Drops Over Shots

Sublingual immunotherapy: an important weapon in the fight against allergies.

Lauri Sullivan and Israel Sierra

Some things are just meant to be. Like the union of Lauri Sullivan and Israel Sierra.

Lauri and Israel met when Lauri was in college, and they were together for five years until their career choices forced them to go in separate ways. Some 20 years later, they found each other again. This time, within three weeks of reuniting, they were married.

Lauri, 47, and Israel are building a life together, doing all those things that married couples do, including buying a home. It’s possible, though, that none of that would be happening had Israel not noticed a couple of years ago that Lauri had become quite sickly.

“I was always getting sinus infections, ear infections and bronchitis,” Lauri remembers, “and my husband, who knew me when I was in my early to mid-20s, said to me one day, You were never a sickly person before, what’s happened?

“I had to admit that I really didn’t know what was going on. I always used to work out and was very fit and healthy, but about six years ago, something took a hold of me and I started gaining weight and just feeling terrible all the time. I was constantly sneezing from allergies and feeling run down from sinus headaches and infections.”

In 2018, Lauri and her husband agreed that she should go to a doctor.

“Unfortunately, the blood work that was done showed nothing,” Lauri bemoans.

A year later, she was hospitalized with the flu, bronchitis and pneumonia.

“That’s how I spent my birthday that year – in the hospital,” she recalls. “It was so bad that time that I honestly didn’t know if I was going to make it through all of this.”

Lauri did make it through, but the cause of her chronic sinus infections and bout with pneumonia remained a mystery even to the physicians at the hospital. As a result, she was advised to visit an ear, nose and throat specialist.

Lauri asked her pharmacist for a recommendation. The pharmacist suggested Devang M. Shah, MD, at Atlantic Ear, Nose & Throat, which has offices in DeLand, Lake Mary and Orange City.

Diagnosis and Treatment

When she saw Dr. Shah for the first time, Lauri was still suffering from intense sinus pressure and pain. To get a gauge on the cause, Dr. Shah ordered a CT scan of Lauri’s sinuses and conducted a thorough allergy test.

The CT scan showed that Lauri had an anatomical obstruction in her sinuses, which were infected. The results of the allergy test showed that Lauri, who rescues and trains abused pit bulls, was allergic to everything from animal fur to grass.

“The infection was a big part of the problem,” Lauri relates. “Dr. Shah told me that there was so much mucus in my sinuses that it couldn’t get out, and it was just festering into one infection after another.”

To resolve the problems, Dr. Shah started his treatment by placing Lauri on a regimen of medications to reduce the mucus and infection. That was done in preparation of a minimally invasive procedure called a balloon sinus dilation, or sinuplasty, which is designed to clear the anatomical obstruction from the sinuses.

“I’m living my life again, and I feel great.” – Lauri

As a follow-up, Dr. Shah recommended that Lauri attack her allergies with a treatment called sublingual immunotherapy, or SLIT.

SLIT is quickly becoming the preferred method of treatment for chronic allergies. Its advantage is that, unlike an injection, it can be administered at home through the use of a small pump that distributes liquid drops of allergen beneath the tongue.

Over time, the proper use of the compound, which is custom made for each patient depending on the allergies, results in the patient
developing a greater allergen tolerance and decreases symptoms.

At Atlantic Ear, Nose & Throat, the makeup of the compound is determined by the results of an allergy skin test in which patients are exposed to 38 allergens specific to Central Florida. As with Lauri, it is often done in conjunction with a sinus dilation.

“The first thing we do is perform the sinus dilation,” Dr. Shah educates. “Then, once the obstruction has been removed, the allergy drops are used to desensitize the patient so they no longer need allergy treatment of any kind.”

The sinus dilation procedure has replaced a more invasive procedure typically performed in an operating room with the patient under general anesthesia. That traditional procedure also required a few days of downtime for recovery.

The balloon procedure is performed using a local anesthetic that allows the patient to remain awake throughout the process, carries far less risk than traditional surgery and allows for a speedier recovery.

“We start by giving the patient a Valium and some pain medication to relax them a bit,” Dr. Shah informs. “Then the local anesthetic is administered. Once that has taken effect, we find the opening of the sinuses and gently insert a deflated balloon.

“There’s a bone that surrounds the opening of the sinus, and once the balloon is in the right spot, we slowly inflate it with water. As the balloon is inflated, it gently shifts that bone over and enlarges the opening. Shifting that bone is what keeps the sinus open, because the balloon actually changes the shape of the opening. It’s not as though you’re moving soft tissue that is going to flop back, so the procedure works very well.

“Another one of the great things about this procedure is that there’s hardly any bleeding involved, and there’s no bruising or packing of the nose afterward. Patients are able to go back to their normal activities the next day.”

“Works Wonderfully”

Lauri’s balloon sinus dilation was done on a Friday in September 2019, and she felt good enough to go back to work the following Monday. A couple of weeks later, she began the sublingual immunotherapy.

“I started taking the allergy drops in October 2019, and I haven’t been sick since,” she reports. “I haven’t had any respiratory issues. I haven’t needed an antibiotic or even had a reason to go back to the clinic at the drug store since beginning the drops.”

Lauri marvels in her “absolutely amazing” treatment outcome. Her hope is that she can stop her immunotherapy in a few years but notes that obtaining her compound every few months is “so convenient and works wonderfully.”

“Thanks to Dr. Shah, I’m living my life again, and I feel great,” she professes. “That’s why I gladly recommended Dr. Shah to anyone suffering the way I was. And I’ll tell you, if I had to, I’d have it done again – by Dr. Shah. He is so gentle that I was able to walk in and walk out after that procedure without any problems.”

©FHCN article by Roy Cummings. Photo by Jordan Pysz. js
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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

    • 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

    • 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