New Help for Allergy Sufferers: What is Sublingual Immunotherapy? – Part 1

If you suffer the misery of seasonal and other allergies, here is some good news you can use. A novel form of treatment may save you time—and the pain of allergy injections.

In April of 2014, the U.S. Food and Drug Administration (FDA) approved the first extract for use with sublingual immunotherapy (SLIT). How is SLIT different from regular allergy shots and what could this mean for you?

Are You Allergic?

Allergies occur when your immune system comes in contact with a substance it identifies as a harmful intruder. Most allergens are harmless, but allergic reactions can be serious, even deadly. Food, drinks, and the environment are common sources of allergens.

According to the Agency for Healthcare Research and Quality (AHRQ), between 20 and 40 percent of adults in North American suffer allergic rhinitis, or hay fever. Globally, allergic rhinitis affects about 400 million people. Allergic rhinitis is considered a risk factor for asthma, a chronic inflammatory condition of the lower airways. For children and adults, effective treatment of hay fever often reduces the severity of asthma.

There are a variety of common triggers for hay fever and asthma, including:

• Household allergens: Dust, mold, pet dander, and dust mites
• Situational substances: Air pollutants like tobacco smoke, off-gassing carpets, varnishes, cleaners, and other products
• Environmental allergens: Botanical allergens like pollen from grass, plants, and trees

Symptoms commonly associated with hay fever include:

• Itchy eyes, nose, or mouth
• Watering, red, or swollen eyes
• Head and ear pressure, often with pain
• Runny and congested nose, sneezing, and sinus pressure
• General malaise and fatigue

Each year, allergic rhinitis, and asthma have a significant impact on the health of those who suffer these symptoms, and those who care for them. Those burdens include:

• Reduced quality of life
• Lost productivity and work days
• Increased medical expenses, doctor, and emergency department visits
• Decreased learning ability
• Greater difficulty in social situations
• Higher incidence of sleep disorders

If you suffer allergies, understanding your treatment options is essential.

Allergy Management in the United States

In the United States, a prominent form of medical management of allergies, and allergic asthma, is subcutaneous immunotherapy (SCIT), or the injection of small doses of specific allergens under the skin of affected patients. Other types of treatment include:

• Identifying and avoiding allergens
• Making lifestyle changes to manage allergens
• Prescriptive use of antihistamines, decongestant, and nasal steroid sprays

Used in European countries for years, sublingual immunotherapy uses small doses of specific extracts to provoke an immune response in a patient. The word “sublingual,” simply refers to where the dosage is administered—under your tongue—where it painlessly dissolves.

While available in the United States as an off-label treatment prior to approval by the FDA, the acceptance of a sublingual allergen extract by that regulatory agency is a positive step for millions of allergy sufferers.

Understanding Sublingual Immunotherapy

Immunotherapy is a broad term used to describe stimulation of an immune response to manage or prevent a disease. When you receive an influenza (flu), or tetanus vaccination, you are triggering your immune system to more effectively fight invading germs.

The focus of allergy immunotherapy is the reduction of symptoms through the administration of small doses of allergens. As we discussed, two forms of allergen-specific immunotherapy (ASI) include SCIT and SLIT. Points about these treatments include the following:

• Both treatments are considered effective for allergic rhinitis and minor asthma. The management of these conditions reduces long-term use of medication, associated costs, and the potential worsening of symptoms.
• SCIT is administered through injection, usually in the upper arm. SLIT is given in tablet or droplet form under the tongue, where it dissolves.
• Injections may be administered weekly. Allergy drops are administered daily.
• Allergen-specific immunotherapy works by increasing the dosage, and your tolerance, to a specific allergen. Over time, a target or maintenance dose is reached. The time to reach that target dose is different for SCIT and SLIT. SCIT may take longer to reach the target dose than SLIT
• Subcutaneous injections are given in a physician’s office until the maintenance dose is reached. Allergy drops are administered the first time in a physician’s office, thereafter, they are taken at home.
• Currently, SLIT is not covered by most insurance providers. SCIT is commonly covered by health insurance.

Chronic and seasonal allergies are nothing to sneeze at. If you have questions about SCIT or SLIT, contact my office in New York or a qualified physician in your area.

Read More (Part 2)