FDA-Cleared · Minimally Invasive

Allergy Immunotherapy: Treating the Cause, Not Just the Symptoms

Antihistamines and nasal sprays manage allergy symptoms. Immunotherapy — shots or sublingual drops — retrains the immune system so those symptoms happen less often, less severely, over years. We offer both, integrated with your ENT care.

Request an Allergy Evaluation

Take A quiz

Why immunotherapy is different from every other allergy treatment

Every other allergy treatment — antihistamines, nasal steroids, decongestants, eye drops — works by blocking or suppressing the symptoms you feel when your immune system encounters something it considers a threat. They are useful. They are also, for most patients, indefinite.

Allergy immunotherapy takes a different approach. Instead of muting the reaction, immuno therapy gradually retrains the immune system to stop reacting so strongly to the substances that bother you. Over months and years of controlled, escalating exposure, the immune system builds tolerance. Symptoms diminish. Medication use often decreases. In many patients, the benefit persists for yearsafter treatment ends.

There are two main forms: subcutaneous immunotherapy (SCIT) — traditional allergy shots — and sublingual immunotherapy (SLIT) — tablets or drops placed under the tongue. Both are effective. They differ in delivery, convenience, and specific indications.

Who benefits from immunotherapy

Immunotherapy is considered for patients with:

Persistent allergic rhinitis — the runny, itchy, congested, sneezing symptoms of environmental allergies.

Allergic conjunctivitis — itchy, watery eyes.

Allergic asthma — particularly when specific allergen triggers are identified.

Stinging insect allergy — venom immunotherapy, an important niche where immunotherapy can be lifesaving.

Medication-inadequate symptoms — patients who need daily medication just to function, or whose symptoms persist despite full medical management.

Sinus disease with a strong allergic component, where reducing allergic burden may improve chronic sinusitis or polyp trajectories.

Immunotherapy is not appropriate for food allergies (a separate, specialized treatment landscape) and is not first-line for every allergy patient. It requires a commitment of time and consistency.

SCIT — subcutaneous immunotherapy (traditional allergy shots)

Subcutaneous immunotherapy is the gold-standard, longest-established form of allergy immunotherapy

How it works. Small amounts of the specific allergens you are sensitive to — as identified by allergy testing — are injected under the skin, typically in the upper arm. The dose is gradually increased over several months (the build-up phase) until a maintenance dose is reached. Injections then continue on astable schedule (the maintenance phase) for several years.

Typical schedule:
‍

Build-up: injections one to two times per week for about three to six months.

Maintenance: injections every two to four weeks for three to five years.

What it treats. SCIT can be formulated to treat a broad mixture of allergens — trees, grasses, weeds, dust mites, mold, animal dander. This is often SCIT's biggest advantage over SLIT: broader coverage in asingle treatment plan.

Safety. Because SCIT injects allergen into the body, there is a small risk of systemic reactions, including anaphylaxis. This is why SCIT is administered in a medical office with observation afterward. Our staff is trained and equipped to manage reactions promptly.

Effectiveness. SCIT reliably reduces allergic rhinitis symptoms, reduces medication use, and — in many patients — produces sustained benefit for years after completion.

How we decide between SCIT and SLIT

The choice depends on:

What you're allergic to. Polyallergic patients often do better with SCIT for broader coverage. Patients whose main triggers align with an FDA-approved SLIT tablet may prefer that route.

Your schedule and preferences. SCIT requires regular office visits. SLIT is largely home-based after the first dose.

Prior treatment history. Patients who have reacted to injections may prefer SLIT.

Medical factors. Certain conditions may favor one route over the other.

We discuss both at your evaluation.

SLIT — sublingual immunotherapy

Sublingual immunotherapy delivers allergen under the tongue — either as an FDA-approved tablet for specific allergens or, in some practices, as liquid drops.

How it works. A dose of allergen is placed under the tongue and held for one to two minutes before swallowing. The oral mucosa is rich in tolerance-inducing immune cells that respond well to this route.

Typical schedule.

FDA-approved SLIT tablets are available for grass pollen, ragweed, dust mite, and (for pediatricpatients) house dust mite. The first dose is given in the office with observation; subsequent dosesare taken at home daily.

