Sublingual Immunotherapy (allergy drops)

Powder Tops Drops for Treating Milk Allergies

2011-12-13T07:07:00.000-05:00

A larger percentage of children with cow's milk allergies achieved desensitization with high doses of powdered milk protein than with low-dose liquid drops, according to a small, randomized study. After therapy, one of 10 patients in the liquid drops group passed a milk challenge, compared with six of 10 patients in a low-dose milk powder group and eight of 10 patients in a high-dose milk powder group, reported Corinne Keet, MD, from Johns Hopkins Hospital, and colleagues.

Oral and sublingual immunotherapies are viable therapies for food allergies, but the optimal mode of administration, mechanism of action, and duration of response are unknown, the authors explained. Previous research by these investigators demonstrated that both approaches can mitigate allergic symptoms, but this is the first head-to-head comparison of the two therapies with regard to efficacy and side effects.

Limitations to this study included the lack of a placebo group and variations in the day-to-day food challenge threshold. Also, the study did not assess whether starting liquid drops first eased the transition to milk powder.

The findings highlight the value of routine milk consumption to preserve desensitization and to avoid relapse, the authors said. The investigators called for more research and warned that because of the risk for serious allergic reactions, neither therapy should be undertaken without medical supervision.

http://www.medpagetoday.com/AllergyImmunology/Allergy/30180

From Medscape Medical News: Sublingual Immunotherapy Improves Ragweed Allergy

2011-11-10T07:07:00.000-05:00

November 9, 2011 (Boston, Massachusetts) — Sublingual immunotherapy for ragweed allergy with ragweed allergy immunotherapy tablets (AIT) is safe and effective, according to a first of its kind study of more than 500 multisensitized North American adults, presented in a poster session here at the American College of Allergy, Asthma & Immunology (ACAAI) 2011 Annual Scientific Meeting.
http://www.medscape.com/viewarticle/753209

Allergen-specific sublingual immunotherapy in the treatment of migraines: a prospective study

2011-10-11T14:43:00.000-04:00

In patients with allergic rhinitis, migraine development and course may have a significant allergic component. Assessment of migraineurs for the possibility of co-existing allergic rhinitis is justified. Treatment of allergic rhinitis by immune response modifiers, such as immunotherapy, may have a place in the management of migraines for these patients.

The allergic patients in this study with migrane were successfully treated with sublingual immunotherapy.

D.S. Theodoropoulos, D.R. Katzenberger, W.M. Jones et al. Eur Rev Med Pharmacol Sci 2011; 15 (10): 1117-1121. http://www.europeanreview.org/article/1044

Stamford University has now joined the list of studies looking at sublingual immunotherapy.

2011-10-09T11:55:00.000-04:00

Go to http://med.stanford.edu/clinicaltrials/detail.do?studyId=8549.

Sublingual immunotherapy for allergic conjunctivitis: Cochrane systematic review and meta-analysis

2011-08-25T21:05:00.000-04:00

Background. Allergic conjunctivitis (AC) is a common manifestation and represents an important co-morbidity of allergic rhinitis (AR). Sublingual immunotherapy (SLIT) is an effective and safe treatment for nasal symptoms of AR; its effectiveness is however less well established for ocular symptoms.

Objectives. To evaluate the effectiveness of SLIT in reducing ocular symptoms, the need for ocular treatments and the threshold exposure for conjunctival immediate allergen sensitivity (CIAS).

Methods. We searched eight databases up to January 2010. We included only randomized controlled trials (RCT), double-blind and placebo-controlled evaluating the efficacy of SLIT in patients with symptoms of allergic rhinoconjunctivitis (ARC) or AC. Primary outcome measures were total ocular symptom scores, individual ocular symptoms scores (itchy eyes, eye redness, watery eyes, swelling eyes), eye drops use and CIAS. Meta-analysis was undertaken using RevMan 5 software.

Results. From 811 abstracts that were screened, 109 studies were reviewed in their full text version. Forty two trials including 3958 participants (n=2011 SLIT and n=1947 placebo) had data suitable for inclusion in the meta-analysis. SLIT induced a significant reduction on both total ocular symptom scores (SMD: −0.41; 95%CI: −0.53 to −0.28; I²: 59%) and individual ocular symptoms scores [red (−0.33; −0.45 to −0.22), itchy (−0.31; −0.42 to −0.20) and watery eyes (−0.23; −0.34 to −0.11)] compared with placebo. Participants in the SLIT group showed an increase in the threshold dose for the CIAS (SMD: 0.35; 0.00–0.69). No significant reduction was observed on eye drops use (SMD: −0.10; −0.22 to 0.03).

Conclusions and Clinical Relevance. SLIT is effective in reducing total and individual ocular symptom scores in subjects with ARC or conjunctivitis. No significant reduction was observed in ocular eye drops use.

Cite this as: M. A. Calderon, M. Penagos, A. Sheikh, G. W. Canonica and S. R. Durham, Clinical & Experimental Allergy, 2011 (41) 1263–1272. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2222.2011.03835.x/abstract

Efficacy of sublingual immunotherapy for grass pollen allergy sustained over time

2011-08-12T11:53:00.000-04:00

The link below is a video clip from www.thedoctorschannnel.com reporting that sublingual immunotherapy (SLIT) is effective.
http://www.thedoctorschannel.com/video/4602.html

ALK: Phase III studies with ragweed allergy immunotherapy tablet (AIT) meet primary endpoints

2011-08-04T07:25:00.000-04:00

ALK announces successful outcome of two Phase III clinical studies of the new innovative ragweed tablet. Both studies met the primary efficacy endpoints and the efficacy results were consistent between the two studies. Copenhagen, 2011-08-03 12:53 CEST (GLOBE NEWSWIRE) --

http://www.cisionwire.com/alk-abello-g/r/alk--phase-iii-studies-with-ragweed-allergy-immunotherapy-tablet--ait--meet-primary-endpoints,e249906

This study among others will lead the Food and Drug Administration (FDA) to ultimately approve sublingual immunotherapy (SLIT) for commerial use.

Sublingual immunotherapy (SLIT) review: effective, with no reported anaphylaxis or epinephrine use

2011-08-01T07:39:00.000-04:00

Allergic rhinitis is common worldwide, with significant morbidity and impact on quality of life. In patients who don’t respond adequately to anti-allergic drugs, subcutaneous allergen immunotherapy (SCIT) is effective but requires specialist administration. Sublingual immunotherapy (SLIT) may represent an effective and safer alternative, according to the review authors. I would add that SLIT requires specialist prescription and monitoring as well.

This Cochrane systematic review is an update of one published in 2003, and included 49 randomised, double-blind, placebo- controlled trials of sublingual immunotherapy in adults and children. There were significant reductions in symptoms (standardised mean difference (SMD), −0.49; P less than 0.00001) and medication requirements (SMD −0.32) compared with placebo. None of the trials reported severe systemic reactions, anaphylaxis or use of adrenaline (epinephrine). The authors concluded that sublingual immunotherapy (SLIT) is effective for allergic rhinitis and appears a safe route of administration.

References: Radulovic S, Wilson D, Calderon M, Durham S. Systematic reviews of sublingual immunotherapy (SLIT). Allergy 2011; DOI: 10.1111/j.1398-9995.2011.02583.x.

Allergy Notes: Allergy and Asthma News Updated Daily by Allergist and Assistant Professor at University of Chicago. http://allergynotes.blogspot.com/2011/07/sublingual-immunotherapy-slit-review.html.

Sublingual immunotherapy for allergic respiratory diseases: efficacy and safety.

2011-05-07T10:09:00.000-04:00

Subcutaneous immunotherapy (SCIT) is effective and safe when properly prescribed and administered. However, a certain risk of severe side effects exists, even when the reaction is managed correctly. These potential adverse effects stimulated the search for new administration routes (nasal, bronchial, oral, sublingual), which were expected to be safer. Not all of these alternative routes provided an improved benefit-safety profile compared with SCIT. The sublingual route (SLIT) seemed to be a good candidate for the clinical practice because of its satisfactory safety profile and is now considered an acceptable alternative to SCIT in adults and children.

Passalacqua G, Canonica GW. Immunol Allergy Clin North Am. 2011 May;31(2):265-77.
http://www.ncbi.nlm.nih.gov/pubmed/21530819

Sublingual Immunotherapy Offers Hope for Children With Peanut Allergy: Presented at AAAAI

2011-03-27T07:35:00.000-04:00

SAN FRANCISCO -- March 24, 2011 -- Sublingual immunotherapy has demonstrated that it can desensitise children who are allergic to peanut protein, according to results from one of the first trials of its kind, presented at the 2011 American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting.

There are currently no treatments available for peanut allergy, noted principal investigator Wesley Burks, MD, Duke Medical Center, Durham, North Carolina.

“There was a wide range of peanuts that these children tolerated following sublingual immunotherapy treatment, or ‘SLIT,’” Dr. Burks stated during an oral presentation on March 23. “We saw individual kids on active treatment who could tolerate 2,500 mg of peanuts at the end of the study compared to 85 mg and less in the placebo arm.”

Dr. Burks and colleagues conducted a 6-month, double-blind, placebo-controlled dose-escalation trial to a total of 2,000 mcg of peanut protein daily. The dose escalation was followed by 6 months of maintenance dosing before a double blind, placebo-controlled food challenge. A total of 18 children, aged 1 to 11 years of age at the beginning of the trial, completed the 1-year study and the food challenge. Eleven children were in the treatment arm and 7 were in the placebo arm.

The study was halted early because the treatment arm showed such strong evidence of efficacy, Dr. Burks noted.

During the final food challenge, children in the active arm were able to consume 20 times more peanuts -- a median of 1,710 mg (6 or 7 peanuts) – than children in the placebo arm, who could tolerate a median of 85 mg -- about 20% of a single peanut (P =.011).

Children in the treatment group showed an increase in peanut-specific immunoglobulin E over the first 4 months of the trial (P =.002) compared with the placebo group, then a steady decrease over the next 8 months (P =.003).

