What can be done for people who have a difficult time upping allergy shot dose due to local reaction?lower dose? repeat 1 dose often?sublingual drops?

Depends: At least 2 studies showed that lowering the dose due to local reaction actually leads to more reactions. On the other hand, one must balance the discomfort against the potential gains. I would ask the patient to take an antihistamine about 2 hrs prior to see if this helps. The next question is whether the dose should be raised any further if there has been sufficient improvement.