This article has been reviewed by Thanai Pongdee, MD, FAAAAI
If you suffer from allergy symptoms, you may wonder if allergy immunotherapy (allergy shots or allergy tablets) is the best treatment for you. While it requires time and patience, the payback can be long-term relief.
Allergies are the result of a hyperreactive immune system. Your immune system serves to protect your body against injections and other conditions. Allergies are caused by an abnormal immune response to substances that are not harmful. For instance, if you have an allergy to grass pollen, your immune system identifies pollen as an invader or allergen and produces antibodies against grass pollen called Immunoglobulin E (IgE.)
Allergy immunotherapy is a treatment that aims to correct or “cure” this abnormal immune response. It involves regular administration of the allergenic substance by injecting it subcutaneously into the arm, which is also known as ‘shots’ or subcutaneous immunotherapy (SCIT), or as a solution or tablet underneath the tongue. Sublingual immunotherapy (SLIT) is the medical term for delivering the allergic substance underneath the tongue. In the United States, the only FDA-approved forms of sublingual immunotherapy are allergy tablets.
Both forms of allergy immunotherapy—the shots and the tablets—are prescribed by allergist / immunologists. An allergist / immunologist, often referred to as an allergist, has specialized training and experience to determine which allergens are causing your symptoms and can discuss if allergy immunotherapy is right for you.
How Do Allergy Tablets Work?
Allergy immunotherapy, whether it’s the shots or the tablets, works much like a vaccine. Your body responds to the added amounts of a particular allergen given, eventually developing a resistance and immune tolerance to it. Allergy tablets can lead to decreased, minimal or no allergy symptoms with symptom relief for years after treatment is completed.
Allergy tablets administer the allergen in a tablet form under the tongue, generally on a daily basis. They are currently available in the United States for grass pollen and/or short ragweed pollen induced allergies. Allergy tablets are also available for dust mite allergies in many European countries and Japan and may soon be available in the United States.
Will I Feel Better?
In clinical studies, during treatment for one ragweed or grass pollen season, patients who received allergy tablets experienced significant improvement in their allergy symptoms, required less allergy medications and in general reported a better quality of life in the first treatment season. These improvements were even better in the second and third treatment year.
If you aren’t responding to allergy immunotherapy, it may be because you have other allergies in addition to grass and ragweed. Other reasons could be that there are high levels of the allergen in your environment or major exposures to non-allergic triggers like tobacco smoke are present.
What Is the Length of Treatment?
The tablets are typically started four months before the start of the featured pollen season and continued throughout the season. Tablets are similar to allergy shots in terms of the effectiveness of controlling allergy symptoms, and both have been shown to provide long term improvement even after the treatment has ended.
The first dose is taken at the healthcare provider’s office, where the patient is to be observed for at least 30 minutes for potential adverse reactions. Future dosages can be administered at home, making the dosage schedule more convenient than allergy shots.
Who Can Be Treated with Allergy Tablets?
Grass allergy tablets are currently approved for ages 10 through 65. Ragweed tablets are currently approved for ages 18 to 65.
Allergy immunotherapy is not started on patients who are pregnant but can be continued on patients who become pregnant while receiving it. In some patients with other medical conditions or who take certain common medications, allergy tablets may be more risky. It is important to mention other medications you take to your allergist.
What Are the Possible Reactions?
Allergy tablets have a more favorable safety profile than allergy shots, which is why it does not need to be given in a medical setting after the first dose. However, the FDA-approved product information for the three tablets available in the United States includes a warning about the possibility of severe allergic reactions, including anaphylaxis, from the tablets.
That is why the preferred location for receiving your first dose is your prescribing allergist’s office. Initial treatments may also be given at another facility where the physician and staff are trained to recognize and treat reactions or have received instructions by your prescribing allergist.
The primary side effects of allergy tablets are local reactions such as itching or burning of the mouth or lips and less commonly, gastrointestinal symptoms. These reactions usually stop after a few days or a week. An epinephrine autoinjector should also be prescribed to patients receiving allergy tablets in the event that a severe allergic reaction should occur at home.
• Allergy immunotherapy (allergy shots and tablets) work by building your tolerance to substances that trigger your allergy symptoms.
• Allergy tablets are currently available in the United States for grass pollen and/or short ragweed pollen induced allergies.
• Allergy tablets for dust mite induced allergies are available in Europe and other countries and are awaiting approval in the United States.
• Ask your allergist if you could benefit from receiving the tablets.
• Most adverse reactions to allergy immunotherapy are mild. However because serious reactions can occur, it is safest to administer the first dose of allergy tablets in an allergist’s office. An epinephrine autoinjector should also be prescribed to patients receiving the tablets.
Feel Better. Live Better.
An allergist / immunologist, often referred to as an allergist, is a pediatrician or internist with at least two additional years of specialized training in the diagnosis and treatment of allergies, asthma, immune deficiencies and other immunologic diseases.
By visiting the office of an allergist, you can expect an accurate diagnosis, a treatment plan that works and educational information to help you manage your disease and feel better.
The AAAAI's Find an Allergist / Immunologist service is a trusted resource to help you find a specialist close to home.
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