Many St. Louisans with allergies sneeze their way through the seasons, often experiencing eye irritation, nasal discharge, congestion and sinus pain in addition. Daily medications may help with symptoms, but they aren’t always a sure bet. Dr. Joe Brunworth, who practices at SLUCare Otolaryngology West County in Creve Coeur, says allergy treatment is evolving to provide longer-lasting relief. One of the best options is sublingual immunotherapy (SI), a relatively new development that allows doctors to expand—and customize—the toolkit of available allergy therapies.
Brunworth notes that it’s important to offer personalized treatment because each patient’s allergy experience is different. Instead of treating symptoms, SI helps prevent them by modifying the body’s response to things like grasses, pollen and dust mites. The therapy is available in sweet-tasting drops that go under the tongue, making it easy for children and adults to stick to a regimen. It’s an especially attractive option for people who don’t relish the idea of allergy injections. (For some specific allergens, SI also is available as a dissolving tablet.)
According to Brunworth, doctors first perform traditional allergy testing to figure out which substances cause problems. The skin is inoculated with different allergens, and doctors note which ones produce a response. Then, the patient’s personalized immunotherapy drops are mixed. “They are made up of the particular components to which you are allergic, up to 15 at a time,” he says. “Your immune system recognizes the allergens and learns to tolerate them, so the next time you’re exposed, the body doesn’t have as severe a reaction. We begin by administering the drops in our office once a week for 12 weeks, and then some patients can continue them at home after training by an allergy nurse.”
Normally, when taking the drops at home, the patient is advised to use one drop on day one, two drops on day two, and so on until the first vial is empty. Then, the next vial is formulated to deliver a stronger dose, according to Brunworth. Once the drops are placed beneath the tongue, the patient holds them there for 2 minutes so they can be absorbed by the mucous membranes. “You shouldn’t eat or drink for 5 minutes or exercise for 2 hours after using the drops,” he says. “Physical activity can cause it to enter your circulation too quickly.” He adds that not everyone likes the idea of a daily regimen, so doctors work carefully with patients to create a treatment schedule that works well for them.
Some people stay on SI for several months, others for several years. It often has long-lasting effects, according to Brunworth. For example, a patient who undergoes therapy for two years may continue to see benefits for five; others even experience permanent relief. “The length of this period depends on people’s individual needs and responses,” he says. “The ideal patient is one who has good results and can stop taking other allergy medications.” He also points out that untreated allergies can have consequences other than discomfort. “They may lead to sinus infections or contribute to asthma problems,” he says. “If you are getting one or two sinus infections a year, you may be a good candidate for SI. If it’s four to six, you may need surgery or another form of treatment.”
He says mold and ragweed are among the most common late-summer and fall allergens, and year-round culprits include pet dander, dust and dust mites in the home. Many people with allergies experience a reaction when removing sweaters and coats from dusty closets at the beginning of winter. “The recent rains and flooding in St. Louis have brought problems for many allergy sufferers as well,” Brunworth says. “The moisture leaves behind mold that gets picked up by hot summer winds, and that makes the mold count rise.” When patients first come in complaining of allergies, SLUCare doctors often start conservatively with medicines like Allegra or Zyrtec and nasal steroids like fluticasone. They also may recommend using a neti pot to flush the nasal passages. “If these ideas don’t work well or the patient wants something more definitive, we likely will do allergy testing and see if SI is a good solution,” Brunworth says.
He adds that no matter what patients are allergic to, SLUCare physicians work closely with them to find out which substances cause trouble and which treatment program can help. “It’s a very customized process, and SLUCare is always at the forefront of new methods,” Brunworth notes. “We often see new patients with serious allergies who have tried everything else and are feeling frustrated about their lack of relief. We enjoy working with them to reach a solution.”
SLUCare Physician Group provides complete allergy care customized to the patient’s individual needs. Pictured on the section cover: Dr. Jastin Antisdel, clinical nurse Amy Marvin, Dr. Joe Brunworth, Dr. Joshua Hentzelman, allergy medical assistant Linda Sigler. For more information, call 314.977.6362 or visit slucare.edu/ent-allergy.
Cover design by Julie Streiler | Cover photos courtesy of SLUCare Physician Group
Pictured at top: Dr. Joe Brunworth explains sublingual immunotherapy.
