Published Online: September 11, 2015
A new form of allergen immunotherapy for grass and ragweed allergy was introduced in the United States in 2014. Three formulations of sublingual immunotherapy tablets were approved by the Food and Drug Administration (FDA) for the treatment of allergic rhinitis caused by grass or ragweed pollen (2 for grass, 1 for ragweed). This form of immunotherapy complements other allergy treatments including environmental controls, subcutaneous injection allergen immunotherapy, and allergy medications.
Sublingual immunotherapy for allergic rhinitis has been successfully used in Europe for many years. A joint expert task force on sublingual immunotherapy was convened in order to produce a consensus report to guide clinicians on the optimal use of sublingual immunotherapy. Representatives from the American Academy of Allergy Asthma and Immunology, and the European Academy of Allergy and Clinical Immunology reviewed the relevant medical literature as well as the real-world experience of sublingual immunotherapy. This consensus report was recently published in The Journal of Allergy and Clinical Immunology (JACI), and is intended to offer practical guidance for the use of FDA approved sublingual immunotherapy, informed by the long-term experience of similar products in Europe.
Multiple well-designed clinical trials show that sublingual immunotherapy is effective in reducing symptoms and supplemental medication use in patients with grass or ragweed induced allergic rhinitis. Allergic conjunctivitis was improved in these studies as well. It is important that patients with allergic rhinitis (with or without allergic conjunctivitis) have a confirmed diagnosis of grass or ragweed sensitivity. This is accomplished through allergy skin testing or in vitro IgE testing. Studies show that the clinical benefits of sublingual immunotherapy can continue even after the treatment is discontinued. One of the grass sublingual immunotherapy products (timothy grass) has an FDA approved indication for sustained effectiveness following cessation of treatment. Local reactions with sublingual immunotherapy can affect about 75% of patients. Itching or irritation of the lips, tongue, ears and throat are common symptoms, as are gastrointestinal symptoms such as nausea or abdominal pain. Most (but not all) local reactions improve or resolve within 2 weeks. Severe, life-threatening anaphylactic reactions are very rare. Thus, sublingual immunotherapy can be administered at home.
Sublingual immunotherapy is a good treatment option when a patient with allergic rhinitis is sensitive to grass or ragweed pollen, when immunotherapy outside a physician’s office is preferred, and when the potential for sustained effectiveness is valued.
The Journal of Allergy and Clinical Immunology (JACI) is the official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.