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Your Health Blog

    New Allergy Treatment: Sublingual Immunotherapy

    Dr. Majed Koleilat Allergist at Deaconess Clinic 09/03/2014
    Allergy season is in full swing.  Most of the tree allergy season is past, but now people who are allergic to grasses are starting to suffer. The options to treat allergies--for decades—have been the use of antihistamine medications and intranasal steroids/antihistamines to help reduce symptoms, as well as allergy shots (immunotherapy) which help your body stop reacting to allergens.
    The FDA recently approved a new type of immunotherapy called sublingual immunotherapy.  Sublingual means “under the tongue.”

    How does sublingual treatment work?

    The patient takes pills that are placed under the tongue and left to dissolve for 3-5 minutes. 
    The first pill is given in the doctor’s office, and the patient is observed for up to an hour. Since it is something you’re allergic to, you could have a reaction so the clinic monitors your initial reaction to the treatment.
    After that, the medication is taken once per day, throughout the season of the allergen. The start is 4 months prior to the season.
    There are currently three brand names available for this medicine—2 for grasses and one for ragweed. For the grasses, in our area, you would start in January.  For ragweed, you would start in April or May. These treatment courses last 6-7 months each year, and it has to be repeated every year for three years. 
    The effect of the treatment decreases over a few years, which is different than allergy shots. Allergy shots have a tendency to “stick” longer.
    How much does this treatment cost, and/or is it covered by insurance?

    The cost for sublingual immunotherapy pills is around $250/month, and there are currently some coupons/vouchers available through the manufacturer (reducing the cost to about $150/month).  Because the product is so new, we don’t know what commercial insurance will do in regards to coverage.

    Pros and Cons of the treatment

    • No shots.  For people who can’t stand being stuck with needles, this is a good thing.
    • Apart from the first pill, it’s a treatment done at home.
    • It treats the underlying cause of allergies.
    • It covers only one allergen group.
    • It can cause some oral symptoms, such as itching/tingling and a feeling of a full throat.
    • Cost/unknown insurance coverage.
    • Has to be repeated every year for three years, and a relapse is possible in the future.
    Who is a good candidate for this oral treatment?

    A good candidate for this treatment is someone who has not started allergy shots, and who is only/mainly allergic to grasses and/or ragweed. Another qualification is compliance—following the directions exactly is of major importance.  You can’t miss days, or be off on your timing.
    So who is NOT a good candidate for this treatment?
    •  People with severe allergies to multiple allergens (such as dust mites, molds, trees, pets)
    • Moderate-to-severe asthmatics·        
    • People with chronic lung disease
    • People with any oral health issues, such as gingivitis
    • People with compliance issues—who will struggle with keeping the schedule and sticking with the program
    • Patients who are already on allergy shots
    If someone wants to find out if they’re a good candidate for this treatment, they should make an appointment with an allergist, and get evaluated/tested (which usually is covered by insurance). Based on a patient’s allergy profile (what they’re allergic to), we can determine if they’re a good candidate for sublingual immunotherapy.

    The patient can then arrange to be seen again four months prior to the start of the allergy season (again, January for grasses, and April/May for ragweed). I think that by January, it’s likely that insurance companies will be providing coverage for these treatments (the extent of which is still to be determined). 
    A few other points to remember:
    •  This treatment is by prescription only, and must be done under the supervision of a physician.
    • While insurance coverage is still unknown, this treatment does qualify as a prescription that would be a reimbursable expense for an FSA.  (The pills are picked up at the pharmacy.)
    • School-aged children may be excellent candidates for this treatment.  The parents can control the schedules, and the child is probably not likely to want shots!  (Plus, there’s the added convenience of not having to go to the doctors’ office for allergy shots.)
    For more information about sublingual immunotherapy, check out this article released by Medscape last week: 

    Learn more about Dr. Koleilat.

    Learn more about Deaconess Clinic Allergy
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