As seasonal allergies return, more people finding relief under the tongue

Nearly three-quarters of allergists are prescribing under-the-tongue tablets, according to new research.

The study, published in Annals of Allergy, Asthma and Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI), shows that most U.S. allergists now prescribe immunotherapy tablets for some patients to treat certain allergies. The study was developed by the organization's Immunotherapy and Diagnostics Committee.

"Five years ago, allergy tablets hadn't been approved by the FDA and weren't being prescribed for people with allergies in the U.S.," said Dr. Anita Sivam, an allergist, ACAAI member and lead author of the study. "Allergists were prescribing allergy shots because they were, and continue to be, a proven effective treatment. Once allergy tablets were approved in 2014, allergists began prescribing them for their patients. Of the 268 U.S. allergists who responded to our survey in 2018, 197 (73 percent) reported prescribing allergy tablets."

Allergy shots have been available for more than 100 years. The tablets, a sublingual immunotherapy, have been used in the United States for about five years as an alternative way to treat allergies without injections. An allergist gives a patient small doses of an allergen under the tongue to boost tolerance to the substance and reduce symptoms.

According to the ACAAI, four FDA-approved tablets are available to treat allergies to northern grass pollens, Timothy grass pollen, ragweed and the house dust mite. The two grass pollen allergy tablets are Oralair (Stallergenes-Greer), which has five kinds of northern grass pollen, and Grastek (ALK Inc.), which has timothy grass pollen. The short ragweed allergy tablet is called Ragwitek (ALK Inc.) and the dust mite tablet is called Odactra (ALK Inc.).

The northern grass pollens and the Timothy grass pollen tablets are both approved down to age 5 years and the other two for those 18 years and older. The tablets differ from allergy shots because after the first dose is given in an allergist's office, they can be taken at home. The tablets are placed under the tongue and dissolve.

In immunotherapy, the regular administration of the allergen doses causes the immune system to become less sensitive to the allergen. Reducing a patient's sensitivity reduces allergy symptoms.

"One of the big differences between shots and tablets is that shots are formulated by your allergist to treat your specific allergy or allergies," says Dr. Mike Tankersley, an allergist, vice-chair of the ACAAI Immunotherapy and Diagnostics Committee and co-author of the study. "Tablets target a single allergy, and our study found that was the main barrier for allergists in prescribing tablets. If a patient has more than one allergy and is able to travel regularly to receive allergy shots, an allergist may recommend shots over tablets."

Both shots and tablets – the only FDA-approved immunotherapy treatments for allergies – are effective by changing your immune system, according to ACAAI. They decrease some cells, chemicals and antibodies in the body that cause allergy symptoms and increase others that improve health. Immunotherapy also cuts down on the inflammation seen in hay fever and asthma, so many sufferers find their symptoms get better.