At the same time, peanut-specific immunoglobulin G4 increased over the 12 months of the trial (P =.014). Treatment also produced significantly smaller skin-prick-testing wheals (P =.020) and a decrease in the secretion of interleukin 5 after 12 months (P =.015).

There were no statistically significant differences in the percentage of T regulatory cells or interleukin 10 and interferon-gamma secretion between the groups, Dr. Burks noted.

The study is continuing, with all of the children in the placebo group moving to active treatment. Tolerance of peanut protein in the original placebo group has increased from a median of 85 mg to more than 500 mg in the latest food challenge, the researchers stated. The goal is to follow these children for a longer term to determine whether peanut tolerance continues to increase and whether the clinical effects of SLIT are long lasting.

[Presentation title: Evidence of Desensitization by Sublingual Immunotherapy in Peanut-Allergic. Abstract 269] http://beta.docguide.com/sublingual-immunotherapy-offers-hope-children-peanut-allergy??tsid=25

The current role of sublingual immunotherapy in the treatment of allergic rhinitis in adults and children

2011-02-21T16:27:00.000-05:00

Allergic rhinitis is a very common disease affecting about 20% of people. It may be treated by allergen avoidance when possible, by antiallergic drugs such as antihistamines and topical corticosteroids, and by allergen-specific immunotherapy. The latter is the only treatment able to act on the causes and not only on the symptoms of respiratory allergy and is able to maintain its efficacy even after stopping, provided an adequate duration of treatment of 3–5 years is ensured. Sublingual immunotherapy (SLIT) was introduced in the 1990s as a possible solution to the problem of adverse systemic reactions to subcutaneous immunotherapy and has been demonstrated by more than 50 trials and globally evaluated thus far by five meta-analyses as an effective and safe treatment for allergic rhinitis. Life-threatening reactions are extremely rare. However, it is important to note that clinical efficacy occurs only if SLIT meets its needs, ie, sufficiently high doses are regularly administered for at least 3 consecutive years. This is often overlooked in the current practice and may prevent the same success reported by trials from being achieved.

Incorvaia C, Masieri S, Scurati S, et al. Journal of Asthma and Allergy. 4:13-17. 2011 http://www.dovepress.com/the-current-role-of-sublingual-immunotherapy-in-the-treatment-of-aller-peer-reviewed-article-JAA

Sublingual immunotherapy (SLIT) for peanut allergy: Clinical and immunologic evidence of desensitization

2011-02-08T09:41:00.000-05:00

January 31, 2011. Kim EH, Bird JA, Kulis M et al. The Journal of Allergy and Clinical Immunology. in press.

Background. There are no treatments currently available for peanut allergy. Sublingual immunotherapy (SLIT) is a novel approach to the treatment of peanut allergy. Objective. We sought to investigate the safety, clinical effectiveness, and immunologic changes with SLIT in children with peanut allergy. Methods. In this double-blind, placebo-controlled study subjects underwent 6 months of dose escalation and 6 months of maintenance dosing followed by a double-blind, placebo-controlled food challenge. Results. Eighteen children aged 1 to 11 years completed 12 months of dosing and the food challenge. Dosing side effects were primarily oropharyngeal and uncommonly required treatment. During the double-blind, placebo-controlled food challenge, the treatment group safely ingested 20 times more peanut protein than the placebo group (median, 1,710 vs 85 mg; P = .011). Mechanistic studies demonstrated a decrease in skin prick test wheal size (P = .020) and decreased basophil responsiveness after stimulation with 10−2 μg/mL (P = .009) and 10−3 μg/mL (P = .009) of peanut. Peanut-specific IgE levels increased over the initial 4 months (P = .002) and then steadily decreased over the remaining 8 months (P = .003), whereas peanut-specific IgG4 levels increased during the 12 months (P = .014). Lastly, IL-5 levels decreased after 12 months (P = .015). No statistically significant changes were found in IL-13 levels, the percentage of regulatory T cells, or IL-10 and IFN-γ production. Conclusion. Peanut SLIT is able to safely induce clinical desensitization in children with peanut allergy, with evidence of immunologic changes suggesting a significant change in the allergic response. Further study is required to determine whether continued peanut SLIT is able to induce long-term immune tolerance.

http://www.jacionline.org/article/S0091-6749(10)03043-5/abstract

Immunological mechanisms of sublingual allergen-specific immunotherapy.

2011-01-23T13:07:00.000-05:00

Within the last 100 years of allergen-specific immunotherapy, many clinical and scientific efforts have been made to establish alternative noninvasive allergen application strategies. Thus, intra-oral allergen delivery to the sublingual mucosa has been proven to be safe and effective. As a consequence, to date, sublingual immunotherapy (SLIT) is widely accepted by most allergists as an alternative to conventional subcutaneous immunotherapy. Although immunological mechanisms remain to be elucidated in detail, several studies in mice and humans within recent years provided deeper insights into local as well as systemic immunological features in response to SLIT. First of all, it was shown that the target organ, the oral mucosa, harbours a sophisticated immunological network as an important prerequisite for SLIT, which contains among other cells, local antigen-presenting cells (APC), such as dendritic cells (DCs), with a constitutive disposition to enforce tolerogenic mechanisms. Further on, basic research on local DCs within the oral mucosa gave rise to possible alternative strategies to deliver the allergens to other mucosal regions than sublingual tissue, such as the vestibulum oris. Moreover, characterization of oral DCs led to the identification of target structures for both allergens as well as adjuvants, which could be applied during SLIT. Altogether, SLIT came a long way since its very beginning in the last century and some, but not all questions about SLIT could be answered so far. However, recent research efforts as well as clinical approaches paved the way for another exciting 100 years of SLIT.

Novak N, Bieber T, Allam JP. Allergy. 2011 Jan 20
http://medicine.journalfeeds.com/allergy/immunological-mechanisms-of-sublingual-allergen-specific-immunotherapy/20110122/

Long-Term Control of Dust Mite Allergies With Sublingual Immunotherapy

2010-12-14T21:15:00.003-05:00

World Allergy Organization (WAO) 2010 International Scientific Conference. Presented December 7, 2010 (Dubai, United Arab Emirates) — Four years of sublingual immunotherapy (SLIT) was found to confer benefits that were maintained for 8 years post-SLIT, and response to retreatment at 8 years was more rapid than the initial response. In addition, 4 years of SLIT were found to be more cost-effective than 3 or 5 years in patients with house dust mite allergy, according to the results of a 15-year follow-up study. The study involved 78 patients with a respiratory allergy to house dust mites; 59 completed the study. Researchers divided patients into 4 groups: pharmacotherapy (control group), SLIT for 3 years, SLIT for 4 years, and SLIT for 5 years. After treatment was stopped, the patients were followed for an additional 8 years. In patients who received SLIT for 3 years, the effect persisted for 7 years. In those who received SLIT for 4 or 5 years, the effect persisted for 8 years. In all 3 SLIT groups, the symptoms and medication scores were significantly different from baseline starting from the first year of the study. This difference remained significant at every year until the end of the study.

http://www.medscape.com/viewarticle/734108

"Sublingual immunotherapy for allergic rhinitis" Cochrane Rev 2010.

2010-12-07T22:13:00.000-05:00

Suzana Radulovic, MD, PhD, of St. Thomas' Hospital in London, England, and colleagues reported in the Cochrane Review an analysis of 60 trials found that SLIT treatment was associated with a significant reduction in symptoms and medication requirements when compared with placebo. Cochrane Review is a widely respected peer reviewed publication that often attempts to analyze other unrelated studies to objectively determine if the literature supports or does not support a conclusion in medicine and in the care of patients.

"These data continue to support the clinical efficacy of sublingual immunotherapy for allergic rhinitis," Radulovic and co-authors wrote.

SLIT involves giving small but increasing doses of the allergen under the tongue as immunotherapy in either pill or drop form. It's more commonly used in patients who are refractory to treatment with antihistamines and nasal corticosteroids.

The review follows a meta-analysis done in 2003, which also suggested that sublingual therapy was effective, but the findings were based on a smaller number of trials. Much more evidence has accumulated since then, the researchers said.

In their current review, which added 38 trials including those involving pollen, dust mites, and cat allergens for a total of 60 studies, Radulovic and colleagues found a significant reduction in symptoms and medication requirements in patients on sublingual therapy compared with placebo (P<0.00001 for both).

"The overall results of the meta-analysis differ little from those seen in 2003," they wrote, "with the overall effect for symptom scores being of a similar magnitude, with tighter confidence intervals reflecting the greatly increased number of study subjects."

In terms of safety, the researchers said that local reactions were common and reported more frequently among those on sublingual immunotherapy compared with placebo.

But none of the trials reported severe systemic reactions or anaphylaxis to SLIT, and none of the systemic reactions required the use of adrenaline, they added. Systemic reactions were largely confined to upper respiratory tract -- although they were more frequent among patients on sublingual therapy.

"SLIT remains a safe treatment with an extremely low incidence of significant side effects," the authors wrote.

When they looked at the results by age, the researchers found that the SLIT treatment was significantly effective for both adults and children (P=0.001 and P<0.00001, respectively).

"SLIT represents a particularly attractive alternative to injection immunotherapy [among children] and our findings are entirely consistent with those reported elsewhere," Radulovic and co-authors commented.

They also found that doses under 5 mcg were not significantly effective, while doses higher than that level -- and those greater than 20 mcg -- were effective for allergic rhinitis.

The length of treatment may also be important, the researchers added. The study showed a trend in symptom score reduction in trials that latest for longer than 12 months.

"Indeed, SLIT is now given for longer time periods, and more recent studies have shown that treatment for longer than 12 months provides consistent clinical improvement in symptom and medication scores," the group wrote.

They noted that there were too few studies to compare sublingual immunotherapy directly with subcutaneous immunotherapy -- so more head-to-head trials are needed.

