Sublingual immunotherapy takes the sting out of seasonal allergy treatment

Posted on July 1, 2020 by in Allergies
 | Oak Street Medical

Those who suffer from grass or ragweed allergies and could benefit from immunotherapy treatment now have another option, one that doesn’t involve shots or regular trips to the allergy office.

Sublingual immunotherapy (SLIT) been used in Europe for more than a decade with success. Last spring, the FDA approved its use in the United States. For those with grass allergies, there are two products, Oralair and Grastek, and for those with ragweed allergy, Ragwitek is available. Like traditional allergy shots, SLIT is used to induce tolerance to a particular environmental allergen, changing the way a body reacts to an allergen over time.

No needle needed

As opposed to shots in the arm, SLIT is taken orally. With this therapy, patients place a dissolvable tablet under the tongue or between the lower lip and gum on a regular basis to help reduce allergy symptoms. It is taken daily from about January through July (for grass sufferers at least), whereas shot patients follow a specific buildup schedule and then a monthly maintenance schedule over five years.

Who’s eligible?

SLIT is currently only available for treatment of allergies to grass or ragweed, whereas shot therapy can include allergens such as animal dander, dust mites, mold, other weeds and trees in addition to grass and ragweed.

Minimal, short-lived side effects

Side effects of both types of therapies are rare, but SLIT is considered safer than shots, which is why it can be taken at home, compared to shots that need to be given at an allergy office. Side effects of SLIT are mostly oral, such as mouth or tongue itching, mouth swelling, throat irritation, cough and throat pain. Usually, these symptoms are short-lived and tend to diminish with continued use. There is a very small risk of an acute allergic reaction, so the first dose is given in the office, and SLIT patients are required to have an EpiPen in case they have a reaction during treatment at home.

What we don’t yet know

Efficacy of SLIT compared to traditional allergy shots is still a little hard to determine, as it is a much newer form of treatment. There hasn’t been many head-to-head studies comparing the two therapies, particularly for grass pollen allergy. Some studies show equal improvement in symptoms, while others suggest shot therapy may be a little more effective.

There are still some unanswered questions regarding SLIT, such as optimal length of therapy, and whether SLIT can help prevent allergic children from developing asthma, as has been shown with shot therapy.

Find out if it’s right for you

If you have moderate to severe seasonal allergies, talk to your doctor about sublingual immunotherapy (SLIT) and whether it might be an option for you.