Sub-Lingual Desensitization Drops

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Sublingual provocation and neutralization

A modification of the Miller-Lee technique is to test substances under the tongue (sublingually). A food or other concentrate is placed under the tongue and the reactions noted. If the patient experiences a symptom, this is neutralized, as before, by serial dilutions. The dilution that switches off the symptom completely is taken as the end-point (Dickey, LD Sublingual Use of Allergenic Extracts (monograph) ed. H C King, Elsevier, New York, 1981).

There is no essential difference between this approach and using an injection, although naturally there are fewer parameters by which to judge reactions or the lack of them. Instead of being able to view a wheal, its size and characteristic, the clinician has only the patient’s subjective symptoms to rely upon, plus what he or she can observe objectively. Yet with practice it is possible to become quite adept at spotting subtle shifts in the patient’s mood or attitude, skin colour, etc. The neutralizing dose would be that which leads the patient to declare his or her symptoms ‘switched off’ and the clinician to note that whatever manifestations arose have disappeared again.

Obviously, subtle reactions may be missed. Well-masked allergens may not react at all. But the technique is especially suitable for children, many of whom don’t like injections and would not willingly sit for several hours tolerating intra-cutaneous needles every 10 minutes.