Still, Radulovic and colleagues concluded that sublingual therapy is "now established as a viable alternative to allergen injection immunotherapy, with a significantly lower risk profile and, on the basis of meta-analyses, little difference in overall efficacy."
http://www.medpagetoday.com/AllergyImmunology/Allergy/23794

House Dust Mite-Induced Asthma Safely, Effectively Controlled by Sublingual Immunotherapy: Presented at ACAAI

2010-11-20T08:26:00.000-05:00

PHOENIX, Ariz -- November 15, 2010 -- House dust mite (HDM)-induced asthma has been shown to be responsive to sublingual immunotherapy (SLIT) in one of the first, large SLIT-controlled studies performed in China, researchers reported here at the 2010 Annual Meeting of the American College of Allergy, Asthma and Immunology (ACAAI).

In fact, "patients with moderate asthma have more than twice the chance to be either well controlled or totally controlled with SLIT than with a placebo," noted lead investigator Jian Yin, MD, Peking University Medical College Hospital, Beijing, China.
Dr. Yin and his team reported here on November 14 that SLIT can be used successfully without adverse events and with good overall safety in adult patients with moderate, persistent asthma attributable to HDM, based on the results of their double-blind, placebo-controlled study. The team screened 699 patients from 14 clinics throughout China and separated 484 of them into 2 groups: 308 active and 157 placebo.

http://www.docguide.com/news/content.nsf/news/852576140048867C852577DC00752FE6?OpenDocument&c=&count=10&id=48DDE4A73E09A969852568880078C249

Preventing progression of allergic rhinitis: the role of specific immunotherapy

2010-11-07T14:47:00.003-05:00

November 2010, London, England - Allergic rhinitis and asthma are examples of allergic airways disease. Despite their differing symptomatology, both disorders affect the mucosal lining of the respiratory tract and are linked by common underlying cellular processes, thus, using the ‘united airways’ approach, they can be considered part of the same allergic disease. The conditions are often comorbid, and there is evidence to suggest that allergic rhinitis in children is a significant risk factor for subsequent development of asthma. Management strategies that target the underlying cause of allergic rhinitis in children have the potential to offer additional symptom control above that of symptomatic medications, and prevent disease progression. Specific immunotherapy (SIT) is the only currently available treatment that is proven to target the disease in this way. SIT affects the underlying cause of allergic rhinitis, producing changes in antibody responses to allergens. It has been shown to be effective in the reduction of allergic rhinitis symptoms in both children and adults, with effects being sustained for several years after treatment completion. Furthermore, a number of trials provide evidence that SIT may prevent the development of new sensitisations and asthma in children and adults with allergic rhinitis. One such open-label, randomised controlled study in children/adolescents (the Preventive Allergy Treatment Study) showed that significantly fewer patients who received 3 years of SIT for grass/birch pollen-induced allergic rhinitis had developed asthma 10 years after treatment initiation versus controls. Some clinical guidelines acknowledge this potential asthma preventive effect in children and the need for additional data from double-blind, placebo-controlled trials to support these findings.
Arch Dis Child Educ Pract Ed doi:10.1136/adc.2010.183095
http://www.ep.bmj.com/content/early/2010/11/01/adc.2010.183095.abstract

(This study used sublingual immunotherapy since injection immunotherapy is not available in England due to its risk of anaphylaxis.)

Long-lasting effects of sublingual immunotherapy according to its duration: A 15-year prospective study

2010-10-12T07:23:00.000-04:00

Marogna M, Spadolini I, Massolo A et al. The Journal of Allergy and Clinical Immunology.published online 11 October 2010.
Background. Data on the long-term effects of sublingual immunotherapy (SLIT) are sparse, and the optimal duration of treatment is a matter of debate.
Objective. We sought to prospectively evaluate the long-term effect of SLIT given for 3, 4, or 5 years and to compare the effect of those different durations.
Methods. In this prospective open controlled study we followed up patients with respiratory allergy who were monosensitized to mites for 15 years. The subjects were divided in 4 groups receiving drug therapy alone or SLIT for 3, 4, or 5 years. Clinical scores, skin sensitizations, methacholine reactivity, and nasal eosinophil counts were evaluated every year during the winter months. The clinical effect was considered to persist until clinical scores remained at less than 50% of the baseline value, and then patients underwent another course of SLIT.
Results. Seventy-eight patients were enrolled, and 59 completed the study. In the 12 control subjects no relevant change in clinical scores was seen throughout the study. In the patients receiving SLIT for 3 years, the clinical benefit persisted for 7 years. In those receiving immunotherapy for 4 or 5 years, the clinical benefit persisted for 8 years. New sensitizations occurred in all the control subjects over 15 years and in less than a quarter of the patients receiving SLIT (21%, 12%, and 11%, respectively). The second course of vaccination induced a benefit more rapidly than the first course. The behavior of bronchial hyperreactivity and nasal eosinophils paralleled the clinical score.
Conclusion. Under the present conditions, it can be suggested that a 4-year duration of SLIT is the optimal choice because it induces a long-lasting clinical improvement similar to that seen with a 5-year course and greater than that of a 3-year vaccination.

http://www.jacionline.org/article/S0091-6749(10)01325-4/abstract

Duke University publicizes that sublingual immunotherapy can treat life-threatening peanut allergy.

2010-09-30T10:35:00.000-04:00

Dr. Wesely Burks, chief of the division of allergy and immunology in the department of pediatrics at Duke University Medical Center, was quoted and featured in an article in the Duke University newspaper, The Chronicle. He and others are conducting studies in oral and sublingual immunotherapy that have made it possible for some children with once-fatal peanut allergies to safely consume peanut products. His subjects receive low doses of peanut daily—increasing from minute to larger doses over a period of years—that desensitize their immune systems to the consumption of peanuts. Some patients can tolerate between 10 and 20 peanuts after several months of treatment, Burks said.

http://dukechronicle.com/article/researcher-develops-immunotherapy-control-peanut-allergies

Is Oral Immunotherapy the Cure for Food Allergies?

2010-09-12T10:47:00.000-04:00

Purpose of review: To review current evidence on food oral immunotherapy (OIT).
Recent findings: Desensitized state, defined as the ingestion of a substantial amount of food in the home diet that protects from severe reactions to accidental exposures, can be achieved by approximately 50–75% of the children treated with OIT. The rate of permanent tolerance is unknown; the longer duration of OIT may result in permanent tolerance. Side effects are common both during the initial dose escalation and during home dosing. Most reactions are mild (oral pruritus, abdominal discomfort, and rashes) and decrease in frequency with the longer duration of OIT. Severe reactions treated with epinephrine have been reported during home dosing. Factors associated with increased risk of reactions to previously tolerated doses during home dosing include exercise, viral infection, dosing on empty stomach, menses, and asthma exacerbation.

Nowak-Węgrzyn A & Fiocchi A. Curr Opin Allergy Clin Immunol. 2010; 10(5):vii-ix. Authors are from the Jaffe Food Allergy Institute and Department of Pediatrics, Mount Sinai School of Medicine, New York, USA and Department of Child & Maternal Medicine, University of Milan Medical School at the Melloni Hospital, Milan, Italy.

http://www.medscape.com/viewarticle/726430

Allergy Shots Are Helpful for Some Asthmatics, Risky for Others

2010-08-08T19:31:00.000-04:00

By Laura Kennedy, Contributing Writer, Health Behavior News Service

Allergy shots can reduce symptoms of asthma, use of inhaled medications and allergy-related asthma attacks, confirms an updated review of studies. Yet, the treatment can also cause systemic side effects that range from a stuffy nose to fatal anaphylactic shock.

The number of patients experiencing systemic reactions of any severity nears 20 percent, the reviewers say, although they note that more than 8 percent of patients receiving placebo experience similar reactions. Fatalities remain extremely rare at one death per 2.5 million injections.

Immunotherapy is most risky for patients with poorly controlled asthma, said Harold Nelson, M.D., of National Jewish Health, a Denver hospital specializing in respiratory, cardiac, immune and related disorders. Nelson is an international authority on immunotherapy. “People with treatment-resistant asthma are not candidates for allergy shots,” he said. Allergists should also review each patient’s symptoms before every injection, Nelson said. “Patients shouldn’t be actively wheezing, they shouldn’t be waking up at night due to asthma symptoms and their pulmonary function should be relatively normal.” If symptoms are flaring up, doctors should postpone the injection. Professional guidelines recommend that patients remain under observation for 30 to 45 minutes after an injection, so that clinicians can recognize any serious reactions and treat them immediately.

“Among allergists there’s no question that asthma caused by allergies is responsive to immunotherapy,” Nelson said. “The advantage of immunotherapy is that it causes long-lasting, if not permanent, improvement.” Furthermore, most people who have allergy-induced asthma also have nasal symptoms, Nelson said. “They have to inhale steroids into their lungs and spray them into their nose, and a lot of people don’t like to do that forever. Immunotherapy treats both the nasal and chest symptoms.”

The review authors say that allergy drops, which patients place under the tongue, might offer effective asthma control with a reduced risk of serious side effects. While widely used in Europe and the United Kingdom, the U.S. Food and Drug Administration has not yet approved “sublingual immunotherapy.”

“During my training as a respiratory physician, I was taught that this was a potentially dangerous form of therapy that was of no benefit in asthma, Abramson said. “I personally have changed my views since working on this series of reviews.”

Abramson MH, Puy RM, Weiner JM. Injection allergen immunotherapy for asthma. Cochrane Database of Systematic Reviews 2010, Issue 8.

http://www.cfah.org/hbns/archives/getDocument.cfm?documentID=22288

Oral peanut immunotherapy in children with peanut anaphylaxis

2010-07-13T07:41:00.000-04:00

The only treatment option for peanut allergy is strict avoidance. However, accidental ingestion followed by allergic reactions is common because of the widespread use of peanuts. As reported in this issue of the Journal, Blumchen et al investigated the efficacy and safety of oral immunotherapy (OIT) in children with peanut anaphylaxis. Twenty-three children with IgE-mediated peanut allergy confirmed by positive double-blind, placebo-controlled food challenges (DBPCFCs) were recruited. After receiving OIT following a 7-day-Rush protocol with roasted peanut, most of the children did not tolerate a protective dose of at least 500 mg of peanut. After continuation with a long-term protocol with daily peanut intake and biweekly dose increases, 14 of the 23 patients finally reached the protective dose; however, mild to moderate side effects were common. OIT was discontinued in 4 patients because of adverse events. As shown in the Figure, threshold levels at final DBPCFC were increased significantly in comparison to DBPCFC before OIT. In general, a long-term protocol for OIT seems to be a quite safe and effective treatment to protect many peanut-allergic patients against accidental reactions. However, until the risk-benefit ratio has been further evaluated in larger controlled studies, OIT for peanut-allergic patients cannot be considered as a therapeutic strategy for routine clinical practice.

