Ask the Allergist: SLIT Decisions On Allergy Tablets



SLIT-150x120Q: “I am considering undergoing sublingual immunotherapy (SLIT), or allergy tablets, to help treat my seasonal allergies. What are advantages and disadvantages of the tablets?”

Kathleen May, MD: Under-the-tongue allergy tablets are a new FDA-approved therapy for patients who experience allergy symptoms to grass pollen or ragweed. Just like allergy shots, the goal of SLIT is to boost the patient’s tolerance to allergy triggers.

Right now there are three prescription products on the market: Grastek®, Oralair® and Ragwitek®. Grastek contains one grass pollen and is for ages 5-65; Oralair contains five grass pollens and is for ages 10-65, with children 10-17 receiving a lower dosage. Ragwitek has ragweed and is intended for adults only, ages 18-65.

Patients using Ragwitek and Grastek are instructed to begin treatment three months prior to the start of their allergy season, while patients using Oralair begin four months before the start of their allergy season.

Taking one tablet per day, the therapy continues on through the allergy season to prevent sneezing, nasal congestion, nasal itching, runny nose and itchy and watery eyes.

The primary advantage is convenience. Allergy shots must be administered in a doctor’s office and require multiple injections to reach a therapeutic dose. Once that is reached, the injections are usually given monthly for 3-4 years.

With SLIT under-the-tongue tablets, the first dose is administered in the doctor’s office. Patients can then take the tablets at home – as long as there are epinephrine auto-injectors available to treat potential anaphylaxis, a severe allergic reaction, which is possible according to the warning in the package insert.

One drawback with allergy tablets is that each covers just one or one type of allergen, while shots can be tailored to treat multiple pollen or environmental allergies at the same time. Another drawback is that SLIT tablets may not offer long-term protection and generally must be taken each year before and during the season for effectiveness, unlike shots which are given for 3-5 years and provide sustained benefit years after the therapy is discontinued.

With SLIT, there appears to be a greater chance for local side effects and a reduced risk for systemic side effects compared to allergy shots. Local side effects may include mouth, throat or tongue irritation and are generally minor. The risk for systemic side effects, involving areas of the body away from the mouth or throat such as skin (hives) or the lungs (wheezing), is less than or equal to 2 percent.

In terms of paying for allergy tablets, the cost may vary depending on insurance coverage. I recommend patients do a price comparison of allergy tablets vs. allergy shots, weigh benefits and risks, and consider short- and long-term goals when discussing this therapy with their doctor.

“How are allergy tablets administered?”

You place the tablet under your tongue and hold it there without swallowing for at least a minute. After taking the tablet, you can’t eat or drink anything for at least five minutes. Oralair instructions advise you to take the tablet in the morning, on an empty stomach.

The tablets are highly allergenic, so it’s important to wash your hands after taking one. If you rub your eyes immediately after handling the tablet, you could risk an allergic reaction.

Parents should monitor their child for 30 minutes after administering the allergy tablet at home and keep epinephrine auto-injectors close by in case of anaphylaxis.

Medication:

Grastek®

Oralair®

Ragwitek®

Pharmaceutical Company:  Merck Greer Laboratories Merck
Pollen Therapy:  Timothy grass Kentucky blue grass, orchard, perennial rye, Short ragweed sweet vernal, timothy grasses Short ragweed
Ages Approved: 5-65 10-65 (ages 10-17 receive lower dose) 18-65


Kathleen May, MD, FACAAI, is a board-certified allergist and immunologist with Allegany Allergy & Asthma in Cumberland, Md. She is a Fellow and serves on the Board of Regents of the American College of Allergy, Asthma & Immunology.


Have a medical question? Email editor@allergyasthmnanetwork.org or write to Ask the Allergist, Allergy & Asthma Network, 8229 Boone Blvd., Suite 260, Vienna, VA 22182.


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