy season each year.

When considering allergy shots vs. tablets, one factor is whether you have allergy sensitivities that extend beyond cool weather grass pollen and ragweed. Most allergy patients are allergic to more than one allergen – many have up to four. So if you have grass pollen allergies and you’re also allergic to mold, house dust mites and pet dander, for instance, allergy shots may be preferred because they can be tailored to cover more than one allergen at the same time. Tablets only cover one: currently grass pollen or ragweed.

Another factor to consider is how likely you are to comply with a weekly allergy shot schedule. If it’s a challenge to go to the doctor’s office once a week for the shot, then oral immunotherapy may be preferred because you can take the tablets at home, starting with the second dose. Of course, this puts the responsibility on patients to take it daily.

Potential side effects to oral tablets, such as mouth or tongue swelling, must be closely monitored. There is a risk of severe reaction, so when taking tablets at home, keep two prescribed epinephrine auto-injectors close by in case of anaphylaxis.

The cost of each type of immunotherapy may vary depending on your insurance coverage. Taking daily tablets for any amount of time can be expensive, so do a price comparison before making a decision.

Allergy immunotherapy or vaccination is a big commitment requiring lots of time and significant expense. The goal is to produce lifetime remission, not just to control symptoms. I urge people to ask questions and even seek a second opinion, if necessary.

Immunotherapy requires close follow-up to ensure the treatment is doing what it is designed to do.

Bobby Q. Lanier, MD, FACAAI, is Executive Medical Director for the American College of Allergy, Asthma & Immunology (ACAAI). He is clinical professor of pediatrics at University of North Texas Health Science Center in Fort Worth, Texas.

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