“Oral peanut immunotherapy in children with peanut anaphylaxis” Remarks by Beyer et al. (JACI July 2010 / Volume 126, No. 1)

http://aaaai.org/patients/jaci/content.asp?contentid=9894

Sublingual immunotherapy in children – ready for prime time?

2010-06-10T08:34:00.000-04:00

June 7, 2010 - After a decade of controversies, high-dose sublingual immunotherapy (SLIT) has been demonstrated to be a safe and effective therapy option for adults and children with pollen. Studies have clearly shown that there is a dose-response relationship with regard to reduction of symptoms and symptomatic medication intake. Moreover, comparison of different trials indicate the fact that clinical efficacy of SLIT may depend on the duration of therapy. Therefore, for both children and adults, SLIT should only be performed with high-dose preparations providing documented efficacy for a sufficient period ot time to ensure that the best benefit is achieved.

Pediatric Allergy and Immunology. Volume 21 Issue 4p1, Pages 559 - 563. Published Online: 7 Jun 2010

http://www3.interscience.wiley.com/journal/123498108/abstract?CRETRY=1&SRETRY=0

Is oral immunotherapy the cure for food allergies?

2010-05-03T07:22:00.001-04:00

Current Opinion in Allergy and Clinical Immunology: June 2010 - Volume 10 - Issue 3 - p 214–219.

Purpose of review: To review current evidence on food oral immunotherapy (OIT).

Recent findings: Desensitized state, defined as the ingestion of a substantial amount of food in the home diet that protects from severe reactions to accidental exposures, can be achieved by approximately 50–75% of the children treated with OIT. The rate of permanent tolerance is unknown; the longer duration of OIT may result in permanent tolerance. Side effects are common both during the initial dose escalation and during home dosing. Most reactions are mild (oral pruritus, abdominal discomfort, and rashes) and decrease in frequency with the longer duration of OIT. Severe reactions treated with epinephrine have been reported during home dosing. Factors associated with increased risk of reactions to previously tolerated doses during home dosing include exercise, viral infection, dosing on empty stomach, menses, and asthma exacerbation.

Summary: These preliminary data on OIT are encouraging. Additional studies must answer multiple questions including optimal dose, ideal duration of oral/sublingual immunotherapy, degree of protection, efficacy for different ages, severity and type of food allergy responsive to treatment and need for patient protection during home administration. Until these questions are answered in rigorous multicenter randomized and placebo-controlled trials, OIT remains an experimental approach with not sufficiently well established risk-to-benefit ratio.

http://journals.lww.com/co-allergy/Abstract/2010/06000/Is_oral_immunotherapy_the_cure_for_food_allergies_.11.aspx

Evidence-based evaluation of grass pollen immunotherapy

2010-04-07T08:15:00.002-04:00

Calderon M, et al. Towards evidence-based medicine in specific grass pollen immunotherapy. Allergy, 2009 (December); 65(4):420-434, published online.

The authors of this study performed a literature review of studies designed to assess the efficacy of grass pollen immunotherapy. They utilized Medline, EMBASE, and the Cochrane Library, reviewing articles through January 2009. They were able to find 33 randomized, double-blind, placebo-controlled trials. Seven of these were pediatric trials.

These trials contained a total of 440 patients for subcutaneous immunotherapy (SCIT); 168 pediatric patients were included. They reviewed trials containing 906 patients studied with sublingual immunotherapy (SLIT). Some of the trials involved the use of allergoids.

From a review of these studies which were multinational, they concluded that there were multinational, rigorous trials of grass pollen immunotherapy, and that these trials offered evidence-based support that specific immunotherapy was effective, and that "SLIT tablets for grass pollen in the treatment of seasonal allergic rhinitis provide the specialist physician with the strongest levels of evidence for drawing reliable conclusions.

http://www.aaaai.org/patients/jaci/content.asp?contentid=9786

Sublingual immunotherapy against latex sensitivity.

2010-03-08T08:39:00.000-05:00

A new study by Italian researchers presented at the World Allergy Organization XXI World Allergy Congress (Buenos Aires, Argentina, December 6-10, 2009) has shown that sublingual immunotherapy (SLIT) against latex allergy has a good safety profile, with only a minority of patients experiencing local adverse effects during the induction of immunotherapy. The adverse effects diminish during the maintenance phase.

The study enrolled 15 participants (11 females, four males) with occupational allergy to natural rubber latex products. The ages of the subjects ranged from 26-46 years (mean, 36.6 years). When diagnosed with latex sensitivity, eight patients had rhinitis, four had rhinitis and asthma and three had urticaria. No other allergic respiratory disease was present. All patients were evaluated with skin-prick tests for standard inhalant allergen extracts; they also received a skin-prick test with latex extract and serum-specific immunoglobulin E.

A four-day sublingual induction phase (in which patients received a cumulative dose of up to 500 [micro]g) was performed in the hospital. The maintenance phase was self-administered at home and consisted of three administrations per week for six months. The latex extract used (ALK-Abello) was an ammoniac extract similar to that used in latex gloves. Patients were asked to record adverse effects or adverse events possibly related to the SLIT, their time of onset, and any treatment.

Of the 15 subjects, three developed local adverse reactions: two reported mouth itching and one reported oral itching and tongue edema. The remaining 12 patients reported no reactions to the SLIT. No systemic reactions were reported.

http://www.thefreelibrary.com/Sublingual+immunotherapy+against+latex+sensitivity.-a0219590661

Paediatric Sublingual Immunotherapy Trial Safety Update: Presented at AAAAI

2010-03-03T22:08:00.001-05:00

March 3, 2010 -- In an interim analysis designed to understand the safety, efficacy, and potential mechanisms behind the development of desensitisation and tolerance in peanut-allergic children, sublingual immunotherapy (SLIT) trials appear safe in children allergic to peanuts. The study was presented here at the 2010 American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting on February 27.

http://www.docguide.com/news/content.nsf/news/852576140048867C852576DB00710C70

Merck Reports Results of Phase III Study of Investigational Oral Allergy Immunotherapy Tablet (AIT) in Patients Ages 5-17 with Grass Pollen Allergy

2010-03-03T10:08:00.000-05:00

March 2, 2010 - In new data from a Phase III study in 345 children and adolescents (ages 5-17 years), patients with grass pollen allergic rhinoconjunctivitis treated with Merck's investigational sublingual grass (Phleum Pratense) allergy immunotherapy tablet (AIT) showed a 26 percent greater improvement in the total combined score (daily symptom score and daily medication score), compared to patients receiving placebo (p=0.001). Allergic rhinoconjunctivitis, or runny nose and itchy, watery eyes due to allergies, is a common condition in children and adolescents. These data were presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting in New Orleans.

http://www.businesswire.com/portal/site/home/permalink/?ndmViewId=news_view&newsId=20100302006984&newsLang=en

'Milk Drops' Under the Tongue Appear to Treat Milk Allergies

2010-02-28T21:41:00.002-05:00

ScienceDaily (Feb. 28, 2010) — Placing small amounts of milk protein under the tongues of children who are allergic to milk can help them overcome their allergies, according to the findings of a small study at Johns Hopkins Children's Center and Duke University. The findings were presented Feb. 28 at the annual meeting of the American Academy of Allergy, Asthma & Immunology.

The approach, known as SLIT (sublingual immunotherapy), involves giving children small but increasingly higher doses of the food they are allergic to until their immune systems "learn" to tolerate the food without triggering an allergic reaction or triggering only mild symptoms.

To read the entire story, go to http://www.sciencedaily.com/releases/2010/02/100228203213.htm

Sublingual immunotherapy in patients with allergic rhinoconjunctivitis caused by ragweed pollen

2010-02-17T08:48:00.002-05:00

BACKGROUND: Specific allergen immunotherapy is most often delivered subcutaneously, but sublingual immunotherapy may confer greater benefit in terms of tolerability and safety, accessibility, and improved antigen delivery. OBJECTIVE: This randomized, double-blind, placebo-controlled trial was conducted to identify a safe and effective maintenance dose range of sublingual standardized glycerinated short ragweed pollen extract in adults with ragweed-induced rhinoconjunctivitis. METHODS: In May 2006, a total of 115 patients with ragweed-induced rhinoconjunctivitis were randomly allocated to placebo (n = 40), medium-dose extract (4.8 mug Amb a 1/d; n = 39), or high-dose extract (48 mug Amb a 1/d; n = 36). In a 1-day (rush) dose-escalation regimen, ragweed pollen extract was administered sublingually in incremental doses until maximum tolerable or scheduled dose was reached and then maintained during the ragweed pollen season. Patient diaries were used to monitor nasal and ocular symptoms and medication. The primary endpoint was symptom score. RESULTS: Both active treatment groups achieved a 15% reduction in total rhinoconjunctivitis symptom scores compared with placebo during the entire ragweed pollen season, but the difference was not statistically significant (P > .10) However, in an analysis of covariance correcting for preseasonal symptoms, both mean daily symptom scores (0.19 +/- 1.16 vs 1.00 +/- 2.30) and medication scores (0.0003 +/- 1.64 vs 0.63 +/- 1.06) for the entire pollen season were significantly reduced in the high-dose versus placebo groups, respectively. Ragweed-specific IgG, IgG(4), and IgA antibodies were increased after treatment in the medium- and high-dose groups and not the placebo group. Frequency of adverse events was similar between the placebo and treatment groups, but oral-mucosal adverse events occurred more often with treatment. CONCLUSION: Standardized glycerinated short ragweed pollen extract administered sublingually at maintenance doses of 4.8 to 48 mug Amb a 1/d was safe and can induce favorable clinical and immunologic changes in ragweed-sensitive subjects. However, additional trials are needed to establish efficacy.

