Immunotherapy for Allergies: Allergy Shots vs. Sublingual Tablets Explained

What Is Immunotherapy for Allergies?

Immunotherapy doesn’t just mask your allergy symptoms-it changes how your body reacts to allergens altogether. Instead of reaching for antihistamines every spring, this treatment trains your immune system to stop overreacting to things like pollen, dust mites, or bee venom. It’s not a quick fix. It’s a long-term plan that can reduce or even eliminate your need for daily meds after 3 to 5 years.

Think of it like a vaccine, but for allergies. You’re exposed to tiny, controlled amounts of the thing you’re allergic to, and over time, your body learns it’s not a threat. This process is called desensitization. The two main ways to do this are allergy shots (subcutaneous immunotherapy) and sublingual tablets-both approved by the FDA and backed by decades of research.

Allergy Shots: The Gold Standard

Allergy shots have been around since 1911, and they’re still the most effective option for most people. They’re customized to your specific allergies. If you react to grass, ragweed, dust mites, and cat dander, your doctor can mix all four into one vial. That’s important because 78% of allergy sufferers are sensitive to more than one trigger.

The treatment happens in two phases. First, the build-up phase: you get a shot once or twice a week for 3 to 12 months. The dose slowly increases until you reach the maintenance level. Then, you switch to monthly shots for 3 to 5 years. Each visit takes about 30 minutes, including a required observation period after the injection to watch for reactions.

According to the American College of Allergy, Asthma & Immunology, 85% of patients see major symptom improvement after three years. Some report being able to stop all other allergy meds. A 2021 study in the Annals of Allergy, Asthma & Immunology found allergy shots reduced symptom scores by 82%, compared to 67% for tablets. That difference matters when you’re dealing with asthma or severe seasonal reactions.

Sublingual Tablets: Convenience Over Coverage

Sublingual tablets are placed under the tongue and dissolved daily. They’re easier. No needles. No clinic visits. You can take them at home, on your commute, or while brushing your teeth. But there’s a catch: each tablet targets only one allergen.

As of 2025, the FDA has approved four tablets:

• Oralair - for five types of grass pollen
• Grastek - for Timothy grass
• Ragwitek - for ragweed
• Odactra - for house dust mites

There’s no combo tablet. If you’re allergic to both ragweed and dust mites, you’d need two separate pills. That’s why many allergists say tablets work best for people with just one major trigger.

Studies show tablets reduce symptoms by about 67%-less than shots. But for someone who hates needles or lives far from an allergist, that 67% might be life-changing. In a 2022 patient survey, 92% preferred tablets for convenience. One user on Reddit said, “I took Grastek for two years. My sneezing cut in half. I didn’t need nasal spray anymore.”

Which One Is Right for You?

There’s no one-size-fits-all answer. It comes down to your allergies, your lifestyle, and your goals.

If you have:

• Multiple allergies - go with shots. Tablets can’t cover them all.
• Severe symptoms or asthma - shots are stronger and proven to prevent worsening over time.
• A busy schedule or travel-heavy job - tablets win. No weekly appointments.
• Only one major trigger (like grass pollen) - tablets are a solid, low-effort option.

Also consider your tolerance for discomfort. Shots can cause swelling at the injection site (about 8.5% of patients). Rarely, they trigger full-body reactions (2.1% of cases). Tablets often cause mild mouth itching or throat irritation (28% of users), but serious reactions are extremely rare.

What About New Options?

Things are changing fast. In April 2024, the FDA approved the first tablet for cat dander allergy-Cat-PAD. That’s a big deal. For years, cat allergy sufferers had only shots as an option. Now, there’s a pill.

Researchers are also testing multi-allergen tablets in Phase 3 trials. If approved by 2026, they could combine grass, ragweed, and dust mite extracts into one daily pill. That would change everything.

Another exciting development is peptide-based immunotherapy. Early studies suggest it could cut treatment time from 3-5 years down to just 1-2. It’s still experimental, but it’s moving fast.

Practical Tips for Success

Whether you choose shots or tablets, sticking with the plan is everything. Miss doses? Your results drop. Skip shots? You reset the clock.

For allergy shots:

• Ask about cluster immunotherapy. Instead of 3-12 months of weekly visits, you can reach maintenance in 4-9 weeks with 8-10 office visits. Most clinics now offer it.
• Plan ahead. If you’re going on vacation, schedule your last shot before you leave. You can’t skip maintenance doses without losing progress.

For sublingual tablets:

• Set a daily phone alarm. One study showed reminders improved adherence by 37%.
• Don’t eat or drink for 5 minutes before or after taking the tablet. It needs direct contact with the mucous membrane.
• Keep a symptom journal. Track sneezing, congestion, eye itch. You’ll see improvement slowly-usually after 3-6 months.

Cost and Accessibility

Allergy shots cost between $1,500 and $3,500 total over 3-5 years, depending on your insurance. Most plans cover them because they’re proven to reduce ER visits and medication use.

Tablets are pricier upfront-$600 to $1,200 per year-but you pay less out-of-pocket if your insurance covers them. Some brands offer patient assistance programs.

Here’s the catch: you need to see an allergist to get either treatment. There are only about 5,300 board-certified allergists in the U.S., and many are concentrated in cities. If you live in a rural area, shots might not be practical. Tablets can be mailed to you, making them more accessible.

What Experts Say

Dr. David M. Lang from Cleveland Clinic calls allergy shots “the only treatment that modifies the underlying immune response.” He’s right. Shots don’t just help you feel better-they can stop you from developing new allergies or asthma.

But experts also acknowledge tablets have a place. Dr. Robert E. Wood at Johns Hopkins says, “For patients who can’t tolerate shots or can’t get to an allergist, tablets are a meaningful alternative.”

The biggest complaint? Tablets can’t handle multiple allergies. Dr. Richard F. Lockey put it bluntly: “Requiring separate tablets for each allergen makes comprehensive treatment impractical for most patients.”

Real Patient Stories

On Reddit’s r/Allergies, a user named “AllergyWarrior42” shared: “After two years of Grastek with only 30% improvement, I switched to shots. By year two, my symptoms dropped 80%. I haven’t used a nasal spray in 18 months.”

Another user, a traveling sales rep, said: “I used to miss work every June because of ragweed. Now I take my tablet in the car on the way to meetings. It’s not perfect, but it’s the only thing that lets me keep my job.”

One common theme? People who stick with shots for the full 3-5 years rarely regret it. People who quit tablets early often say, “I didn’t see results, so I stopped.” But results take time.

What Happens If You Quit Early?

Immunotherapy only works if you finish. Stopping after one year means you lose almost all benefit. The immune system needs that full 3-5 years to retrain.

Some people feel better after 1-2 years and think they’re cured. They stop. Then, the next season hits-and their symptoms come back worse than before.

That’s why allergists stress: this isn’t a treatment you start and stop. It’s a commitment. But for many, it’s the only path to true freedom from allergies.

Final Thoughts

Allergy shots are the most powerful tool we have to rewire your immune system. They work for multiple allergies, prevent new ones, and offer long-term relief. But they demand time, consistency, and access to a clinic.

Sublingual tablets are simpler. They’re perfect for single-allergen sufferers who want to avoid needles. But they’re not a magic bullet-and they won’t help if you’re allergic to five things.

There’s no shame in choosing either. The goal isn’t to pick the ‘best’ option-it’s to pick the one you can stick with. And if you’re unsure, talk to an allergist. Bring your symptom history. Ask about cluster shots. Ask if a tablet covers your specific trigger. Don’t settle for just managing symptoms. You deserve to live without them.