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NLM Director’s Comments Transcript
Under-the-Tongue Allergy Drops?: 05/28/2013

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Greetings from the National Library of Medicine and

Regards to all our listeners!

I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.

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Under-the-tongue drops, currently not approved in the U.S., may provide a future, convenient, treatment alternative for seasonal allergies, pinkeye, and allergic asthma, suggests a systematic review of 63 studies recently published in the Journal of the American Medical Association.

The systematic review reports under-the-tongue allergy drops therapy led to a 40 percent or higher easing of chest tightness, coughing, and wheezing compared to a placebo for allergy patients in eight of 13 studies. The evidence from these studies also suggests under-the-tongue therapy drops (also known as sublingual immunotherapy) work best among children with allergies.

Similarly, the systematic review adds under-the-tongue drops allergy therapy led to a 40 percent or higher improvement in seasonal allergies, such as a stuffy nose and itchy eyes, compared to a placebo in nine out of 35 studies.

Comparing conditions, the systematic review suggests the evidence is more robust that under-the-tongue allergy drops therapy helps treat allergic asthma. There is modest evidence under-the-tongue allergy drops therapy eases seasonal allergies and pinkeye. The researchers report some of the side effects of under-the-tongue allergy drops include swelling of the lips and cheeks and occasional hives.

In under-the-tongue allergy therapy, a patient receives extracts of things such as ragweed, dust mites, and pollen in drops to build up one’s tolerance. Currently in the U.S., allergy patients can receive prescription, weekly shots given in a physician’s office or medical center. Although over-the-counter allergy medications are available widely in the U.S., the studies in the systematic review focused on patients who received prescription allergy therapy.

The study’s eight researchers assessed 63 studies with about 5,100 overall participants. Most of the research was conducted in Europe where prescription under-the-tongue allergy drops are approved for patient use.

While the systematic review’s eight authors emphasize under-the-tongue allergy drops have not been approved by the U.S. Food and Drug Administration (FDA), the authors explain some U.S. physicians legally use the drops ‘off label.’  

The systematic review’s authors estimate about 20 to 40 percent of Americans have allergies. While under-the-tongue drops may be more convenient than weekly allergy shots in a physician’s office, the studies assessed in the systematic review do not suggest which approach is more clinically efficacious.

An editorial that accompanies the study notes new research is needed to compare allergy drops to shots as well as assess other issues, such as determining a recommended dose of under-the-tongue allergy drops for different age groups, and routine treatment protocols. The editorial’s author adds future research needs to determine how long a patient needs to take under-the-tongue allergy drops in order to build a long-term tolerance.’s allergy health topic page explains allergies are a reaction of your immune system to things that may not bother other persons, such as pollen, dust mites, and pet dander.

Updated information about prescription allergy shots is provided by the American Academy of Family Physicians in the ‘treatment’ section of’s allergy health topic page. Information about allergy medications is provided by the Mayo Foundation for Medical Education and Research also within the ‘treatment’ section of’s allergy health topic page.’s allergy health topic page provides an array of information about allergy’s diagnosis/symptoms, treatment, prevention/screening, and alternative therapy.’s allergy health topic page contains links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to related clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. From the allergy health topic page, you can sign up to receive email updates with links to new information as it becomes available on MedlinePlus.

To find’s allergy health topic page, just type ‘allergy’ in the search box at the top of’s home page. Then, click on ‘allergy (National Library of Medicine).’ also has health topic pages devoted to hay fever, asthma, and pinkeye.

Overall, the systematic review’s findings may be promising to allergy patients, but existing research gaps need to be addressed before under-the-tongue drops become routine in the U.S. The clinical efficacy of allergy drops-versus-shots strikes us as a good candidate for comparative effectiveness research.

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