Immunotherapy vs. Over-the-Counter (OTC) Allergy Medications: Which is Right for You?

Whether you have seasonal allergies, sensitivities to pet dander, or a similar allergy, finding an effective treatment can be a game-changer. In general, you have two options: over-the-counter (OTC) allergy medications and allergy immunotherapy. 

OTC meds offer short-term symptom relief that kicks in fast, while allergy immunotherapy offers long-term relief that takes longer to take effect. Both have merits, so you may find that one is better suited to your needs. Here’s what you need to know. 

Understanding Allergy Immunotherapy

Allergy immunotherapy, commonly referred to as allergy shots or allergy drops, is a medical treatment designed to reduce sensitivity to allergens over time. It works by gradually exposing the immune system to control doses of allergens, which helps it build an allergen-specific tolerance.

This treatment requires a more extended time commitment, usually 3 to 5 years, but it can lead to long-term relief and may even reduce the risk of developing new allergies. For some, this treatment can dramatically reduce symptoms and may even lead to no symptoms at all when exposed to the allergen. Of course, everybody is different, so results can vary from one person to the next. 

Types of Allergy Immunotherapy

Two primary types of allergy immunotherapy: sublingual immunotherapy and subcutaneous immunotherapy. 

The first, called sublingual immunotherapy, is administered under the tongue via tablets or drops. It’s often called allergy drops or allergy tablets. These tablets and drops are ultra-convenient and can be administered at home without the need for medical supervision to administer each dose.

The second type, called subcutaneous immunotherapy, is administered under the skin via an injection. This type presents a higher risk of an adverse reaction, so you’ll need to visit your doctor or allergist for each injection. They’ll keep you after each dose for monitoring, just to make sure that you don’t have an adverse reaction, although rare.

The Science Behind Allergy Immunotherapy

Allergy immunotherapy, while it might be new to you, is nothing new on the allergy scene. It has been around for over a hundred years, originally introduced in 1911 by Leonard Noon and John Freeman as allergen desensitization or hyposensitization.

 Since its introduction, it has been studied in depth by countless researchers and healthcare professionals. These studies have produced extensive documentation showcasing the efficacy of allergy immunotherapy as a whole.

For example, a handful of research and clinical trials evaluated the efficiency of repeated subcutaneous injections in achieving an allergen-specific tolerance that offers clinical benefits, even for years after discontinuation. This particular set of trials found that these injections could, indeed, achieve that allergen-specific tolerance.

Another study done in Europe examined AIT-treated subjects compared to a control group. It found that the treated group was consistently associated with more significant reductions in allergic rhinitis and asthma prescriptions than the control group. It also found that the treated group had a higher chance of stepping down asthma treatment. 

Over-the-Counter Allergy Medications: Explained

 OTC allergy medications, such as antihistamines, decongestants, and corticosteroids, are widely available and provide fast relief for common allergy symptoms like sneezing, itching, and congestion. These medications come in various forms, including tablets, nasal sprays, and eye drops. They work by blocking histamines (the chemicals responsible for allergic reactions) or reducing inflammation in the nasal passage. 

Here are the basics of how each common medication works:

• Antihistamines: These medications block histamines to prevent symptoms like itching, sneezing, and runny nose. Common examples include loratadine (Claritin) and cetirizine (Zyrtec).
• Decongestants: Decongestants reduce nasal congestion by constructing the blood vessels in your nasal passages. Examples include pseudoephedrine (Sudafed) and nasal sprays like oxymetazoline (Afrin). 
• Corticosteroids: Nasal sprays such as fluticasone (Flonase) reduce inflammation and are particularly effective for chronic nasal symptoms. 

These medications can be highly effective in providing immediate relief from allergy symptoms. Unfortunately, the effects don’t last long. For the most part, these medications offer between 24 and 72 hours of allergy relief before the symptoms return. This means that in order to preserve the effects of the medication, you’ll continue to have to take it. 

AIT vs. OTC Allergy Medications: How They Compare

While both are designed to help with allergies, allergy immunotherapy and over-the-counter medications aren’t the same. Here are a few things to consider. 

Cost

Cost is an important consideration. Over-the-counter medications are generally cheaper, but the cost adds up over time,  especially if you experience chronic allergies. 

Immunotherapy requires a significant initial investment, especially for subcutaneous immunotherapy, which involves regular clinic visits. While insurance may cover a significant portion of these costs, out-of-pocket expenses can still add up.

Sublingual immunotherapy, on the other hand, is not always covered by Insurance in the US, so patients may need to pay for it entirely out of pocket. However, these treatment programs tend to be more affordable than subcutaneous immunotherapy, so costs tend to be manageable. 

Side Effects and Safety Considerations

The side effects and safety considerations are a big thing to think about when debating between allergy immunotherapy and OTC medications. Both are generally considered safe when used as directed by a doctor.

However, OTC medications can have a handful of side effects. For example, antihistamines may make you feel drowsy, have a dry mouth, or become dizzy. Decongestants may lead to increased blood pressure, nervousness, and rebound congestion, especially when used for extended periods. Corticosteroids are generally safe but may cause dryness or irritation in the nasal passages over time. 

Of course, immunotherapy, too, can present side effects. Subcutaneous immunotherapy can cause localized swelling or redness at the injection site, while sublingual immunotherapy might cause mild mouth itching or irritation. In rare cases, severe reactions can occur with allergy shots, causing anaphylaxis, so patients are usually observed for a short period after injections. Sublingual immunotherapy presents little risk of these aggressive side effects, so they’re considered safe for home use. 

Effectiveness and Long-Term Relief

In terms of efficacy and long-term relief, over-the-counter medications and allergy immunotherapy are quite different. 

Over-the-counter medications are effective for providing immediate relief for allergy symptoms, with most providing relief within 30 minutes to an hour. However, the effects are short-lived, typically only lasting 24 to 72 hours, depending on the medication type. Regular use is necessary for chronic allergy sufferers, and over time, some may find that their symptoms aren’t fully controlled.

Immunotherapy, on the other hand, takes longer to take effect. However, once it does, it can provide long-term relief from allergy symptoms. Many studies show that after 3 to 5 years of consistent treatment, many patients experience significant symptom reduction even after discontinuing immunotherapy. For some, the benefits may last a decade or more, providing a more permanent solution compared to daily medications.

The Verdict: Is Allergy Immunotherapy Better Than Over-the-Counter Medications?

Allergy immunotherapy isn’t inherently better than OTC medications, nor vice versa. Choosing between the two largely depends on the severity and frequency of your allergy symptoms, as well as personal preferences and lifestyle. 

OTC medications offer convenient, quick relief for milder seasonal allergies but require ongoing use. Immunotherapy, on the other hand, involves a longer commitment but addresses the underlying causes of allergies, providing lasting relief.

Ultimately, it depends on you. If you’re unsure which is right for your needs, chat with your healthcare provider. They can help you determine which treatment best suits your needs based on your medical history.