The FDA has approved two novel under-the-tongue treatments for those who suffer with grass pollen allergies. 
In mid-April 2014, Grastek, produced by the pharmaceutical company Merck, was given the green light, and two weeks earlier Oralair, developed by French manufacturer Stallergenes, got the go-ahead. Both treatments are new, non-invasive forms of immunotherapy, in which the patient dissolves a tablet under the tongue once a day to gradually reduce grass allergy symptoms.
Prior to this approval, the only FDA-sanctioned treatment for grass allergy was traditional immunotherapy, known as allergy shots. These require a large number of injections and multiple doctors’ visits, since every shot must be given under medical supervision.
“The approval of oral immunotherapy tablets is advancement in the right direction,” said Chicago allergist Dr. Michael Foggs. “It’s an additional treatment option for those who are allergic to some types of grasses, but not those allergic to other varieties of grass, trees and weeds.”
Grastek and Oralair require medical supervision for the first tablet, in case any reactions occur. After that, either can be taken at home. It’s recommended to start treatment three to four months before allergy season and to continue throughout.
The Oralair tablets contain pollen extracts from five different grass species (Timothy grass, Kentucky blue grass, perennial rye, sweet vernal and orchard), while Grastek contains extract from Timothy grass and Merck says it also treats cross-reactive grass pollens. This form of what’s called sublingual immunotherapy – SLIT for short – works by “retraining” the immune system to accept an allergen by introducing it in small, steady amounts. Grastek can be given to patients starting from the age of 5 years old and up, while Oralair is approved for those age 10 and up.
Dr. Foggs tempers the optimism about the new treatments with a couple of cautions: they will only work for the specific grass allergens and, unlike old-fashioned allergy shots, the tablets are not tailored to the individual patient.
“It would be ideal if tablets could be customized like allergy shots,” he notes. “Since allergy treatment is not a one-size-fits-all approach.”
While not a cure, the new treatments will be welcomed by anyone with severe grass allergy symptoms – and there are millions of Americans who fit that description. In studies, symptoms and medication use were significantly reduced by using the tablets.
Grastek and Oralair have already been available in Europe for years, and more recently were approved in Canada. Ask your allergist if you or your child is a candidate for this treatment.
Sublingual tablets for dust mites are also on the horizon.