Drop It

Sublingual immunotherapy proves most effective in fight against allergies.

If Meril Salzburg suffered through any kind of an allergic episode while growing up, she doesn’t remember it. To the best of her recollection, she was one of the lucky ones who made it through childhood and adolescence without ever having to fight with the sneezing, congestion and itchy, watery eyes that spark such bouts.

Meril Salzburg found relief from allergies through sublingual immunotherapy.

Meril Salzburg

She never had to wrestle with any of those issues during her first 40 years of adulthood either. That all changed a few years ago, when the onset of the paradisiacal Central Florida spring sparked an allergy attack the likes of which the now-retired marketing executive had never encountered.

“It was that time of the year when the pollen is everywhere here in Florida, and I suddenly became very congested and was actually having trouble breathing,” Meril, 64, relates. “I also had a lot of ear problems at the time. There was a lot of pressure in my ears, like when you’re in a plane and your ears won’t pop.

“When people talked to me, it sounded as if they were in a tunnel or something. My ears were so clogged up, it felt like they were going to explode. And then, all that clogging and everything descended into my nose and into my throat, and my head felt like it was very, very heavy and full of who knows what.”

The sudden outbreak of symptoms that Meril had seldom if ever experienced before motivated her to visit her doctor, who immediately referred her to an ear, nose and throat specialist. The specialist Meril was referred to was Daniel L. Rothbaum, MD, of Atlantic Ear, Nose & Throat. He has dealt with cases such as Meril’s many times before.

“Meril was a patient with late-onset allergies,” Dr. Rothbaum recounts. “She is an excellent example of how problems with allergies can begin at any time in life, and that when they do happen, they can progressively become very serious and really affect one’s life.”

No Needles, No Shots

Most allergy sufferers seek relief from an array of over-the-counter medications such as ZYRTEC®, Allegra® and Claritin®. Most over-the-counter options only mask the symptoms, however, which is why people with severe allergies often receive treatment with immunotherapy.

Immunotherapy is designed to desensitize patients to the allergens that affect them. Unlike medicines, immunotherapy is designed to fix the underlying problem causing the allergies.

At Atlantic Ear, Nose & Throat, Dr. Rothbaum treats allergy patients with a form of immunotherapy called allergy drops. Allergy drops are designed to desensitize patients to the things in the environment to which they are allergic.

Meril Salzburg found relief from allergies through sublingual immunotherapy.

“It is by far the safest form of allergy treatment and the one that’s most compatible with a busy schedule. . . . They are very user-friendly and because of that, we have found that compliance is much higher . . .”
– Dr. Rothbaum

Allergy drops are natural extracts of the things that cause allergies. Patients apply this extract themselves by placing a few drops of it under their tongue once a day.

Referred to clinically as sublingual immunotherapy, or SLIT, allergy-drop therapy is fast becoming the preferred treatment for allergies. To know what patients might benefit from allergy drops, the allergy nurse at Atlantic ENT performs a specialized skin test to determine precisely the type and severity of a patient’s allergies.

“We do what we call a modified quantitative test, which is a skin test that not only tells us what the person is allergic to but how allergic they are quantitatively,” Dr. Rothbaum explains. “We get those results by doing what we call dilutional testing, where we test for different concentrations of allergens.

“This test gives us a better understanding of what the patient is most allergic to, and from there, we formulate a custom drop specifically for that patient. We can also track quantitatively how the patient is responding to the allergy-drop
immunotherapy. Every year that the patient is on the drops we recheck the allergy test to see how much they have improved.”

“After retesting, depending on what allergies remain, we can modify the drops. Our goal is to desensitize the patient fully so they no longer have allergies. Once the patient is no longer allergic, the patient stops the drops altogether.

“How fast this happens depends a lot on the patient’s own immune system and response. We have found that allergy drops are a safe and very effective way to help patients move past their allergies.”

Patient Friendly

One of the keys to success in desensitizing patients through allergy-drop therapy is the rapid escalation Dr. Rothbaum uses. In general, after only ten days, a patient on allergy drops has reached the maintenance or target dose. This rapid escalation approach means that patients can desensitize faster.

Meril Salzburg found relief from allergies through sublingual immunotherapy.

“My husband was an allergy sufferer who had to get shots when he was a kid. He said he wished they had these drops back then because it would have made his life a lot easier.”
-Meril

Dr. Rothbaum says that in general, it takes three to four years of allergy-drop therapy to achieve full desensitization. However, some patients, such as Meril, achieve desensitization much faster. The rate depends on how fast the patient’s immune system responds to therapy.

“It is by far the safest form of allergy treatment and the one that’s most compatible with a busy schedule,” Dr. Rothbaum adds. “You don’t have to go to a doctor’s office every week or two to get shots; it avoids needles, so it’s better for children, and the drops have a sweet taste to them, so children and adults don’t complain about taking them.

“They are very user-friendly and because of that, we have found that compliance is much higher, meaning patients stick with them longer. We used to give allergy shots, and we found that the patients taking drops do a much better job of staying on schedule, and because of that, they get better faster.”

Meril was one of those who got better fast. She says her allergy symptoms improved steadily over the course of the first six months she was on the drops and that within a year, she was able to get off the drops completely. She says she has not had a bout such as the one she experienced in the spring of 2015 since.

“I’ve had little flare-ups here and there, but nothing that I can’t get rid of without an over-the-counter antihistamine or decongestant,” she says. “I don’t like to take too many of those kinds of medications, and because I took the drops for a year, I really don’t have to. The drops really are remarkable.

“My husband was an allergy sufferer who had to get shots when he was a kid. He said he wished they had these drops back then because it would have made his life a lot easier. That’s why, if anyone has any allergy problems, I’d advise them to go see Dr. Rothbaum. He’s caring, patient and really smart. He’s just a tremendous doctor.”

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    • Atlantic Ear, Nose and Throat, P.A.

      Atlantic Ear, Nose & Throat is a comprehensive, full-service otolaryngology practice with offices in both Seminole and Volusia counties. In the practice, Devang Shah, MD, and Daniel Rothbaum, MD, combine surgical excellence with a compassion... Read More

    • Daniel Rothbaum, MD

      Daniel Rothbaum, MD, is board certified in otolaryngology. After receiving his undergraduate degree from Harvard University and his medical degree from the Yale School of Medicine, he completed his general surgical internship and residency at J... Read More

    • Devang Shah, MD

      Devang M. Shah, MD, is board certified in otolaryngology. After receiving his medical degree with honors from Robert Wood Johnson Medical School, New Brunswick, NJ, he completed his surgical internship and residency at Johns Hopkins Hosp... Read More