Dr. David Morris thought about studying engineering at Purdue University, but his parents hoped he would consider medicine.
His parents encouraged him to visit two distant cousins in California, both physicians. His Santa Barbara cousins took an interest in Morris. Morris attended Carroll College in his hometown of Waukesha, Wis., and entered the University of Wisconsin-Madison Medical School.
Morris said allergies and immunity fascinated him. His older brother was severely allergic to molds and had a type of asthma that causes chronic coughing. After completing his internship in Duluth, Minn., in 1955, Morris served two years as a United States Air Force flight surgeon. After that, he joined a private practice in West Salem, Wis.
Morris said many of his patients had farmer's lung problems caused by mold allergies. When Morris first started his Wednesday night allergy clinic, he offered patients a choice: shots or drops, also known as sublingual immunotherapy.
"After three years," said Morris, "no one was lining up for shots anymore."
Morris opened Allergy Associates in July 1970 in the Professional Arts Building across from St. Francis Hospital in La Crosse. He's still there today.
"We have treated more than 120,000 patients with sublingual immunotherapy, many in the La Crosse area and the Midwest," Morris said. "However, we have seen patients from all over the world. The average patient drives 200 miles each way to see us."
He said he has used sublingual immunotherapy more than any other American allergist and that his clinic is the world's largest sublingual clinic. He works with five other physicians, including his daughter, Dr. Mary Morris.
Morris talks about sublingual immunotherapy and the controversy over the treatment:
Q: What is sublingual or drop immunotherapy?
A: Sublingual allergy treatment involves giving small amounts of what the patient is allergic to (antigens) under the tongue to train the immune system to be less sensitive. Immunotherapy, whether given by shots or with drops under the tongue, helps treat the cause of allergic disease. Immunotherapy is the only treatment that changes the natural course of allergic disease. Symptom relief does occur with both immunotherapy and medications, but immunotherapy also retrains the immune system so eventually even without allergy shots or drops, the benefits remain.
Q: How does it work?
A: For people who have allergies, exposure to even small amounts of allergen such as grass and tree pollen or mold triggers an allergic reaction. This doesn't happen in nonallergic persons; their immune system tolerates or doesn't react to the allergens.
The area under the tongue has a highly developed mechanism that trains the immune system to tolerate things that go in the mouth, like food or, in this case, allergy drops. We use this mechanism with sublingual immunotherapy to train the immune system to tolerate an allergen.
The area under the tongue, or mucosa, has the highest concentration of immune cells, called dendritic cells, which have projections that sense antigens.
Here, the dendritic cells are professionals at presenting allergens to other immune cells that regulate the allergic response, called T-regulatory cells. When dendritic cells repeatedly present an allergen to T-regulatory cells in that context, the allergic response is suppressed and the immune system develops tolerance to that allergen. This tolerance to an allergen persists even after treatment stops. The allergic person now responds more like a nonallergic person when exposed to their allergens.
Q: What's in the drops?
A: The drops contain the same FDA-approved allergy extract used for skin testing or injection therapy. The allergy drops for each patient are based on that individual's specific allergy skin tests or blood tests. The amount of extract is linked to the patient's allergic sensitivity.
This ensures that the amount of allergen in the drops is always at a safe level. A severely allergic patient to dust-mite antigen is given less dust mite extract than someone with a mild allergy. As the allergy symptoms and skin tests improve, the amount of allergen in the drops is increased.
Q: What does the therapy treat well?
A: Sublingual immunotherapy works well for dust mite, pollen, molds and animal dander. The biggest advantage of sublingual immunotherapy is a superior safety profile when compared with allergy shots, which allows us to treat a broader set of patients including children and others with chronic conditions such as asthma, eczema or people with such strong allergies that they are not candidates for allergy shots. Because of the superior safety profile, drops can conveniently be taken at home. This also expands the benefits of immunotherapy to patients who would be unable to comply with the requirement that allergy shots need to be given in a doctor's office.
Food allergies such as peanut and tree nut allergy are also being extensively studied with sublingual immunotherapy because of the superior safety profile. In our clinic, we treat for common food allergies.
Q: Why has the therapy been so controversial?
A: Previously, the thought regarding the sublingual use of extracts was that the extracts when swallowed would be destroyed by stomach acid. With our new understanding of mucosal immunity, we now understand that the extracts are taken up by the dendritic cells in the mucosal surface (under the tongue) where they have their beneficial effect.
As new research has become available over the past 15 years, the science has shown the safety and effectiveness of this treatment. The controversy has definitely died down with the many double-blind placebo-controlled studies that have been completed. We have seen growing acceptance among physicians and scientists in recent years.
For more questions and answer with Dr. David Morris, click here.