The good news is the risk of anaphylactic shock with allergy drops is incredibly low. The literature cites that risk as 1/billion or 1/100 million which is thankfully very low. Indeed, in 30 years of using allergy drops there has never been a documented reaction that caused a death.

Like I do for all of my in office patients that also take at home allergy drops we always educate our patients thoroughly about the risks of treatment and the correct way to use it. We also use the same emergency plan for our patients as we have used in office.

Thankfully in the thousands of patients I, and most of my colleague physicians, have treated this has not been an issue.

I need a bit more clarification to

> .. risk of anaphylactic shock with allergy drops is incredibly low. The literature cites that risk as 1/billion or 1/100 million which is thankfully very low. Indeed, in 30 years of using allergy drops there has never been a documented reaction that caused a death.

Can you point me to the specific literature? The reason I am asking as the Asthma & Allergy Foundation of USA states 1 in 50 for anaphylaxis (not the allergy drops). That discrepancy is an incredibly large number. (https://www.aafa.org/anaphylaxis-in-america/)

Absolutely, one great paper that summarizes many of the studies is the Cochrane review. They are an independent scientific body focussed on evidence based medicine. You can read the Cochrane review article on sublingual immunotherapy here:

https://pubmed.ncbi.nlm.nih.gov/21154351/

Another paper discussing the safety of sublingual immunotherapy can be found here:

Sublingual allergen immunotherapy: mode of action and its relationship with the safety profile https://pubmed.ncbi.nlm.nih.gov/22150126/

That number is from the line "SLIT-induced anaphylaxis equate to around one case per 1000 million SLIT administrations or per 526,000 treatment years'.

Another nice review paper can be found here:

https://pubmed.ncbi.nlm.nih.gov/28964530/

Hope this helps!

Manan