The literature supporting allergy drops is very impressive. There are more than 400 citations in Pub Med including 100 double blind studies and four meta-analysis. That sublingual immunotherapy works and is safe and cost effective is undeniable. There are important benefits such as a four-fold decrease in asthma as reported by Novembre et al. There is no medication that can do this. Sublingual immunotherapy has equivalent efficacy to injection therapy yet is safer, has better compliance and costs less.
The limitation on the use of sublingual immunotherapy is a lack of expertise. Tucker et al reported that less than 6% of Allergists have any experience with this form of immunotherapy. There are more ENTs prescribing allergy drops than Allergists and this gap in expertise will continue to grow. The Allergist's approach of prescribing medications as first line treatment rather than prescribing a safe form of immunotherapy means that patients will go where they can get help.
The reason only 6% of Allergy/Immunolgy specialists use it is because 94% don't believe in it's efficacy. And while ENT's or Otorhinolaryngologists receive some training in allergy, the majority of their field focuses on head, neck and maxiofacial surgery. Allergy Immunogolists receive the most training in the field of allergy than any other specialists. Furthermore, utilzing shot therapy is a very involved process. It requires an understanding and knowledge of mixing extract and keeping the necessary extract in-house. This requires both knowledge and the willingness to undergo the expense to manage it. In addition, there are liability issues and thus a professional and experienced staff is required to manage the extract or risk patients undergoing anaphylaxis or ineffective treatment. This is the reason most primary care physicians and ENT's do not offer allergy shots is due to their lack of expertise, liability issues and costs involved. They don't have enough allergy patients to offset the costs of maintaining shot therapy. This is why sublingual immunotherapy is an attractive option for them because it is far less expensive to admister it and it's questionable efficacy eliminates the risk of a patient undergoing anaphylaxis.
Having citations on Pub Med doesn't necessarily validate this approach. Many banned and controversial treatments have citations on Pub Med. One famous example would be hormone replacement therapy in post menopausal women which is no longer endorsed due to its cardiovascular risks. Furthermore, research journals and publications vary in regards to its credibility. There are literrally hundreds of journals available and getting published is not a difficult task which is why only a select number of respected peer reviewed journals such as the New England Journal of Medicine and the Journal of the American Medical Association are the most strict in regards to accepting research for publication. Thus far, there have not been any good studies in these two journals advocating sublingual immunotherapy. In short, the two most respected medical journals have no well designed randomized double blind studies proving its efficacy which is why the FDA has yet to approve of this method.
In addition, the people advocating this therapy are primary care physicians, ENT etc. These physicians are not trained nor have experience managing FDA approved allergy shots and thus have incentive to provide this treatment as it is quick and can be an easy money maker for them. Unlike board certified Allergy/Immunology physicians, these doctors did not complete a fellowship in the field of Allergy Immunology nor did they pass a rigorous board examination to become licensed in this field. Patients are certainly free to choose to undergo sublingual immunotherapy however, they should be properly informed of all the facts.
It is too bad and sad that most allergy doctors do not believe in sublingual drops. Personally, I have had a history of SEVERE allergies to numerous things. I had asthma when I started therapy. I received shots for a number of years which helped tremendously but switched over by same doctor to the sublingual drops because of severe arm swelling and a few other problems from the shots. The sublingual drops helped the same as the shots only with no swollen arm. My asthma went away with both treatments, shots or drops. The drops were just as effective as the shots. I have been getting drops for 40 years from an Akron, Ohio board certified allergist and immunologist who has also received recognition and awards from many national allergy boards. He still gives shots to a few patients but has a huge practice in which most patients receive the drops. Shame on all you other physicians for being so stubborn, behind the times, or maybe just to lazy to learn the method of giving drops.
I agree, it is hard to find such Dr., trying to recall the Dr's name you are mentioning. I had moved out of Akron Ohio area years ago. Can't find Drs who use allery drops. This was very effective as diagnosing my allergies and treatment for me and my daughters. Many allergy triggers we never knew or were found with skin testing. Wish I could find such a Dr. in my area, hard to find listings.
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Though SLIT doesn't have FDA approval, it IS and HAS BEEN available in the US for quite some time. It's simply an off-label treatment. Off-label treatment isn't uncommon.
There's plenty of research to validate SLIT's effectiveness, though much of it hasn't been done in the US (though much of it has been done by the same people who are recognized researchers for injection immunotherapy). Fortunately, that's finally changing, and studies are underway in the US.
Several of my family members, as well as friends, have benefitted from SLIT after getting no relief from other treatments. I would hope that the resistance to this treatment will begin to dissipate as more of the US studies are complete. With allergies and related asthma on the rise, as well as healthcare costs, it's time to look for options. It's unfortunate that so many people continue to suffer in the meantime.
Similarly, I see patients who experienced no relief from SLIT and are now being effectively controlled with shot therapy. They sufferred for years and were misinformed that shot therapy was ineffective and needless. If someone continues to suffer after being placed on shot therapy then I certainly don't mind if they want to try SLIT or other off-label therapies. However, I don't believe it should be an initial form of therapy because it is not FDA approved and there isn't enough peer reviewed research to advocate its use.