J Allergy Clin Immunol. 2010 Feb 10. In press.

Comparison of allergen immunotherapy practice patterns in the United States and Europe.

2010-01-24T22:30:00.002-05:00

OBJECTIVE: To discuss important differences and similarities in the allergen specific immunotherapy (SIT) treatment practices for aeroallergen sensitivity in the United States and Europe. DATA SOURCES: Information on regulation and standardization in the United States and Europe was obtained from a Food and Drug Administration Allergenic Products Advisory Committee meeting, published literature, personal communications, and information obtained from the extract manufacturers. STUDY SELECTION: Information from the published literature included articles known to the authors and acknowledged consultants, textbooks, and PubMed, with search terms dependent on the particular subtopic. RESULTS: Key differences between Europe and the United States include allergen extract regulation, standardization, formulation, types of allergen extracts, routes of administration, and reimbursement. Most SIT is formulated in US allergists' offices, whereas virtually all SIT is formulated by extract manufacturers in Europe. Sublingual immunotherapy represents a significant percentage of SIT treatment in Europe (approximately 45%), but only a small percentage of US allergists (approximately 5.9%) prescribe sublingual immunotherapy. Similarities between European and US allergist specialists lie in their perception of SIT and approach to providing optimal SIT care, which is detailed in their practice guidelines. CONCLUSION: Significant differences and similarities exist in SIT practice patterns of US and European allergy specialists. The differences lie primarily in the availability of allergen extracts and how these extracts are formulated. A key similarity is that both recognize the need for ongoing research focused on developing safer and more effective SIT.

Cox L, Jacobsen L. Comparison of allergen immunotherapy practice patterns in the United States and Europe. Ann Allergy Asthma Immunol. 2009 Dec;103(6):451-59; quiz 459-61, 495.

http://www.ncbi.nlm.nih.gov/pubmed/20084837?dopt=AbstractPlus

Guidelines Issued for Sublingual Immunotherapy

2010-01-06T21:50:00.002-05:00

From Medscape Medical News
Laurie Barclay, MD

December 21, 2009 — Evidence-based guidelines for use of sublingual Immunotherapy (SLIT) are issued in the World Allergy Organization Position Paper 2009, reported in the November issue of the World Allergy Organization Journal. This article is co-published as a supplement to the December 2009 issue of Allergy.

"...SLIT has gained wide acceptance in many European countries and has raised the level of interest in immunotherapy among practicing allergists and primary care physicians," write World Allergy Organization (WAO) chair G. Walter Canonica, MD, from the University of Genoa in Genoa, Italy, and colleagues.

"Large pivotal double-blind, placebo-controlled, randomized clinical trials have confirmed the efficacy and safety of SLIT, although some negative trials have also been published. In 2008, the...[WAO] Board Of Directors decided that it was important and timely to advise our global constituents on the current State of the Art on SLIT, to offer consensus on its use based on currently available evidence and expert opinion, and to develop practice parameters."

On January 22-23, 2009, WAO convened a global consensus meeting on SLIT in Paris, France. Regional, national, and affiliate WAO member societies were represented, as were nongovernmental organizations working in the field of allergy, as well as Allergic Rhinitis and its Impact on Asthma, the European Federation of Allergy and Airway Diseases Patients Association, the International Primary Care Respiratory Group, the International Association of Asthmology, the Global Allergy and Asthma European Network, and others. The meeting and position statement were totally independent from funding or other influence of the pharmaceutical or the allergen extract/vaccine industries.

Topics in the Position Statement

In addition to offering guidelines for clinical practice using SLIT, the meeting aimed to identify unmet needs by analyzing recent and ongoing SLIT clinical trials and by recommending additional studies needed and appropriate methodology.

Topics included in the SLIT position statement are the following:

Introduction and historical background regarding SLIT.
Allergen-specific immunotherapy.
Mechanisms of SLIT.
Clinical efficacy of SLIT.
Safety of SLIT.
Effect of SLIT on the natural history of respiratory allergy.
Use of SLIT in children.
Guidelines and recommendations concerning SLIT.
Definition of patient selection for SLIT.
The future of immunotherapy in the community care setting.
Methodology of clinical trials evaluating SLIT.

In determining their recommendations for SLIT, the WAO noted that there have been several adequately powered, well-designed, randomized clinical trials. Findings from these studies suggest that high-dose, sublingual, specific immunotherapy is effective in carefully selected patients.

Appropriate indications for use of SLIT include rhinitis, conjunctivitis, and/or asthma caused by pollen and/or house dust mite (HDM) allergy. Although the safety of SLIT has been confirmed in randomized clinical trials, many patients report local adverse effects. Systemic reactions have been reported only rarely.

In appropriate patients, SLIT may be considered as initial treatment; failure of pharmacologic treatment is not required before starting therapy. Special SLIT indications exist in patients whose allergies are uncontrolled with optimal pharmacotherapy, patients in whom pharmacotherapy induces undesirable adverse effects, patients refusing injections, and patients who do not want to be receiving constant or long-term pharmacotherapy.

Immunotherapy Recommendations

To reduce risk and improve efficacy of SLIT, the WAO recommends the following considerations for starting immunotherapy:

There should be the presence of a demonstrated immunoglobulin E (IgE)–mediated disease, with positive skin test results and serum-specific IgE to an allergen concordant with clinical symptoms.
There should be documentation that the symptoms can be explained by specific sensitivity, based on appearance of symptoms related to exposure to the allergen(s) identified by allergy testing. Optional confirmation may include allergen challenge with the relevant allergen(s).
Severity and duration of symptoms should warrant use of SLIT, with confirmation from objective parameters such as missing time from work or school. For rhinoconjunctivitis, patients should have subjective symptoms of sufficient severity and duration. For asthma, the control questionnaire should not show uncontrolled asthma, and pulmonary function testing is required to exclude patients with severe asthma. Pulmonary function should be monitored during therapy.
SLIT therapy should only be started in settings where standardized or high-quality vaccines are available. Only specialists should prescribe specific immunotherapy. Subcutaneous immunotherapy should be administered only by physicians trained to manage systemic reactions if anaphylaxis occurs.
Although SLIT is administered at home, patients should be educated regarding possible risks and how to control adverse effects that may develop.
Patients with a single allergen sensitivity are more likely to benefit from specific immunotherapy vs patients sensitive to multiple allergens, but more data are needed in this area.
Specific immunotherapy will not benefit patients with nonallergic triggers.
For safety reasons, asthmatic patients must be asymptomatic when receiving SLIT injections. Asthmatic patients with severe airways obstruction are more likely to have lethal adverse reactions.
To maximize the efficacy and safety of SLIT in asthmatic patients, forced expiratory volume in 1 second with pharmacologic treatment should reach at least 70% of predicted values.

World Allergy Organization J. 2009;2:233-281.
Allergy. December 2009, supplement.

The above article is posted on-line at http://www.medscape.com/viewarticle/714137?src=rss.

Sublingual Immunotherapy for Grass Pollen Allergy Has Long-Lasting Effect

2009-12-24T08:29:00.001-05:00

A new study shows that sublingual immunotherapy against grass pollen allergy not only provides symptom relief during the period of administration, it also has long-lasting effects on symptom reduction 1 year after completing the course of treatment.

Presented December 9, 2009 at World Allergy Organization XXI World Allergy Congress (WAC), Buenos Aires, Argentina: Abstract 914.

http://www.medscape.com/viewarticle/713928
http://www.jacionline.org/article/S0091-6749(09)01583-8/abstract

Investigational Sublingual Allergy Immunotherapy Tablet Meets Primary Endpoint In A Study Of Adult Subjects With A History Of Grass Pollen Allergies

2009-12-23T22:06:00.000-05:00

Schering-Plough Corporation (NYSE: SGP) announced that its investigational sublingual Grass (Phleum Pratense) Allergy Immunotherapy Tablet (AIT) has met the primary endpoint in a Phase III study of adult subjects in the U.S. with a history of grass pollen induced rhinoconjunctivitis with or without asthma. The investigational Grass AIT treatment is designed to work by inducing a protective immune response against grass pollen allergy and providing sustained prevention of allergy symptoms, treating both the symptoms and the underlying cause of the disease.

The study was a U.S. multicenter, randomized, placebo-controlled, double-blind, parallel-group clinical trial evaluating the efficacy of the grass sublingual tablet versus placebo in the treatment of grass pollen-induced rhinoconjunctivitis based on the combined (sum of) rhinoconjunctivitis daily symptom score (DSS) and rhinoconjunctivitis daily medication score (DMS) averaged over the entire grass pollen season (GPS). In the study 439 adults were randomized to receive either placebo or grass tablet. The study met its primary endpoint. Additionally, the adverse events experienced by subjects receiving the drug in this study were similar to previous studies in adults and include oral itching, with no new or unexpected findings.

These data are planned to be submitted for presentation at a U.S. medical conference in 2010.

http://zikkir.com/health/20447

Article in the Journal of Asthma acknowledges that SLIT is efficacious and well-tolerated.

2009-12-20T11:10:00.000-05:00

Allergen-specific sublingual immunotherapy is now recognized to be an efficacious and well-tolerated treatment for allergic rhinitis. Emerging treatment strategies are also aimed at the primary treatment of allergic asthma, particularly allergy to house dust mites. Knowledge of the exact mechanisms of action of sublingual immunotherapy is at a basic level, although there appear to be similarities to the immunological changes seen in subcutaneous immunotherapy. An improved understanding should allow the development of more effective treatment programs and widen the potential use of this form of immunotherapy. This review discusses the possible mechanism of action of sublingual immunotherapy, including data from animal and clinical studies, while comparing this with the current understanding of subcutaneous immunotherapy.

