Looking For An Alternative to Allergy Shots? Brick Doctor May Have Your Answer

When most people think of allergy testing, they think of dozens of little pinpricks, up and down their back, each one checking for a response to a specific substance: mold, grasses, pet dander.

When Alysha Simmons finally agreed to go for allergy testing, after years of constant health issues, the testing she underwent was nothing like that.

“It felt like someone was pressing a Lego on your back,” said Simmons, 22, of Toms River. “It didn’t hurt at all.”

The testing Simmons underwent is a newer form of allergy testing that doesn’t use needles, according to Dr. John Infantolino, an internist whose office is in Brick. Instead, resin drops containing the various allergens are put on the skin, covering everything from trees and various seasonal pollen irritants to animals and dust mites. It also covers food allergies, he said.

“It’s 70 resin drops on the skin, not under,” Infantolino said. “Not injecting it under the skin avoids an anaphylactic reaction,” making it a safer way to test for allergies.

But it’s not just the testing that’s different. The treatment is completely different as well. Instead of receiving individualized shots for specific allergies, the patient receives one custom-mixed vial of drops to treat all of their allergies, and that medication is administered under their tongue daily.

Called sublingual immunotherapy, this method of treating allergies has been used in Europe for 30 years, Infantolino said. It has become popular in Florida, but for the most part the treatment is considered an off-label use of the medication by the Food and Drug Administration, he said.

“It’s a lot less expensive than the shots,” Infantolino said, because unlike the shots, which require office visits weekly for the shots to be administered, then the patient observed to ensure they do not have a serious reaction, these can be self-administered at home by the patient.

“There’s a lack of serious side effects,” Infantolino said, “because this system does not overwhelm the immune system like the subcutaneous shots do. That’s why you have to sit in a doctor’s office afterward.”

Dr. Sandra Lin, an otolaryngologist at Johns Hopkins University in Baltimore who has studied the sublingual immunotherapy, said in a March 2013 article on NPR.org that studies have shown as much as a 40 percent improvement in allergy symptoms for those using the drops, with even greater improvement for children.

“The most severe reaction has been hives,” said Infantolino, one of a handful of doctors in the Northeast who employ the treatment. Most of the patients he has treated this way feel better after four weeks on the drops, he said. Other reactions can include a constant sore throat, ear infections, and skin rashes. But those reactions are not seen often, he said.

It is the evidence he has seen himself that has convinced him of the treatment’s effectiveness, he said.

“I was skeptical,” he said. “I had to see absolute proof.”

That proof came one evening in Florida, during dinner with another doctor Infantolino knows. The man was significantly allergic to dogs and cats.

“He had put himself on the drops,” Infantolino said. While they were dining, the Infantolinos’ dog came into the room. The visiting doctor looked surprised and said, “I didn’t realize you have a dog,” Infantolino said. It was then the other doctor told them of his dog allergy -- and the sublingual allergy drops.

“There was not one sneeze, not one sniffle, not one itch,” Infantolino said. “I saw it in person live,” adding that’s when he became a believer in the drops’ effectiveness.

For those who suffer seasonal allergies, the drops can ease the symptoms, Infantolino said.

And for those, like Simmons, whose allergies are more complex and include food allergies, they can make all the difference in the world -- which she didn’t believe until she lost her vial of drops while traveling.

“I remember thinking, ‘I don’t really think these are working,’ “ Simmons said. But when she lost the vial, “I was sick two days later.
“I got really sick,” and that’s when she knew the drops had in fact been working. They have eased her food allergies, too.

“I’m allergic to soy and wheat,” she said. “I try to eat what I’m supposed to eat, but since I started taking the drops, my stomach isn’t as bad as it was.”

Because most of the drops prescribed are an “off-label” use -- which both Infantolino and Lin noted is legal, like prescribing aspirin to help prevent a heart attack -- they are usually not covered by insurance. However, the testing itself, which is necessary to determine the needed mix, is covered by insurance companies. And Infantolino said the cost of the drops is lower than what people typically spend on medicines like Claritin to manage their allergies.

The FDA has approved one sublingual allergy immunotherapy drug, called Oralair, which targets various grass species, in April. But it is the only one that has been approved so far.

“It enhances your immune system,” Infantolino said. And for those who don’t find relief, conventional treatment is still an option.
“You can always go back to the shots,” he said.

(PHOTO: Needleless allergy testing “feels like a Lego being pressed on your back,” according to one patient, and lowers the risk of a serious reaction. Its companion treatment, sublingual immunotherapy, removes needles from the allergy equation altogether, doctors say. Photo courtesy of Cathy Hutton)