Immunotherapy for Allergies: Allergy Shots vs. Sublingual Tablets Explained

If you’ve spent years sneezing through spring, coughing from dust mites, or panicking after a bee sting, you know that antihistamines only give you temporary relief. What if you could actually change how your body reacts to allergens - not just mask the symptoms? That’s what immunotherapy does. It’s not a quick fix. It’s a long-term plan that retrains your immune system to stop overreacting to things like pollen, dust, or pet dander. And for many people, it’s the only treatment that offers real, lasting relief.

How Immunotherapy Works

Immunotherapy doesn’t just treat allergies - it changes them. The idea is simple: expose your body to tiny, controlled amounts of the allergen you’re sensitive to, then slowly increase the dose. Over time, your immune system learns not to treat it like a threat. Instead of releasing histamine and causing sneezing, itching, or wheezing, it starts to ignore the substance. This shift happens because your body begins producing special antibodies called IgG4, which block the allergic response. It’s like teaching your body to be less afraid.

This approach isn’t new. It was first used in London in 1911 by two doctors treating hay fever. Today, it’s backed by decades of research and is the only allergy treatment proven to alter the disease course. Studies show that after 3-5 years of treatment, many patients see their symptoms cut in half - and some never need medication again. Even better, immunotherapy can reduce the chance of developing new allergies or asthma later on.

Allergy Shots: The Gold Standard

Allergy shots, or subcutaneous immunotherapy (SCIT), are still the most effective option for most people. They involve injections under the skin, usually in the upper arm. You start with very low doses and gradually increase them over weeks or months until you reach a maintenance dose. Once you’re there, you get shots less frequently - often once a month.

The big advantage? Customization. Your allergist can mix multiple allergens into one vial - grass, ragweed, dust mites, cat dander - all in a single shot. That’s critical because 78% of allergy sufferers react to more than one trigger. A 2021 study found allergy shots reduced symptoms by 82% in multi-allergen patients, compared to just 67% for tablets.

There are three ways to build up to the maintenance dose:

• Traditional build-up: Weekly shots for 3-12 months. Low risk of reactions, but time-consuming.
• Cluster build-up: 8-10 visits over 4-9 weeks. Faster, with slightly higher but still safe reaction rates.
• Rush immunotherapy: One long day of multiple shots. Reserved for serious cases like venom allergies.

After reaching maintenance, you continue for 3-5 years. Most people notice improvement within 6-12 months. By year 3, many are off their inhalers, nasal sprays, and antihistamines entirely. The American Academy of Allergy, Asthma & Immunology calls it the only treatment that modifies the immune system itself.

Sublingual Tablets: Convenience Without Compromise?

Sublingual immunotherapy (SLIT) tablets are a newer option. You place a small tablet under your tongue and let it dissolve. No needles. No office visits. Just daily doses at home.

The FDA has approved four tablets so far:

• Oralair: For grass pollen (taken 4 months before and during pollen season)
• Grastek: Also for grass pollen (daily year-round)
• Ragwitek: For ragweed (daily year-round)
• Odactra: For dust mites (daily year-round)

Each tablet targets only one allergen. That’s the catch. If you’re allergic to grass and dust mites, you’d need two tablets. If you’re allergic to three things? No option yet. And while tablets are convenient, they’re less effective for multi-allergen sufferers. A 2023 Reddit analysis of over 1,200 users found that 68% had better results with shots.

Side effects are milder - mostly itchy mouth or throat - but they can be annoying. About 28% of users report oral itching in clinical trials. And if you miss doses? Effectiveness drops sharply. One study showed adherence below 80% cut results in half the benefit.

Still, for people who travel often, have busy schedules, or hate needles, tablets are a game-changer. A 2022 survey found 92% of tablet users preferred them over shots - mostly because they could fit treatment into their daily routine without disrupting work or life.

Which One Is Right for You?

There’s no one-size-fits-all answer. Here’s how to decide:

• Choose allergy shots if: You’re allergic to three or more allergens, your symptoms are severe, you want the best possible results, and you can commit to regular visits.
• Choose sublingual tablets if: You’re allergic to just one thing (like grass or dust mites), you can’t make weekly appointments, and you’re okay with slightly less dramatic improvement.

Experts agree: if you have multiple allergies, shots are the clear winner. Dr. David M. Lang from Cleveland Clinic says, “Subcutaneous immunotherapy remains the most effective long-term treatment for allergic rhinitis.” But if convenience matters more than maximum efficacy, tablets are a valid alternative.

One thing both methods share: they require patience. You won’t see results overnight. It takes months. But for many, the payoff is worth it. One patient wrote in a Google review: “After two years of shots, I went from using three medications daily to none. I finally slept through the night.”

What to Expect During Treatment

If you choose shots, expect to spend time in a clinic. During build-up, you’ll need to stay for 30 minutes after each shot because of the small risk of an allergic reaction. That’s why 32% of patients drop out - they can’t fit it into their schedule. Cluster build-up helps: you can compress months of visits into a few weeks.

For tablets, you’ll need to be disciplined. Set a daily alarm. Don’t skip days. Avoid eating or drinking for five minutes after taking it. And if you feel swelling in your throat or trouble breathing, stop and call your doctor - rare, but possible.

Both treatments require follow-ups. Your allergist will track your progress and adjust your plan if needed. Most clinics now use digital tools to help you log symptoms and adherence.

Cost, Access, and the Future

Allergy shots are covered by most insurance plans, but you’ll still pay copays for each visit. Tablets are pricier upfront - often $200-$400 per month - but you don’t need to go to the doctor as often. Some insurers cover them only after you’ve tried other treatments.

Access is another issue. There are only about 5,300 board-certified allergists in the U.S. Many rural areas have none. That’s why tablets are growing fast - they don’t require a specialist nearby.

The future looks promising. In April 2024, the FDA approved a new tablet for cat dander. More multi-allergen tablets are in Phase 3 trials and could be available by 2026. Researchers are also testing peptide-based treatments that might shorten the course from 3-5 years to just 1-2.

For now, the choice comes down to your needs. If you want the strongest, most comprehensive treatment - and you’re willing to put in the time - shots are still the best option. If you need something simple, safe, and easy to stick with, tablets work well - as long as your allergies are limited to one or two triggers.

Either way, you’re not just treating symptoms. You’re changing your body’s relationship with allergens. And that’s something no pill can do.