G. Scadding & S. Durham‌, Mechanisms of Sublingual Immunotherapy. Journal of Asthma 2009, Vol. 46, No. 4, Pages 322-334.

http://informahealthcare.com/doi/abs/10.1080/02770900902785729

SLIT was succesful at treating peanut allergy at Duke

2009-12-18T15:33:00.003-05:00

Duke University School of Medicine is participating in a multi-institutional study looking at treating life threatening peanut allergy with sublingual immunotherapy (SLIT or allergy drops). Dr. Wesley Burks, Chief of the Division of Pediatric Allergy, was recently quoted in the Duke Medicine Review 2009, published and distributed by Duke University. According to Dr. Burks, "It appears these children have lost their peanut allergy." This is the first demonstration of long-term peanut tolerance in study participants, measured via immunologic indicators in the body. These finding were presented at the American Academy of Asthma and Immunology in Washington, DC.

Is SLIT Research in ENToday:Volume 4(4) April 2009 p 11

2009-12-12T09:36:00.001-05:00

In response to a letter to the editor of ENToday, Dr. Steven B. Levine described some of the misperceptions about sublingual immunotherapy even within the broader allegy professional community.

http://www.entoday.com/pt/re/entoday/fulltext.01265117-200904000-00007.htm;jsessionid=JspTq0v5sfNpbG4L98Ly7LylX0Q1MTcTsLqnF1BTTpTLpkmLD4vL!1553038018!181195628!8091!-1

Merck: Schering-Plough announces that its investigational sublingual allergy immunotherapy tablet meets primary endpoint in a study of adult subjects

2009-11-02T21:54:00.002-05:00

Schering-Plough Corp (SGP) announces that its investigational sublingual Grass (Phleum Pratense) Allergy Immunotherapy Tablet has met the primary endpoint in a Phase III study of adult subjects in the U.S. with a history of grass pollen induced rhinoconjunctivitis with or without asthma. The investigational Grass AIT treatment is designed to work by inducing a protective immune response against grass pollen allergy and providing sustained prevention of allergy symptoms, treating both the symptoms and the underlying cause of the disease. In the study 439 adults were randomized to receive either placebo or grass tablet. The study met its primary endpoint. Additionally, the adverse events experienced by subjects receiving the drug in this study were similar to previous studies in adults and include oral itching, with no new or unexpected findings.

http://news.moneycentral.msn.com/provider/providerarticle.aspx?feed=BCOM&date=20091102&id=10623317

Sublingual immunotherapy in children: facts and needs

2009-10-26T16:42:00.002-04:00

Allergen specific immunotherapy (SIT) is the practice of administering gradually increasing doses of the specific causative allergen to reduce the clinical reactivity of allergic subjects, and is the only treatment targeting the causes of hypersensitivity and not only the symptoms, as done by drugs. The traditional, subcutaneous immunotherapy (SCIT) was burdened by the problem of systemic reactions which may be sometimes severe and - though very rarely - even fatal. This was the background to develop non injections routes for SIT and particularly sublingual immunotherapy (SLIT), that emerged as a real treatment option for respiratory allergy. A number of studies was conducted to evaluate efficacy and safety of SLIT, the first meta-analysis - including 22 placebo-controlled trials - concluded for positive results in both issues, but the number of studies on children was too low to draw definite conclusions. Since then, many other studies became available and make possible to analyze SLIT in children in its well defined aspects as well as in sides still requiring more solid data.

Marseglia GL, Incorvaia C, La Rosa M et al. Italian Journal of Pediatrics 2009, 35:31
http://www.ijponline.net/content/35/1/31/abstract

Efficacy of sublingual specific immunotherapy in intermittent and persistent allergic rhinitis in children

2009-10-15T18:50:00.002-04:00

Efficacy of sublingual specific immunotherapy in intermittent and persistent allergic rhinitis in children: an observational case-control study on 171 patients. The EFESO-children Multicenter Trial

Pediatric Allergy and Immunology, Volume 20, Number 7, November 2009 , pp. 660-664(5)

Sublingual-specific immunotherapy (SLIT) is considered as a valid treatment of respiratory allergies. However, there are few data on large sample size regarding its clinical role in `real life' in term of reduction of symptoms, rescue medications and prevention of asthma in patients suffering from allergic rhinitis (AR) especially in children. We performed a multicenter, case-control study to evaluate the effect of SLIT in children (age 6-18 yr) with intermittent or persistent AR. 171 children (27% girls and 73% boys) with AR due to seasonal or perennial allergens were enrolled in a multicenter case-control study. Cases (n = 90) were defined as patients with intermittent (64%) or persistent (36%) AR who were treated for at least two consecutive years with specific SLIT with the related allergen extracts (SLITone® ALK-Abellò). Controls (n = 81) were defined as sex-age- and type of allergen matched AR children who were never treated with specific immunotherapy and had no asthmatic symptoms at the beginning of observation period. Main outcomes of the study were the rhinoconjunctivitis symptom score (SS) (sneezing, rhinorrea, nasal itch, congestion, ocular itch and watery eyes) with a ranging scale from 0 (=no symptoms) to 3 (=severe symptoms) and the medication score (MS) evaluating symptomatic drug intake (antihystamine and inhaled corticosteroids). SS and MS were evaluated at the end of the observational period in relation with the period, considering the last 12 months, in which patients suffered the highest symptoms levels (i.e., peak of relevant pollen season (seasonal AR) or during the period of maximum allergen exposure in case of perennial AR). Secondary outcome of the study was the development of asthma symptoms during the observation period. SS (mean ± SD) was 4.5 ± 2.5 in cases and 9.0 ± 3.0 in controls (−50%) (p = 0.0001). MS (mean ± SD) was 2.5 ± 1.9 and 3.6 ± 2.1 in the case and control groups, respectively (−31%) (p = 0.0001). At the end of the observation period asthma symptoms were present in 14 subjects in the case group (15%) and in 20 children (24%) in the control group (p = 0.13). New skin sensitizations appeared in 6% of cases (n = 2) and in 36% (n = 12) of the controls (p = 0.001). The EFESO trial shows that a 2-yr once daily SLIT treatment in children with intermittent or persistent AR is associated with lower symptom and medication scores in comparison with subjects treated with symptomatic drugs only.

SLIT vs SCIT: A Q&A

2009-10-12T15:37:00.001-04:00

Sublingual immunotherapy (SLIT) is gaining acceptance in otolaryngology circles, but is it really any better than subcutaneous injections? Which patients can benefit from it? How can it affect practice?

These are questions ENT Today set out to answer by asking three physicians who use SLIT in practice: Bradley F. Marple, MD, Professor of Otolaryngology at University of Texas Southwestern Medical School; Mary Morris, MD, a leader in allergy & immunology and partner at Allergy Associates of La Crosse, and Medical Director for Allergy Choices in Wisconsin; and Steven B. Levine, MD, Assistant Clinical Professor of Otolaryngology at Yale University.

http://www.entoday.com/pt/re/entoday/fulltext.01265117-200902000-00008.htm;jsessionid=JhTWS5gTNn4PdG2TZ49QNB84FkkxXlGJkHYxrdqmMHW7LLHvlVC9!-858031623!181195628!8091!-1

Life is no picnic for kids with life-threatening food allergies

2009-09-02T23:16:00.001-04:00

This is an excellent news article about using sublingual immunotherapy to treat children with food allergy. http://www.winonadailynews.com/news/local/education/article_2f436af6-973c-11de-821f-001cc4c03286.html

Safety and efficacy in children of an SQ-standardized grass

2009-08-19T10:43:00.002-04:00

Albrecht Bufe, Peter Eberle, Eivy Franke-Beckmann, et al. Hamburg and Wiesbaden, Germany and Hørsholm, Denmark

Background: Immunotherapy with the SQ-standardized grass tablet Grazax is efficacious and well-tolerated in adult patients with rhinoconjunctivitis. Allergic asthma and rhinoconjunctivitis are closely linked, and a strategy combining treatment of the upper and lower airways is recommended.

Objective: To investigate the efficacy of treatment with the grass tablet on grass pollen–induced rhinoconjunctivitis and asthma as well as the immunologic response and the safety profile in children.

Methods: A total of 253 children age 5 to 16 years, with grass pollen–induced rhinoconjunctivitis with/without asthma, were randomized 1:1 to active treatment or placebo. Treatment was initiated 8 to 23 weeks before the start of the grass pollen season 2007 and continued throughout the entire season. Symptomatic medication was provided as relief medication to both groups in a stepwise fashion. Primary endpoints were rhinoconjunctivitis symptom and medication scores.

Results: The rhinoconjunctivitis symptom and medication scores and the asthma symptom score were all statistically significantly different between the 2 treatment groups. The differences in medians relative to placebo were 24%, 34%, and 64% in favor of active treatment. The immunologic response was similar to that observed in adults. The most common adverse reaction was oral pruritus, reported by 40 subjects (32%) in the active and 3 (2%) in the placebo group. Six subjects withdrew because of adverse events. No serious adverse events were assessed as treatment-related.

Conclusion: Immunotherapy with the grass tablet reduced grass pollen–induced rhinoconjunctivitis and asthma symptoms in a pediatric population and introduced an immunomodulatory response, consistent with treatment of the underlying allergic disease. The treatment was well tolerated.

J Allergy Clin Immunol 2009;123:167-73.

Is Sublingual Immunotherapy “Ready for Prime Time”?

2009-07-17T10:01:00.002-04:00

This published editorial is in the peer-reviewed journal, Chest. The author concludes, "In summary, this is the first metaanalysis to demonstrate significant efficacy in the use of SLIT in children with asthma. The outcome of current ongoing studies should determine if SLIT is approved by the Food and Drug Administration and is 'ready for prime time.'” http://www.chestjournal.org/content/133/3/589.full

Sublingual Allergen-Specific Immunotherapy Comparable With Subcutaneous Therapy in Daily Routine: Presented at EAACI

2009-06-12T10:06:00.002-04:00

WARSAW, Poland -- June 11, 2009 -- According to a meta-analysis presented here at the 28th Congress of the European Academy of Allergy and Clinical Immunology (EAACI), both subcutaneous (SCIT) and sublingual allergen-specific immunotherapy (SLIT) lead to substantial reductions in rhinitis and conjunctivitis symptoms in patients with grass pollen allergy, but the probability for systemic or anaphylactic reactions is higher with the subcutaneous administration.

