Sublingual Immunotherapy is Coming to the United States

The FDA has recently approved the first formulations of Sublingual Immunotherapy in the United States.  Currently approved are two different formulations one for grass allergy and one for ragweed.  It is likely that a formulation to treat dust mite allergy will also be approved in a couple of years.  These come in the form of a dissolvable tablet that is placed under the tongue daily.  Similar to allergy shots, sublingual immunotherapy exposes patients to the substances which they are allergic to in a way to decrease their sensitivity over time.

Who would benefit from these Sublingual Immunotherapy Tablets?

These sublingual tablets will be a safe & convenient option for patients who are only allergic to grass, ragweed, or dust mite or for those patients who have one of these allergens as their major allergic trigger.  There is some risk for an allergic reaction to the tablets so it is recommended that the first dose be given in a medical facility with a 30 minute wait time afterwards.  The subsequent doses would be given at home, but it is recommended that patients have a self-injectable epinephrine device (EpiPen or AuviQ) available in case of a severe allergic reaction. To be effective, the doses must start 3 months before the pollen season.  If you have multiple allergies, like the majority of patients who seek medical care, this type of immunotherapy will only work on the specific allergen treated and is not known to be effective for other allergens. In addition, studies have not been done on patients with moderate or severe allergic asthma. Please keep in mind that it is uncommon for people to be mono allergic, meaning allergic to only one allergen. Most people, especially in the South, are poly allergic, allergic to multiple allergens.

What about allergy drops?

Some providers have offered allergy drops under the tongue in order to try to treat multiple, different allergies. These providers use the immunotherapy extracts that are approved for allergy shots and allow patients to use them by mouth. It is difficult to get high enough doses under the tongue with multiple allergens to be effective. Additionally, since these extracts are not FDA approved in the United States for oral use they generally are not covered by health insurance.

Who would benefit more from Subcutaneous Immunotherapy (Allergy Shots)?

In general, allergy shots will provide greater relief of allergies for most patients.  Unlike the tablets, allergy shots canbe tailored to a specific patient’s allergies.  Allergy shots can include effective doses to most or all of the different substances to which a patient is allergic in order to desensitize them to each allergen (i.e. animal dander, pollens, dust mites, mold, etc.).  Allergy shots can provide long lasting relief of allergies, reduce development of new allergic sensitivity and potentially reduce the development of asthma with decreased need for medications.  After a course of immunotherapy patients can come off shots with ongoing relief.

It is important to see a Board Certified Allergist/Immunologist (a recognized subspecialty of both Internal Medicine and Pediatrics) when making your allergy and asthma healthcare decisions. Allergist/ Immunologists are trained in interpretation of laboratory and skin tests, know the effective allergen doses required and which can be combined together safely.