Duration is typically three to five years, similar to SCIT.

What it treats. FDA-approved SLIT tablets are single-allergen products. Broad polyallergen coveragetypically requires SCIT.

Safety. SLIT has a lower risk of systemic reactions than SCIT and can be taken at home after the initial inoffice dose. Local symptoms — itching under the tongue, mild throat irritation — are common but usually mild and self-limited.

Effectiveness. For the specific allergens that FDA-approved tablets cover, SLIT is effective and comparable to SCIT.

What the process looks like — from evaluation to maintenance

Step 1: Allergy testing

Skin testing (or in-vitro blood testing when skin testing is contraindicated) identifies which specific allergens are driving your symptoms. This is fundamental — immunotherapy targets the specific allergens you react to.

Step 2: Treatment plan

Based on testing and your clinical picture, we design a SCIT or SLIT plan tailored to your allergen profile.

Step 3: Build-up phase

For SCIT, weekly to biweekly injections in our office. For SLIT tablets, daily dosesat home after the first observed dose.

Step 4: Maintenance phase

Reduced-frequency injections (SCIT) or continued daily doses (SLIT) for the full course of treatment — typically three to five years.

Step 5: Follow-up

We monitor symptoms, adjust as needed, and coordinate with the rest of your care

Why an ENT-integrated approach matters

Most patients who need immunotherapy also have other ENT concerns — chronic sinusitis, nasal polyps, nasal obstruction, sleep symptoms, or all of the above. Allergy is rarely the whole story.

At Exhale, immunotherapy sits within a broader ENT plan. If you have a deviated septum contributing to obstruction, we treat it. If you have chronic sinusitis, we address it. If you have polyps, we manage them. Immunotherapy addresses the immune-response layer; the rest of our care addresses everything else.

This is different from a stand-alone allergy chain that treats immunotherapy in isolation. Neither approach is wrong — but for patients with layered ENT problems, integrated care often means fewer providers, more coherent decisions, and better outcomes.

Allergy Impact Assessment

See what allergies are really costing you — sleep, focus, and time.

This five-question assessment measures how much your allergies interfere with the things that matter: sleep, breathing, productivity at work or school, the activities you skip, and your overall frustration level. Each answer scores 0 to 4, for a total from 0 to 20. Higher scores mean allergies are meaningfully reducing your quality of life — and that symptom-by-symptom masking with over-the-counter medication may no longer be enough. Your physician uses the result to decide whether testing or immunotherapy is worth discussing.

✓

Evidence-Based

✓

1 Min Assessment

✓

Confidential

Frequently Asked Questions

How long until I feel better?

Most patients notice meaningful symptom reduction within the first year oftreatment. Full benefit typically develops over the second and third years.

Do I have to do it forever?

No. Standard treatment is three to five years. Many patients experience benefit that lasts for years after completing the course.

Is it painful?

SCIT injections are quick and use a small needle; discomfort is minimal for most patients. SLIT is taken orally with no needles at all.

Can I do SCIT and SLIT at the same time?

Generally, no. We select one route as your primary immunotherapy plan.

What if I miss doses?

For SCIT, missed injections may require dose adjustment; contact us if you miss a scheduled visit. For SLIT, occasional missed doses are usually fine, but consistent daily use is important.

Is it safe during pregnancy?

Maintenance-phase SCIT is generally considered safe to continue during pregnancy, but we do not typically start or escalate during pregnancy. We coordinate with your OB.

Is it covered by insurance?

Immunotherapy is often covered, though specifics vary by plan.

Can children receive immunotherapy?

Yes. Both SCIT and certain SLIT tablets are appropriate for pediatric patients under specific indications.

What if my allergies are seasonal only?

Immunotherapy can still be worth while for patients with severe seasonal allergies, particularly if symptoms significantly affect quality of life or if allergic asthma is present.

Will immunotherapy help my chronic sinusitis?

Reducing allergic burden often improves the trajectory of chronic rhinosinusitis, particularly when allergy is a significant contributor. It is one lever in a broader treatment plan.