Alabama Nasal & Sinus Center
New Options in Immunotherapy
It’s that time of year again! No, not Christmas in March, it’s allergy season. Spring Allergy Season
Finding someone who suffers from seasonal allergies in Birmingham is about as easy as finding a good barbeque restaurant – they’re everywhere. Unlike the ubiquitous good barbeque restaurant (the worst BBQ I ever had was still pretty good eatin’!!), allergies are no fun and not at all tasty. We need some relief! This is where Alabama Nasal and Sinus Center comes in.
Traditional therapies for allergies include nasal steroid sprays, oral antihistamines, antihistamine nasal sprays, and leukotriene inhibitors. For patients who do not respond to medical treatment or when the diagnosis of allergy is uncertain, or when knowledge of the specific causative allergen is needed to target therapy, allergy testing is recommended. Once the allergy test data is analyzed, the patient may be started on immunotherapy. The traditional way of administering immunotherapy is with a shot. Many of you are probably aware of this type of allergy therapy. The patient goes to the doctors office once a week (at first), gets an injection and then waits 20 – 30 minutes in the office to ensure no adverse reactions. This type of therapy is fairly successful in helping patients improve control of allergy symptoms, with 60-80% of patients seeing significant improvement. The downside to subcutaneous immunotherapy (SCIT), or allergy shots, is that it is relatively inconvenient for most people because of the weekly visit to the doctor’s office. Some companies and practices now mix antigen vials for patients and send them home for the patient to administer their injection themselves. Our practice does not do this because we consider it unsafe practice. However, there is an alternative delivery system that has been used for many years with equal success to SCIT, with fewer adverse reactions, and in a fashion convenient for the patient.
What is this miracle method of allergy immunotherapy? It is sublingual immunotherapy, or SLIT. SLIT has been utilized in Europe and the United States for decades now with great success. With SLIT, the antigen is delivered to the bloodstream by absorption through the tissues under the tongue. The antigens are mixed in a solution, a few drops of which are placed under the patients tongue every day. As with SCIT, the concentration of the antigen is slowly increased as the patient tolerates. Once maintenance levels have been reached, the patient continues therapy for several months. The total time for a patient to complete immunotherapy is quite variable, but most will finish in two or three years.
So, if SLIT is so wonderful, why doesn’t everyone do it? Money. Because of some political reasons I do not fully understand, the FDA has not approved SLIT in the United States. This, even though there is overwhelming data and clinical experience that says SLIT is equally effective and safer than SCIT. Because SLIT lacks FDA approval, most insurance companies will not pay for SLIT, but they will pay for SCIT. However, when one counts the cost of missed work, decreased productivity, and simple inconvenience, the relatively low out of pocket cost of SLIT is often a very good value for the patient.
More good news! Now there are commercially produced sublingual immunotherapy tablets for patients with positive reactions to grass pollen and/or ragweed pollen. These are two common and powerful antigens. Often patients have multiple allergies – that is, they react to grass, trees, dust, and molds, etc. Traditionally we have treated patients with doses of all of the antigens to which they respond. However, we are learning now that treatment with only one of these potent antigens can be equally effective at decreasing sensitivity to other antigens. This means that a patient who reacts with allergic response to grass antigen can be treated with sublingual grass antigen for a period of time and is likely to have a positive response to not only grass, but most or all of the other antigens to which she or he may have tested positively. This is an exciting new method of treatment for patients who suffer from seasonal allergies. The advantage of the commercial products is that insurance may cover the cost of the tablets. Often, what insurance will not cover, the pharmaceutical companies will reimburse with coupon or rebate programs, thus keeping your out-of-pocket costs down.
The new sublingual immunotherapy tablets are indicated for patients 5 to 65 years of age, who have allergic rhinitis due to grass pollen or ragweed pollen, as indicated by positive skin test or in vitro (blood) testing for pollen-specific IgE antibodies. This type of therapy is not indicated in patient s with severe, unstable asthma, a history of severe systemic allergic reaction after taking sublingual allergen immunotherapy, or for anyone with a history of eosinophilic esophagitis.
We’d love the opportunity to discuss these treatment options with you in more detail. Call 205-980-2091 to make an appointment today. Have a great day!