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Sneezing, runny nose, congestion or irritated eyes? Yes, we hear you: the misery of seasonal allergies is real. Many people find temporary relief with self-care drugs, but these do not treat the cause.
As we enter the grass pollen season in the coming months, here is an option to consider: Many allergologists are now prescribing immunotherapy tablets that work in the same way as allergy shots to some of their patients with grass allergies.
But unlike allergy shots, which require frequent trips to the doctor, you can take the tablets at home. "It's a small wafer that you put under your tongue and solve in about ten seconds," says allergist Mike Tankersley, who practices in Memphis, Tennessee.
The treatment, known as sublingual immunotherapy or SLIT, is more convenient than shots and has proven to be safe. But it won't work for everyone. Each tablet is aimed at only one allergy. There are four FDA approved tablet products on the market for treating grass pollen, house dust mites and ambrosia.
"I have had several patients who were very happy with having something to take home," says Tankersley.
According to a recent study by the American College of Allergy, Asthma and Immunology, 73 percent of allergologists now prescribe these immunotherapy tablets to some of their patients. Since these products were approved, starting five years ago, "there has been a significant change in practice in the United States," says Tankersley.
Tankersley, who also serves as vice-president of the ACAAI committee for immunotherapy and diagnostics, says he still recommends allergy shots to the majority of patients because most of them have multiples allergies. Shots can be formulated to target all allergies in one go.
Tankersley says he recommends this ACAAI quiz for patients trying to decide whether shots or tablets are the best option.
Just like allergy shots, the tablets are a form of immunotherapy that can change your immune system. It is a complex reaction, but part of what happens when you take the photos or tablets is that your body can produce regulatory cells that "suppress the immune response." says Harold Nelson, allergist and immunologist at National Jewish Health in Denver. In other words, immunotherapy can slow down the immune response and suppress the symptoms.
In the very long term, Nelson says, when immunotherapy works well, "the entire balance in the immune system is restored to almost what is seen in non-allergic people."
The tablets work best if you only have one or two allergies that disturb you. For example, if grass pollen is your problem, there are two tablet products to combat grass allergies.
"If you live in a place like the Willamette Valley in Oregon or Northern California, where grass is the most important allergen, and that's what really bothers you, the tablets are great," Nelson says.
The pollen of ambrosia, which is found in many areas of the United States, causes allergy symptoms in up to 23 million people. And the ambrosia tablet has proven to be a safe and effective treatment. Similarly, dust mite allergies – which do not have much seasonal ebb and flow – can be effectively treated with the dust mite tablet, research said. The grass dusting tablets are approved for adults and children (5 years and older). The ambrosia and dust mite tablets are approved for people 18 years and older.
So far, no sublingual tree pollen immunotherapy approved in the United States has triggered early spring allergies. In Europe, a tablet has been developed to treat birch allergies, which Nelson says may be effective against some oak allergies. And in Japan there is an approved tablet for Japanese cedar, which can be effective in treating some cedar and juniper allergies in the US. Tankersley says allergologists hope that in the coming years a tablet for some tree pollen allergies may be available in the US.
What if you have two major allergies that disturb you? Say, grass allergies in late spring or summer and ambrosia, which is often called hay fever and tend to worry in mid-September. Can you take both tablets? "Yes you can," says Nelson.
There are indications of both safety and efficacy, Nelson explains, for taking two immunotherapy tablets simultaneously. But usually the tablets are started at different times, says Nelson. A disadvantage is that some insurance plans do not cover two tablets at the same time. However, with tablets you do not have the copy that may come with office visits.
Many people get allergy relief with freely available nasal steroids such as Flonase and Nasacort and antihistamines. And Tankersley says they can be effective in treating symptoms. But unlike allergy shots and immunotherapy tablets, these drugs do not address the cause of the problem.
"That's the big advantage of immunotherapy," he says. "We are really shooting a medicine."