Considering allergy shots for those troublesome allergies, but don’t have time? Before you decide to skip that appointment with your doctor, you should know about a promising new therapy for allergies, called sublingual immunotherapy. Several sublingual therapies have recently been approved by the FDA for use in patients with allergies to ragweed and to certain grasses related to timothy grass and bluegrass.
What is sublingual immunotherapy?
Sublingual immunotherapy is similar to allergy shots, in that it depends on the body forming a tolerance to very small quantities of an allergen being given as a medication. It only works for nasal allergies, not for food allergies or sensitivities like gluten intolerance. It is usually given for several months prior to, during, and after the allergy season. The best immunity is built up after at least 3-5 years of treatment.
Sublingual immunotherapy, or SLIT, is different from traditional allergy shots because it is given under the tongue. SLIT may be given “off label” as customized drops but the FDA has only approved two brands of tablets, which are placed under the tongue, where they dissolve. Typically, if the patient has no reactions to the first dose, it may be given daily at home, instead of weekly, at the office.
Whom should consider sublingual immunotherapy?
- People who have allergic rhinitis or conjunctivitis–that is, eye and nose symptoms only. SLIT does not work well for food allergies or eczema.
- People who have moderate to severe symptoms enough to consider allergy shots. If your symptoms are easily controlled with other medications such as pills, sprays, or eye drops, then the risk of anaphylaxis with SLIT is not worth the potential benefit.
- People who cannot tolerate regular allergy medications due to side effects.
- People who are allergic to relatively few allergens. To take SLIT, you should have already had allergy testing, either a blood test, patch test, or scratch test. People who are allergic to many allergens should probably stick with allergy shots because SLIT has only been approved for relatively few allergens.
- People who prefer to take their allergy medicine at home, and are comfortable giving themselves the Epipen if they have an unexpected anaphylactic reaction.
Who should not take sublingual immunotherapy?
- People with severe, unstable, or uncontrolled asthma. People who have less severe asthma should be aware that some preparations have not been studied in asthmatics or people taking controller medications for asthma. SLIT has been shown to be effective in asthmatics and may improve symptoms, but there is also a risk that an asthmatic might develop a severe exacerbation from SLIT. Doctors prefer to treat these patients in their offices, where they can be supervised and provided with emergency care if necessary.
- People who are taking beta blockers. These medications, commonly used for high blood pressure and migraine prevention, can make the Epipen ineffective if you have a severe reaction to the medication.
- People who are taking allergy shots should be aware that taking both shots and SLIT can increase the risk of any allergic reactions to both the injected and the sublingual medication.
- People who have difficulty remembering to take a medication every day may not find this therapy to be as effective as allergy shots given once weekly.
One month’s supply of Ragwitek is $220, but the manufacturer currently has a coupon for 50% of each month for 12 months.
The manufacturer has not publicized the cost of Oralair, though it is likely to be similar to Ragwitek.
Like most new drugs, neither therapy is currently covered by health insurance companies, but it is likely that the therapies will be covered either later in 2014 or in 2015 for some insurances.
Paladin Labs, Inc. Oralair: Prescriber and Pharmacist Guide. Quebec, Canada: Paladin Labs, 2014. Paladin Labs, Inc. Paladin Labs, Inc. Web. 1 May 2014.
“RAGWITEK® Available.” What Is RAGWITEK® (Short Ragweed Pollen Allergen Extract)? Merck, Sharpe, and Dohme, Corp, n.d. Web. 29 Apr. 2014.
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