Allergy immunotherapy gradually builds a person’s tolerance to specific allergens by exposing the patient to ever-increasing doses over a period of time – eventually reducing or eliminating symptoms. Allergy shots are the most familiar form in the U.S., but physicians and researchers have been testing under-the-tongue immunotherapy (sublingual, or SLIT) using tablets or drops, therapy already adopted for use in Europe and Canada.
The three tablets recently approved by the U.S. Food and Drug Administration (FDA) are Grastek® (Timothy Grass Allergen Extract) approved for ages 5-65; Oralair® (Sweet Vernal, Orchard, Perennial Rye, Timothy and Kentucky Blue Grass Mixed Pollens Allergenic Extract) for ages 10-65; and Ragwitek™ (Short Ragweed Pollen Allergen Extract) for ages 18-65.
“This is an important development in allergy treatment,” says Florida allergist Linda Cox, MD, past-president of the American Academy of Allergy, Asthma & Immunology (AAAAI), “because it may make this disease-modifying therapy more accessible to grass- or ragweed-allergic patients who currently may only be taking medications that control symptoms but do not treat the underlying cause.”
Instead of going to a doctor’s office for allergy shots, patients can take the grass tablets at home or when travelling. Beginning 3-4 months before the start of your allergy season and continuing throughout, you take one tablet a day, placing it under your tongue and letting it dissolve for a couple of minutes, before swallowing. If successful, the tablets will reduce your allergy symptoms and need for medications.
A limitation of the newly approved tablets is that each brand treats just one class of allergen, while allergy shots usually treat multiple allergies at the same time. That means the tablets may be less practical for those allergic to numerous seasonal or year-round allergens.
None of the tablets are indicated for patients with severe, unstable or uncontrolled asthma, and each carries a safety warning about possible severe allergic reactions, recommending patients carry and know how to use auto-injectable epinephrine in case of anaphylaxis.
“These first tablets are not going to be appropriate for everyone,” says Dr. Cox, “but they do offer hope for the future. Seasonal allergies cause a great deal of disruption in people’s lives, from missed work or school days to just overall misery. People looking for long-term solutions should talk with a board-certified allergist about available options.”
Another form of sublingual immunotherapy in development uses drops of liquid allergens. As with the tablets, you hold the drops under your tongue for a couple of minutes, then swallow. Concentrated allergen extracts for drop therapy have not been approved yet in the U.S., but some physicians are taking extracts manufactured and approved for allergy shots and using them as drops instead.
This experimental off-label use is not usually reimbursed by insurance companies. If you are receiving drop therapy with insurance coverage, it could be fraud. Check your medical billing to confirm accuracy.
— By Laurie Ross
Reviewed by William Berger, MD