Similar decreases were seen in both groups in terms of frequency and severity of conjunctivitis symptoms. "The total rhinoconjunctivitis score was significantly reduced in both groups by about 50%," Dr. Sieber said (P < .001 with both SLIT and SCIT). "There was no significant difference between the 2 treatment forms."

Adverse events occurred mainly during the titration phase and abated during the maintenance phase. This observation matches the known event pattern. As Dr. Sieber pointed out, no severe systemic or anaphylactic reactions arose with the SLIT treatment, whereas with SCIT, one severe systemic reaction and one anaphylactic reaction occurred during the titration phase."

In terms of efficacy, SCIT and SLIT are comparable," Dr. Sieber summarised. "As SLIT appears more tolerable, we think that it should be used preferentially for the treatment of pollen allergies."

http://www.docguide.com/news/content.nsf/news/852571020057CCF6852575D20063235A

Combined Subcutaneous, Sublingual Immunotherapy More Effective Than Either Approach Alone for Cross-Reactive Food Allergy: Presented at EAACI

2009-06-10T22:51:00.001-04:00

WARSAW, Poland -- June 10, 2009 -- In a study presented at the 28th Congress of the European Academy of Allergy and Clinical Immunology (EAACI), combined subcutaneous and sublingual immunotherapy was more effective in patients with seasonal allergic rhinitis and cross-reactive food allergy than either approach alone. A study investigated the clinical and immune changes in reaction to subcutaneous allergen-specific immunotherapy (SCIT), sublingual allergen-specific immunotherapy (SLIT), and a combination of both treatments in patients with seasonal allergic rhinitis, who also have cross-reactive food allergy, typically displaying clinically as oral allergy syndrome in the majority of patients. The rationale for the study was the assumed increase of the immunomodulatory impact by combining SCIT and SLIT.

http://www.docguide.com/news/content.nsf/news/852571020057CCF6852575D100577458

Safety and tolerability of seasonal ultra-rush, high-dose sublingual-swallow immunotherapy in allergic rhinitis to grass and tree pollens

2009-05-31T09:31:00.003-04:00

This is a large observational study in 193 children and adolescents with allergic rhinitis due to grass or tree pollens to evaluate the safety and tolerability of an ultrarush high-dose sublingual immunotherapy (SLIT) regimen reaching a maintenance dose of 300 index of reactivity within 90 minutes. CONCLUSION: Ultrarush titration was safe and well tolerated. Pediatric patients with asthma should be carefully monitored and adequately trained to use their rescue medications. J Investig Allergol Clin Immunol. 2009;19(2):125-31.

http://www.ncbi.nlm.nih.gov/pubmed/19476016?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

Sublingual immunotherapy for inhalant allergies deserves deeper consideration

2009-04-30T08:40:00.001-04:00

Sublingual immunotherapy for the treatment of allergy symptoms caused by a wide variety of environmental inhalants has been effectively used in Europe. It should be employed to further treatment of allergies in the United States, where allergic symptoms are largely undertreated, according to an invited article in the April 2009 issue of Otolaryngology-Head and Neck Surgery.
http://www.genengnews.com/news/bnitem.aspx?name=53622302

SLIT Research in ENToday:Volume 4(4) April 2009 p 11

2009-04-20T21:01:00.004-04:00

In response to a letter to the editor of ENToday, Dr. Steven B. Levine described some of the misperceptions about sublingual immunotherapy even within the broader allegy professional community.

http://www.entoday.com/pt/re/entoday/fulltext.01265117-200904000-00007.htm;jsessionid=JspTq0v5sfNpbG4L98Ly7LylX0Q1MTcTsLqnF1BTTpTLpkmLD4vL!1553038018!181195628!8091!-1

Cure to allergy in a nutshell: Denver Post: Monday, March 16, 2009

2009-03-16T07:08:00.002-04:00

Research released on Sunday, March 15, 2009, is being heralded as the first indication that life-threatening peanut allergies can be cured with sublingual immunotherapy (SLIT). The pilot study was presented at a meeting of the American Academy of Allergy, Asthma and Immunology in Washington, D.C. Five young children in the study were given tiny amounts of peanut over a period of years until their immune systems tolerated the allergen that once could have threatened their lives. This report is part of an ongoing study from Duke University's School of Medicine and and the University of Arkansas Children's Hospital. Other institutions also studying SLIT to treat peanut allergy include National Jewish Health in Denver, the Mount Sinai School of Medicine in New York, and Johns Hopkins University School of Medicine in Baltimore.

http://www.denverpost.com/news/ci_11921744

SLIT vs SCIT: A Q&A

2009-02-22T12:42:00.004-05:00

Sublingual immunotherapy (SLIT) is gaining acceptance in otolaryngology circles, but is it really any better than subcutaneous injections? Which patients can benefit from it? How can it affect practice?

These are questions ENT Today set out to answer by asking three physicians who use SLIT in practice: Bradley F. Marple, MD, Professor of Otolaryngology at University of Texas Southwestern Medical School; Mary Morris, MD, an allergist and partner at Allergy Associates of La Crosse, and Medical Director for Allergy Choices in Wisconsin; and Steven B. Levine, MD, Assistant Clinical Professor of Otolaryngology at Yale University.

http://www.entoday.com/pt/re/entoday/fulltext.01265117-200902000-00008.htm;jsessionid=JhTWS5gTNn4PdG2TZ49QNB84FkkxXlGJkHYxrdqmMHW7LLHvlVC9!-858031623!181195628!8091!-1

Efficacy and safety of 5-grass-pollen sublingual immunotherapy tablets in pediatric allergic rhinoconjunctivitis

2009-01-21T06:55:00.002-05:00

Ulrich Wahn, MD; Ana Tabar, MD; Piotr Kuna, MD; Susanne Halken, MD, DMSc; Armelle Montagut, PhD; Olivier de Beaumont, MD; Martine Le Gall, MD

Published on the web site of the American Academy of Allergy, Asthma & Immunology.

A recent study showed that sublingual immunotherapy (SLIT) using a 300IR dose of five-grass pollens which was taken as a tablet that dissolved under the tongue was effective in treating grass pollen allergic rhinitis in adults. In a study to be published in the January issue of The Journal of Allergy and Clinical Immunology, Wahn, et al., tested this same dose of five-grass pollen tablets in treating rhinoconjunctivitis in a pediatric population. The 278 children studied were given either a once-daily dose of SLIT tablets that contained active grass allergens or placebo.

No serious side effects were reported. The authors’ findings show that 300IR five-grass pollen SLIT tablets is a safe and effective way to treat children and adolescents with grass pollen rhinoconjunctivitis and the relief takes effect in the first treatment season.

http://www.aaaai.org/media/jaci/content.asp?contentid=8382

Positive results with Oralgen(R) Grass Pollen in second season of treatment

2009-01-16T21:26:00.001-05:00

Follow-up study with the anti-allergy medication Oralgen® Grass Pollen demonstrates that the efficacy of sublingual immunotherapy (drops applied under the tongue) increases when the treatment period is extended. Clinical efficacy convincingly demonstrated during second season of treatment. http://www.pipelinereview.com/content/view/24682/100/

Safety and efficacy in children of an SQ-standardized grass

2009-01-10T08:05:00.002-05:00

Updates on current research

2009-01-05T15:05:00.002-05:00

Greer, a leading developer and supplier of allergy immunotherapy products and services, has completed enrollment for its polar Phase III clinical trial designed to study the efficacy of sublingual-oral immunotherapy (SLIT) as a treatment for adults with allergic rhinoconjunctivitis caused by shortsighted ragweed pollen. Between March and June, 556 patients were screened for the randomized, double-blind, placebo-controlled trial, of which 430 were enrolled. The participants will be observed at 31 clinical sites across the area. The trial will last approximately seven months, end in mid-October to coincide with the completion of the short ragweed pollen season. This work is significant because it is the first large Phase III trial conducted in the United States for the sublingual-oral administration of fluid allergenic extracts.

The following is from the US National Library of Medicine and the National Institutes of Health

2009-01-03T08:11:00.005-05:00

Sublingual immunotherapy reduces soluble HLA-G and HLA-A,-B,-C serum levels in patients with allergic rhinitis.Ciprandi G, Contini P, Pistorio A, Murdaca G, Puppo F.DIMI, University of Genoa, Genoa, Italy.

http://www.ncbi.nlm.nih.gov/pubmed/19100344?dopt=Abstract

Allergic rhinitis (AR) is characterized by Th2 polarized immune response. Soluble HLA (sHLA) molecules play an immunomodulatory activity. Specific immunotherapy is the only causal treatment for AR. So far no study investigated the effect of sublingual immunotherapy (SLIT) on sHLA molecules. The aim of the study was to evaluate sHLA-G and sHLA-A,-B,-C serum levels in AR patients with pollen allergy before and after a pre-seasonal course of SLIT. Forty AR patients with pollen allergy were enrolled and they assumed a pre-seasonal SLIT course for 3 months. Serum sHLA-G and sHLA-A,-B,-C and IFN-gamma and IL-4 levels were determined by ELISA method at baseline and 3 months after the end of the SLIT course. Symptoms severity was assessed by a Visual Analogue Scale. Both sHLA-G and sHLA-A,-B,-C levels significantly diminished (p<0.0001 r="0.84)." r="0.60">

Overview

2008-06-29T10:04:00.006-04:00

Sublingual immunotherapy, also known as allergy drops, has been used in the U.S. for many years but at very low concentrations often called a "neutralizing" dose. Thanks to an increase in European research over the past decade using high doses of antigens and tremendous growth in the use of allergy drops worldwide, we now have valid scientific evidence that corroborates that allergy drops are both safe and effective. Sublingual immunotherapy will likely prove to be one of the most important innovations in allergy treatment in the past century.

Until allergy drops are more widely available in the U.S. and more resources are dedicated to educating providers and patients about allergy drops, it’s important to understand the facts about this treatment to help you determine whether it’s the right course of treatment for you.

ENT and Allergy Associates, LLC has partnered with the clinical and educational services of Allergychoices™ to keep informed of the latest developments in sublingual immunotherapy, and to provide the best of care to our patients. The practice website is at http://www.entallergymd.com/ and the office is located at 160 Hawley Lane in Trumbull, Connecticut (USA). The telephone number is 1.203.380.3707.

