New sublingual pill may help allergies

May 30, 2014 by Sarah Worth, University of South Florida
Credit: Eric Younghans, USF Health Office of Communications

Allergy sufferers are breathing a sigh of relief with the news that FDA-approved medications taken via a pill or drops under the tongue over the course of weeks – as opposed to a series of injections that might last years – are starting to hit the market.

The sublingual medication is as effective in some patients as injections, a standard course of treatment that has changed little in the past 100 years, said Richard F. Lockey MD, FACP, professor and director of the Division of Allergy and Immunology in the USF Health Morsani College of Medicine and holder of the Joy McCann Culverhouse Chair of Allergy and Immunology.

"Sublingual immunotherapy has been around for a long time but earlier concentrations were ineffective because they were in too small of doses to help patients build immunity," Dr. Lockey said. "These new standardized pills and drops are now in larger doses and have proven to be as effective in double-blind, controlled studies. These properly balanced studies showed a statistically significant benefit to patients."

The first pills and drops available this summer target certain grasses and ragweed. Formulas for cat, and other allergens should be available next, Dr. Lockey said, while those for oak, Bahia and Bermuda grasses, other trees, weeds and molds may take years.

Credit: Eric Younghans, USF Health Office of Communications

On-going clinical studies play into the pace for when the new sublingual immunotherapies become available. USF Health is a clinical site for the study related to dust mite allergies and continues to seek people allergic to dust mites to participate in the study, Dr. Lockey said. For more information about the dust mite study, call (813) 631-4024.

The number one allergen for Floridians is oak, Dr. Lockey said, so local will have to wait because it is not yet a standardized allergen and not available for sublingual immunotherapy.

Patients who might benefit from the new medications are those who are allergic to only one or two things, and only seasonally. Those allergic to multiple things, called polysensitized, would likely see bigger benefits from shots, Dr. Lockey said. That's because the serum used for injections can include concentrations for multiple allergens, creating a medication that is tailored to match each patient's allergies. The new sublingual immunotherapies target only single allergens, making them somewhat like "one-hit wonders."

But it also depends on where the person lives, he said. For example, people allergic to ragweed might be a candidate for the sublingual medications if they live up north, where ragweed blooms only seasonally. If they live in Florida, where ragweed is a year-round bloomer, they would not be prescribed the sublingual option.

The advantages for the new sublingual pills and drops are significant for patients, Dr. Lockey said, with time savings being the greatest. Sublingual immunotherapies are taken for about 12 weeks before the season begins and during the season for a patient's particular allergen, he said. Injections are typically given one or two times each week for three to five months and monthly thereafter for three to five years or more. In addition, sublingual medications can be self-administered once the patient has taken the first dose at a physician's office to monitor for adverse reactions. Injections require a visit to the physician's office.

One of the big hopes, Dr. Lockey said, is that the new easy-to-take medications might entice more people to find relief.

"Some cannot pursue shots because of time constraints," he said. "Sublingual immunotherapies can be given at home."

Explore further: Review article examines sublingual immunotherapy for treatment of allergic rhinitis and asthma

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