Those who suffer from allergic conditions know that allergies can interfere with quality of life. Compared with the general population, more people with allergies complain of difficulty getting to sleep, waking up during the night, waking up feeling exhausted, or a combination of these as a result of their symptoms. The majority of allergy patients describe their symptoms as impacting their daily life significantly. Because allergies usually present in childhood, it is important that the underlying condition is identified as soon as possible and be appropriately treated. By getting the allergy under better control, patients can halt the progression of the allergy, lessen the risk of developing secondary complications such as asthma and sinusitis, and most importantly, get lasting relief that impacts their quality of life.
It has long been established that Allergy immunotherapy can reduce a patient’s reaction to allergens. Immunotherapy not only reduces an allergy sufferers symptoms, it can also prevent children who have allergic rhinitis from developing the ‘onward march’ toward asthma and other chronic conditions.
When to consider Allergy Immunotherapy:
Recommendations on when to get started with immunotherapy vary, but in general, an allergy sufferer may want to consider treatment when:
- The allergic substances are hard to avoid
- The allergic patient may have to chronically use rescue medications such as antihistamines or inhalers in order to manage symptoms
- Avoiding allergens and using medicine do not adequately control symptoms
- Side effects of medicines are a problem. (i.e: dry eyes and nose, drowsiness, edginess)
- Allergy symptoms are severe enough that the benefit from treatment outweighs the expense and the time spent getting the treatment.
- The patient is seeking treatment for the cause of his or her allergy, rather than treatment for just the symptoms.
- The patient may have another condition that is being affected by allergic rhinitis, such as asthma
- The patient wants to lower the chance of developing asthma.
Allergy Shots or Allergy Drops: Injection versus sublingual route:
Subcutaneous allergen immunotherapy (SCIT), or “allergy shots” are considered a well-accepted therapy for managing allergic symptoms, allergic rhinitis and asthma. Subcutaneous Immunotherapy requires regular injections at a doctor’s office over a period of 3 to 5 years. Allergy shots are still considered the “gold standard” for allergy treatment in the North America.
Sublingual immunotherapy (SLIT) is an alternative approach of administering allergens orally, with a sublingual (under the tongue) application of either drops or tablets. There have been numerous clinical trials on the use of sublingual immunotherapy and it is accepted by both the WAO and the WHO. Because Sublingual immunotherapy has an excellent safety profile, it and allows patients to treat themselves at home as opposed to going regularly to the doctors office for injections. For certain patient groups, such as small children, needle phobic, or patients who have not responded favorably to shots in the past, sublingual is becoming a leading choice. Many physicians feel that Sublingual immunotherapy (SLIT) offers several specific advantages over injection immunotherapy. SLIT can be self administered by patients or caregivers, does not require injections, and carries a much lower risk of anaphylaxis compared with SCIT.
Off Label: Health Canada has not approved compounded SLIT treatment in Canada as today. However, some physicians offer SLIT as an off-label treatment. Off-label refers to the administration of a Health Canada approved product or treatment in a manner for which it was not intended or for treatment of a disease for which it was not approved. Off-label treatments are legal, giving physicians an opportunity to literally experiment with medications that may offer some promise of relief in patients that have not responded to approved medications or cannot tolerate approved medications.
Sublingual Delivery Systems: Drops Versus Tablets
Sublingual Immunotherapy (SLIT) has garnered a great deal of attention recently since two sublingual tablet formulations to treat grass allergy were approved. Oralair™ and Grastek™ tablets are designed specifically to treat grass pollen allergy symptoms. What is the difference between these 2 methods of delivery?
- Sublingual aqueous or glycerinated liquid allergen extracts (SLIT-drops) – An aqueous or liquid (eg, glycerinated) extract of allergen, generally administered as drops, is held under the tongue for a specified period of time and then the residual is swallowed. The allergen is taken up through the rich vascular lymphoid network of the mouth.
- Sublingual allergen tablets (SLIT-tablets) – The allergen is formulated into a tablet that is held under the tongue until completely dissolved. Currently, sublingual tablets are available in single antigen form only for grass, or ragweed.
Availability: — Sublingual tablet immunotherapy (SLIT-tablet) has been approved by the European regulatory authorities and is in use throughout the European Union (EU). Some SLIT-tablets are available in Canada. In April 2014, the US Food and Drug Administration (FDA) announced approval of a five-grass sublingual tablet, followed by a Timothy grass tablet (Grastek) and a short ragweed tablet (Ragwitek). This acceptance of sublingual immunotherapy is a welcomed change to current allergy treatment protocols. Sublingual immunotherapy works. It has been proven to be both effective and offers an excellent safety profile.
Patient specific liquid sublingual drops are available in Canada off label. These can be custom made according to a patients specific allergies. Whereas the tablet will successfully treat a grass allergy, SLIT drop can treat any number of allergens: pollens, danders, dust mite, moulds etc.
To find out which route is the best for you, speak to your doctor about getting a referral to an Allergy Specialis. Diagnose the allergy, and treat exactly what needs to be treated. Immunotherapy is a long term solution to allergies.