On April 3, Dr. Mehmet Oz hosted a segment on his TV show called “How to Survive the Allergy Epidemic”. In keeping with many news reports released this spring, Dr. Oz declared: “This year, you’re going to feel even more miserable than ever before.”

New York allergist and Allergic Living contributor Dr. Clifford Bassett was invited to help explain to viewers why this may be. He said that climate change factors, such as warm seasons starting earlier and ending later, are to blame. He also noted that tree pollen and grass pollen seasons can overlap resulting in a “pollen bomb” that can cause misery for allergy sufferers.

Dr. Oz did an excellent job explaining how certain weather patterns can cause what allergy specialists and botanists now call ‘the priming effect’ – where pollen levels rise, fall and rise again in late winter and early spring. When it’s unseasonably warm, plants begin producing pollen early. When the temperature drops again, they stop, and then begin again once the warmer weather returns. In pollen-sensitive individuals, this can cause worsened allergy symptoms that are tougher to control because their immune system has been ‘primed’ for pollen allergens.

The topic of conversation then moved to treatment. Most medications for spring allergies work by blocking histamine receptors, so the histamine in one’s body has nowhere to bind to and cause symptoms. These treatments are effective for most people, but they treat the symptoms but not the underlying allergic disease. Upon each re-exposure, the symptoms will have to be blocked again.

This is why doctors often recommend immunotherapy, or allergy shots, in which a small amount of the allergen (i.e. pollen) is injected into a sensitized individual on multiple occasions over a long period of time. The goal is to allow the patient to build tolerance to the allergen and eventually no longer be sensitized to it.

The trouble with this traditional type of immunotherapy, which Dr. Bassett noted has been available for almost 100 years, is just that – the trouble: injections are required several times before each allergy season for several years, resulting in many, many hours in the allergist’s office.

Fortunately, Dr. Bassett informed Dr. Oz’s audience that sublingual immunotherapy (SLIT), which is a type of immunotherapy that uses under-the-tongue tablets or drops instead of needles, is gaining ground. It is far less invasive: once an allergist determines the proper dosage, a patient can actually conduct this immunotherapy by themselves, at home.

While not yet approved by the FDA, several clinical trials have demonstrated that this type of treatment can be effective, and it has been available in Europe for years. One brand, Oralair, was recently approved for prescription use in Canada.

See the full episode of The Dr. Oz Show here

See also:
Peanut Drops Hold Treatment Promise
Milk OIT Not Lasting
Dr. Oz on Nut Proteins in Olive Oils

One of the tablets, known as Oralair, recently became available by prescription in Canada, but not the United States. This pill has proven effective in international studies, and is now approved by Health Canada.

Another tablet, known as Grazax in Europe, has been submitted to the FDA in the United States for final approval. Unfortunately, the tablet (which will have a different brand name in the U.S.) most likely won’t become available until next year’s grass season at the earliest.

When it comes to grass allergy, taking antihistamines does the job for some people. But allergists have traditionally steered those with more severe symptoms and asthma toward immunotherapy, also known as allergy shots. The tablets are a new form of this therapy – called sublingual immunotherapy, or SLIT, because the dose is taken under the tongue.

Although it’s recommended to begin taking these tablets four months before allergy season begins, they have been known to show significant improvement after being taken for as little as one month. This is far less invasive and time-consuming than traditional immunotherapy: instead of visiting an allergist several times to get your shots, you can simply place a tablet under your tongue and allow it to dissolve.

Sublingual immunotherapy is actually not so new.  For years now, researchers have been studying it, not just for grass allergy but potentially for food allergy as well. It works with the same principle as traditional allergy shots: introduce tiny amounts of the specific allergen into the patient’s system (in this case, via drops), with the goal of building toward tolerance.

See also:

Allergic Living’s Full Report on SLIT for Grass Allergy
Milk OIT Not Lasting

Known as sublingual immunotherapy, or SLIT, this treatment works by having study subjects take tiny, daily doses of an allergen – in this case, peanut – in steadily increasing amounts over an extended period of time.

The new study, published in the January edition of the Journal of Allergy and Clinical Immunology, involved 40 peanut-allergic patients between the ages of 12 and 37 in five U.S. cities. The subjects were randomly divided in half, with one group taking liquid drops containing peanut powder under the tongue and the other taking drops with a placebo.

After 44 weeks of the daily doses, 70 percent of those getting the peanut powder could tolerate at least 10 times more peanut in an oral food challenge before showing symptoms than they could have at the outset of the study. In a follow-up challenge at 68 weeks, they could tolerate about twice as much again. (Patients were also to be retested at 88 weeks.)

This suggests that longer treatment could lead to even better results. The end goal is to slowly build up tolerance until the individual is no longer sensitized to the allergen.

“It gives us hope that this type of therapy might be used in the future for some type of treatment,” Dr. Wesley Burks, lead author of the study and Chair of the Department of Pediatrics at The University of North Carolina, told Allergic Living.

But Burks is quick to acknowledge the hurdles that remain. First, the treatment was not effective for 30 percent of the subjects. He believes this has to do with finding the proper dosage for those individuals, which could be related to their specific immune and gastrointestinal systems.

He says it shows that more and larger studies are required before this type of treatment – currently only done with strict medical supervision – becomes widely available.

The second issue is that, after 44 weeks, the average amount of peanut one of the responding allergic patients could consume was still fairly small: 496 milligrams. That equates to about two peanuts (a single peanut typically contains 250 to 300 mg of protein).

The treatment “is not ready for practical day-to-day usage,” says Burks. “There is some efficacy, but it is not the right thing to do right now”.

Even if SLIT’s results are being measured in incremental successes, that is still significant and promising, especially when compared to the sole, current allergy treatment of strict avoidance of peanuts.