NORTH SIOUX CITY -- For some people, grasses, trees, weeds, mold, dust mites and pet dander can cause severe upper and lower respiratory symptoms.
"These same things that we're allergic to in our nose can cause asthma, so a lot of people who have inhalant allergies, can have inhalant asthma to the same things that they're allergic to," explained Dr. Thomas Kenny, an otolaryngologist with Ear, Nose & Throat Consultants in Dakota Dunes.
Kenny said spring and fall are busy times at the clinic. He said trees begin to pollinate in the late winter or early spring, followed by grasses in late spring and weeds in late summer and early fall.
"We're pretty much barraged with pollen for six months, so we see a lot of people during that time," he said. "Wintertime, as all those pollens go away, we still have things like dust mites in our house or pet dander and mold year round that can be problematic, too."
Kenny said it's sometimes hard to tell whether a patient's symptoms are due to allergies, sinusitis or both, as the symptoms are similar. Runny nose, headache, sinus pain and pressure are common complaints. He said almost all of his patients have tried various over-the-counter antihistamines before seeking medical attention for persistent stuffiness, drainage, sneezing and facial pain.
"Are you treating allergies? Maybe you have a sinus infection, because it's hard to tell the difference sometimes," he said. "That's when we'll say, 'Let's go ahead and test and look for allergies and possibly do a CT scan and take a history.'"
For patients who do have inhalant allergies, Ear, Nose & Throat Consultants is offering a new treatment option: sublingual immunotherapy (SLIT). Like subcutaneous immunotherapy (SCIT) or allergy injections, patients get small doses of allergen to boost tolerance to the allergen and reduce symptoms. But, instead of having to come to the office for weekly injections, they place drops of allergen under their tongues in the comfort of their own homes.
"Sublingual therapy has gotten a little bit more scrutiny," said Kenny, who said insurance companies have been reluctant to cover SLIT.
SLIT and SCIT both stimulate the body's immune system to produce antibodies against allergens. According to Kenny, studies have shown that both therapies show the same rise of antibodies. After three to five years of either SLIT or SCIT therapy, patients may find lasting relief from their symptoms and be able to stop taking the drops or getting the shots.
"The sublingual's probably not robust initially, but it eventually is," Kenny said. "If you have an antibody response, your immunity is now your friend. It's going to help you take care of your own allergies."
Kenny said some of his patients are completely new to immunotherapy, while others have received SCIT, but decide to switch to SLIT because of the convenience it offers.
"You can give yourself sublingual at home. You can have anaphylaxis with subcutaneous, that's why we have to give shots and watch," he said. "With sublingual there's never been a reported incidence of anaphylaxis. It's super safe."
Even though few insurance companies cover SLIT, Kenny said some patients may find that they actually save money on SLIT versus SCIT. He said some patients' weekly copays for allergy shots are higher than the cost of buying a month's supply of sublingual immunotherapy allergy drops, which are specially made for each patient and cost between $60 and $120.
"We only put in there what they are allergic to," he said.
Patients administer five drops daily. The first vial, Kenny said, is less concentrated. The second vial, which patients get to in about a week, is fully concentrated. Side effects of SLIT include local irritation in the floor of the mouth, lymph node swelling under the chin, itchy or scratchy throat.
"If you were going to do subcutaneous immunotherapy, to get to that full concentration it could take you months, whereas with sublingual, it's so safe, you just give it to yourself," he said. "It's very well tolerated."
Kenny said patient response to SLIT has been positive. He said patients are pleased with the therapy's effectiveness, as well as its ease of use.
"We've had people, especially in this area, who used to drive to Wisconsin to get it," he said. "We may be the only one around here that does sublingual."