Sublingual Immunotherapy for Hayfever
People with ragweed allergy may get relief by administering drops made from ragweed extract under their tongues, according to a study in International Archives of Allergy and Immunology (2003;131:111–8). Taking daily or weekly oral drops to treat ragweed allergy is a safe, effective alternative to receiving weekly allergy shots.
In the study, 110 participants between the ages of 7 and 55 years with ragweed allergy were randomly assigned to receive sublingual immunotherapy (SLIT) from a standardized ragweed extract or a similar looking placebo for 7.5 months overlapping with ragweed season. Treatment started with 2 drops per day; this amount was slowly increased up to 20 drops per day for one month. Participants were then switched to sublingual tablets for another month and were then kept on a maintenance amount, varied depending on each person’s tolerance, for 5.5 months. Symptom scores for sneezing, runny nose, nasal blockage, itchy nose and eyes, redness of eyes, and tearing were recorded periodically throughout the study. Use of other allergy medications, assessment of efficacy by physician and participant, and skin-prick tests were also measured at the conclusion of the study.
Those taking ragweed SLIT had significant reductions in sneezing, runny nose, nasal blockage, and tearing of the eyes, compared with those taking placebo. The number of people experiencing asthma attacks was almost 50% lower in the SLIT group than in the placebo group. Skin-prick reactivity was markedly reduced in those taking ragweed SLIT, suggesting increased tolerance to ragweed allergen. People taking ragweed SLIT also used less allergy medication than those receiving placebo. More than 85% of participants and 80% of physicians felt that SLIT led to either complete or partial improvement of hayfever symptoms. No one receiving ragweed SLIT had any serious adverse effects or worsened while undergoing treatment.
Injection immunotherapy has been the standard treatment for various allergies for almost 100 years, but it can cause serious side effects, such as anaphylaxis (a severe reaction that causes swelling in the eyes, face, and throat and may cause difficulty with breathing) in a small number of individuals. The World Health Organization has determined that SLIT is a viable, effective alternative to injection immunotherapy for allergic diseases. Several studies have demonstrated that SLIT is effective in treating ragweed and dust mite allergies. While many physicians have used SLIT to treat other types of allergies (such as tree pollen, mold and animal danders), few controlled studies have been done. However, of the studies that have been done, none have found that SLIT causes the severe and sometimes fatal allergic (anaphylactic) reaction that can occur in allergic people.
There are several advantages of SLIT over injection therapy. Some people who have not responded well to injection therapy do better with daily administration of oral drops. It is unknown why this occurs, but some researchers suggest that taking the allergenic substance on a daily basis alters the immune response more favorably than weekly or monthly injections. Oral immunotherapy is more convenient than injections, since the drops are administered at home and no needles are involved. This means fewer office visits and no pain, which is particularly important for those who are fearful of getting injections. The annual cost of SLIT is also substantially less than injections. Given the excellent safety profile, SLIT may be beneficial for people who have previously had an adverse reaction to injection immunotherapy.
The author of this article and other physicians have successfully treated thousands of allergic people with SLIT and have not reported any serious adverse effects. Unlike injection immunotherapy that can take years to control allergies, SLIT will often help relieve symptoms in a matter of weeks. SLIT may also be helpful in people with allergies to animal danders, mold, dust, and insects.
Darin Ingels, ND, MT (ASCP), received his bachelor’s degree from Purdue University and his Doctorate of Naturopathic Medicine from Bastyr University in Kenmore, WA. Dr. Ingels is the author of The Natural Pharmacist: Lowering Cholesterol (Prima, 1999) and Natural Treatments for High Cholesterol (Prima, 2000). He currently is in private practice at New England Family Health Associates located in Southport, CT, where he specializes in environmental medicine and allergies. Dr. Ingels is a regular contributor to Healthnotes and Healthnotes Newswire.
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