This forum provides an opportunity to answer many questions about this alternative to traditional allergy shots including comments from patients who have experienced both allergy treatment modalities. Please post any comments, thoughts or questions on the final page.

A great website for parents of allergic children is http://www.allergymoms.com/. They have a great overview of allergy drops and current research for inhalant and food allergy at http://www.allergymoms.com/uploads/newsletters/allergymoms_newsletter_11_16_08.html.

Comments, thoughts & more questions

2008-06-29T08:58:00.005-04:00

Please feel free to click on the link below to post your comments and thoughts about sublingual immunotherapy (allergy drops). This page is monitored and any questions you raise will be answered.

How do I start allergy drops?

2008-06-28T18:49:00.006-04:00

Allergy drops are custom ordered for each patient based upon the sensitivities that can be identified. Thus, the first step is an office visit to corroborate that allergy is present, and follow that with allergy testing.

Allergy skin tests are the most specific and sensitive method of testing. Qualitative skin tests determine the antigens to which a patient is sensitive. Common antigens are house dust mites, molds, grasses, trees, weeds, and animal hair or dander. Many foods today are also possible antigens, including peanut, cow milk, soy, eggs and wheat. Allergy drops may be prepared using these results and would start at the highest safe concentration.

Quantitative skin tests permit allergists to assess how sensitive the patient is to the test antigens. Allergy drops prepared from these results can safely start at higher concentrations, and patients notice an improvement much quicker.

RAST is a blood test that quantitatively measures the antibodies in the blood stream to the test antigens. While it may not be as sensitive as skin tests, allergy drops may also be prepared using these results.

Once the antigens that contribute to allergy symptoms are identified, the allergy drops are prepared. Our patients begin using one drop per day for the first week, increase to one drop twice per day for the second week, and then increase and stay at one drop three times per day thereafter.

Most of our allergy drops patients stop in our office only once every three months so we can monitor their progress and address any issues or concerns. For those patients who travel long distance to see us, we will ship the drops to them and ask them to stop in for a visit when convenient.

Video clips

2008-06-27T11:53:00.010-04:00

http://www.youtube.com/watch?v=0Txq3vxDJfE

http://www.youtube.com/watch?v=aKJz4A-_z3E

http://www.youtube.com/watch?v=UAgnJ21Nln4

Click on the following link to see a recent new report filmed at ENT and Allergy Associates in Trumbull, CT. http://www.youtube.com/watch?v=RTjss0LmQ80

Click on any of the links below to view patient stories published on You Tube
http://www.youtube.com/watch?v=PDDhXiz0rhM
http://youtube.com/watch?v=zqpnt7BCYWA
http://youtube.com/watch?v=JADIGfKcgqE
http://youtube.com/watch?v=DVPJwLQUE4U

Who should take allergy drops?

2008-06-27T11:46:00.004-04:00

Our allergy philosophy has always been that if symptoms are episodic and occasional, we usually can find medication to provide relief. However, for those who suffer with allergy symptoms on a regular basis, or who take medication on a regular basis to control symptoms, we have alternatives that reduce or remove the need for medication.

Immunotherapy is the process of changing the body’s immune system. For allergy sufferers, this means reducing sensitivity and reactions to their triggers (called antigens). Traditional immunotherapy has been allergy shots; however, there is a large cadre of the population that can benefit but typically are not getting this form of treatment. Allergy drops resolves these barriers.

People with inhalant allergies including dust, pollen, molds & animals. This group has been typically treated with allergy shots and in general with excellent results. The limitations are (1) reactions associated with the shots which may be severe and life-threatening, (2) the inconvenience of going to the doctor’s office weekly for the injection and then to wait at the office after the injection for up to 30 minutes to assure no adverse reactions, and (3) the emotional trauma of receiving weekly injections, especially for younger children and older children with other medical issues. Allergy drops have none of these limitations.

People with food allergies. The symptoms of food allergy can vary widely from life threatening anaphylaxis to stomach bloating and eczema, making this group somewhat difficult to diagnose. Traditional allergy management begins with identification of foods that as best as we can tell are triggers for the symptoms, and then eliminating them from the diet permanently. Allergy shots are usually not offered since the shots often trigger severe symptoms. While studies of allergy drops for treating food allergy are ongoing, the results indicate that at least allergy drops reduce the sensitivity to food allergy and at best may eliminate them. A great website for parents of allergic children is http://www.allergymoms.com/.

Thus, allergy drops are especially ideal for:

Infants and children*
Highly sensitive people
Those with chronic conditions including sinusitis, asthma, and eczema
Those on blood pressure medicines, since some medicines increase risks associated with allergy shots

*Allergy management is helpful for children with eczema and recurrent ear infections, which often have underlying allergic causes. Research shows that many children with untreated eczema and allergies often develop asthma and other chronic conditions later in life, so treating them early can have life-long benefits.

For those who just are unable to commit to weekly allergy shots yet suffer from allergies, this is an ideal alternative. Its safety profile allows patients to take the drops at home or at work. We have a number of students attending college and university who get their drops delivered to their dormitory address and have complete relief of symptoms. Further, we have the capability to ship solutions all over the world.

What are the advantages of allergy drops compared to allergy shots?

2008-06-27T11:29:00.004-04:00

In addition to being able to treat patients of all ages safely and effectively, there are other advantages to allergy drops.

Time commitment for allergy shots. Patients on allergy shots visit the office weekly initially, and with each visit wait for up to 30 minutes to observe for possible reactions to the shots. After 9-12 months of weekly injections, the frequency of injections shifts to every 2 weeks and ultimately once every 4 to 6 weeks.

Time commitment for allergy drops. Patients receiving allergy drops visit the office every three months, at which time they pick up their solutions and get checked to be sure that the therapy is working. For those who are not local to our community, we ship allergy drops anywhere and those patients stop in for a visit when they are conveniently in the area.

Convenience. Allergy shots are only administered under direct physician supervision. On the other hand, you can take allergy drops at home or wherever you need to be, making it much easier to stay with your treatment. Those on allergy drops experience less time lost from work and school.

Patients who take either allergy drops or allergy shots ultimately take less medication to control symptoms. Both groups report feeling better. Patients typically report fewer clinic visits, hospitalizations, and lost time from work or school due to illness.

Are allergy drops safe?

2008-06-27T10:59:00.004-04:00

Allergy drops have been used around the world for more than 60 years, and numerous studies validate both the safety and effectiveness. In fact, the World Health Organization has endorsed sublingual immunotherapy as a viable alternative to injection therapy. The Cochrane Collaboration, the world’s most-trusted international organization dedicated to reviewing healthcare treatments, recently concluded allergy drop immunotherapy significantly reduced allergy symptoms and use of allergy medications.

The US Food & Drug Administration (FDA) approves the injection of antigens into sensitive patients for the purpose of reducing allergy sensitivities. The acknowledged potential risk to the patient includes anaphylaxis. Anaphylaxis is an emergency allergy condition that includes swelling of the lips, tongue and throat, wheezing and shortness of breath, as well as rapid drop in blood pressure. Intervention must be immediate to reverse these symptoms, which is why allergy shots are administered in a physician's office and under physician supervision.

Allergy drops use the same FDA-approved antigens that are placed under the tongue. Since there are no cases of anaphylaxis yet reported, the drops may be used safely away from a physician's direct supervision. Physicians commonly recommend "off label" FDA approved treatments especially when safety and efficacy has been proven.

To promote safety, the starting concentration of allergens is based upon each patient's individual allergy test results. Over time, the concentration of allergen increases to the same maintenance concentration as we use in allergy shots.

Because many patients find weekly allergy shots interrupting to their schedule, by common convention, most allergists reduce the maintenance injections to every other week and ultimately monthly. On the other hand, once maintenance concentration is attained with allergy drops, patients continue using the drops three times per day. Thus, at maintenance, patients on allergy drops have 100 times the exposure to full concentrate antigen compared to patients on monthly allergy shots and they still do not get reactions.

To see original medical papers on the topic, go to our website, www.entallergymd.com, click on "Medical Articles and Links", and then click on "Allergy".

How long will I need to take my drops and how long can I expect the effects to last?

2008-06-27T10:55:00.001-04:00

Most patients take allergy drops each day for as long as five years, but it varies according to the severity of your allergies and the seasonality. Most patients report improvement within 3-6 months; the soonest we have seen has been 2 weeks after starting treatment.

A benefit of immunotherapy—whether it’s allergy shots or allergy drops—is that it can alter the course of allergic disease by treating the root cause, not just the symptoms. Key studies have already been conducted to explore the long-lasting effect of allergy drops, including a 10-year prospective study on children with asthma that demonstrated drops maintained effectiveness long after treatment had stopped.

The key to ensuring the effects last is compliance, which is an additional benefit of allergy drops. Studies show that patients taking allergy drops tend to stay with their treatment 90 percent of the time, which is significantly higher than with other routes of treatment. Why is compliance so much higher? Patients appreciate the convenience of being able to take their drops wherever they are, eliminating the need to make frequent clinic visits and the savings in time and money that result. They also tend to see improvement within one to three months, which motivates them to continue a treatment that leaves them continuing to feel better.

But even the best treatments won’t work if you don’t stay with them. Like allergy shot treatment, it’s important to stay with allergy drop treatment until your doctor has determined treatment can be discontinued. A typical patient will continue treatment for four to five years, depending upon the severity of allergic problems.

Continuing with your treatment will help you reap the long-term rewards. A recent study showed that the use of allergy drops with children can significantly lessen the development of asthma later in life—as much as an 80 percent decrease than found in patients who haven’t had immunotherapy. These findings are consistent with the Pediatric Asthma Treatment study done by leading European researchers who found similar results with injection therapy.

Cost is an issue since health insurance will not yet accept this as a covered service. We charge $20 per week for this therapy, less than most patients co-pays. Coupled with less frequent office visits and co-pays, the rising cost of gasoline, and less time away from work and family, allergy drops is often significantly less expensive than allergy shots.