Immunotherapy for Allergies: Allergy Shots vs. Sublingual Tablets Explained

When your allergies turn spring into a nightmare-sneezing nonstop, eyes watering, nose clogged-you’ve probably tried antihistamines, nasal sprays, and air filters. But what if there’s a way to stop the reaction at its source? That’s where immunotherapy comes in. Unlike medications that just mask symptoms, immunotherapy trains your immune system to stop overreacting to allergens like pollen, dust mites, or bee venom. It’s not a quick fix. It’s a multi-year commitment. But for many, it’s the only thing that brings real, lasting relief.

How Immunotherapy Actually Works

Immunotherapy doesn’t suppress your immune system-it reprograms it. Think of it like a vaccine, but for allergies. You’re exposed to tiny, controlled amounts of the things you’re allergic to. Over time, your body learns these aren’t threats. Instead of releasing histamine and causing inflammation, your immune system starts producing blocking antibodies. These antibodies act like shields, stopping allergens from triggering a full-blown reaction.

This isn’t new. The first allergy shots were given in London in 1911. Since then, science has refined the process, but the core idea stays the same: gradual exposure leads to tolerance. The goal? To reduce or even eliminate symptoms so you don’t need daily meds. Studies show that after 3 to 5 years of treatment, up to 85% of patients see major improvements. Some stay symptom-free for years after stopping treatment.

Allergy Shots: The Gold Standard

Allergy shots, or subcutaneous immunotherapy (SCIT), are still the most effective option. They’re custom-made for you. Your allergist tests you for sensitivities-maybe to ragweed, grass, dust mites, and cat dander-and creates a unique vial with those exact allergens. Each shot contains a tiny amount of each one. Over time, the dose increases.

The process has two phases. First, the build-up phase. You get shots once or twice a week for several months. This can take 3 to 12 months depending on your schedule. Then comes maintenance: you switch to monthly shots for 3 to 5 years. Each visit requires a 30-minute wait after the shot to watch for reactions. It’s inconvenient, yes. But the results? Powerful.

Why? Because allergy shots can handle multiple allergens at once. Most people are allergic to more than one thing. Research shows 78% of allergy sufferers react to three or more allergens. Shots can cover all of them in one vial. A 2021 study found SCIT reduced symptoms by 82% in multi-allergen patients. That’s higher than any tablet can achieve.

Doctors at the Cleveland Clinic and National Jewish Health agree: if you have multiple allergies or severe symptoms, shots are the best bet. They’re also the only treatment proven to prevent new allergies from developing and to reduce the risk of asthma in kids with allergic rhinitis.

Sublingual Tablets: Convenience Without Compromise?

Sublingual immunotherapy (SLIT) tablets are the newer, easier option. You place a small tablet under your tongue every day. No needles. No clinic visits. You can do it while brushing your teeth or eating breakfast.

The FDA has approved four tablets so far: Oralair and Grastek for grass pollen, Ragwitek for ragweed, and Odactra for dust mites. In April 2024, Cat-PAD became the first tablet approved for cat dander. That’s progress. But here’s the catch: each tablet covers exactly one allergen. No combinations. No custom mixes.

If you’re allergic to grass and dust mites? You’d need two tablets. One in the morning. One at night. That’s two daily doses. Two different bottles. Two chances to forget. And even then, you’re only treating two of the allergens you might react to.

Studies show SLIT tablets reduce symptoms by about 67% in single-allergen cases. That’s good-but not as good as shots. A 2022 patient survey found 58% of tablet users reported limited effectiveness, especially if they had multiple allergies. On Reddit, users who tried both often say shots worked better. One wrote: “After two years of Grastek with only 30% improvement, I switched to shots and got 80% relief by year two.”

But convenience matters. In the same survey, 92% of tablet users said they preferred it over weekly shots. For busy parents, travelers, or people without easy access to an allergist, that’s huge. Tablets also have fewer serious side effects. The most common? A tingling or itching under the tongue. Rarely, swelling or stomach upset. Severe reactions are extremely rare.

Which One Is Right for You?

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

• Choose allergy shots if: You’re allergic to three or more allergens, your symptoms are severe, you want the strongest possible effect, or you’re trying to prevent asthma. You’re willing to commit to weekly visits for months, then monthly for years.
• Choose sublingual tablets if: You’re allergic to just one or two allergens (like grass or dust mites), you travel often, you hate needles, or you can’t find a clinic nearby. You’re okay with daily pills and slightly less dramatic results.

There’s also a middle ground: cluster immunotherapy. Instead of spreading build-up over months, you get several shots in one day, over 4 to 10 visits. This cuts the build-up phase from 6 months to under 2 months. It’s becoming more common-74% of clinics now offer it. It’s still shots, but faster.

Rush immunotherapy is another option-for people with life-threatening insect sting allergies. You get multiple doses in one 8-hour session. It’s intense. It carries higher risk. But for those who’ve been stung and nearly died, it’s worth it.

What to Expect During Treatment

With shots, you’ll need to plan your week. You can’t skip appointments. If you miss one, you might need to repeat the last dose. Side effects are usually mild: redness, swelling at the injection site. About 2% of people have a systemic reaction-hives, trouble breathing. That’s why you wait 30 minutes after every shot. Clinics are equipped to handle it.

With tablets, you take one daily. The first dose must be taken in a doctor’s office, just in case. After that, it’s home-based. You’ll feel a tingling under your tongue for the first few days. That’s normal. If you get swelling in your throat, trouble breathing, or vomiting, stop the tablet and call your doctor. That’s rare, but serious.

Adherence is everything with tablets. If you miss more than 20% of doses, the treatment fails. A 2021 trial showed effectiveness dropped to 45% in low-adherence patients. Set phone reminders. Keep tablets in your pill organizer. Don’t skip days.

Cost, Access, and Future Trends

Insurance usually covers both shots and tablets. But shots often cost more upfront because of clinic visits. Tablets are pricier per month, but you pay less for office time. In the U.S., shots make up 68% of the immunotherapy market. Tablets are growing fast-up to 27% now.

Access is still a problem. There are only about 5,300 board-certified allergists in the U.S. Many rural areas have none. That’s why tablets are gaining ground-even if they’re less effective for complex cases.

The future? Multi-allergen tablets are in Phase 3 trials. If approved by 2025, they could change everything. So could peptide-based therapies, which might shorten treatment from 5 years to 2. Doctors are also using component-resolved diagnostics to match allergens more precisely, making treatments smarter.

For now, the choice comes down to your life, your allergies, and your priorities. Shots are the strongest tool. Tablets are the easiest. Neither is perfect. But both are better than just living with sneezing every spring.

Is Immunotherapy Worth It?

Let’s say you spend $500 a year on allergy meds. That’s $2,500 over five years. Add up missed workdays, ruined weekends, sleepless nights. Now imagine cutting those symptoms by 80%. You’re not just saving money-you’re getting your life back.

People who stick with immunotherapy often say the same thing: “I wish I’d started sooner.”

Next Steps

If you’re tired of living with allergies, talk to an allergist. Ask about testing to find out exactly what you’re allergic to. Then ask about both options-shots and tablets. Don’t assume one is better just because it’s newer or easier. Your allergies are unique. Your treatment should be too.

Start with a consultation. Bring your symptom history. List what triggers you. Ask about cluster build-up if you want to speed things up. And don’t be afraid to ask about cost, insurance, and what happens if you miss a dose. The right treatment can turn your worst season into your easiest one.