"Allergy tablets" cut hay fever symptoms safely

NEW YORK (Reuters Health) - Under-the-tongue tablets may be a safe alternative to allergy shots for people who don’t get enough relief for their itchy eyes and runny noses with standard drugs, according to scientists who reviewed 60 studies on the treatment.

Allergy shots build up the immune system’s tolerance by exposing it to increasing amounts of the substance that’s bothering it, such as pollen, dust mites or cat dander.

But the shots can be uncomfortable and lead to itching, swelling or other more serious reactions. So researchers have been testing needle-free alternatives, either in a daily tablet or as drops left under the tongue, which patients can self-administer at home -- so-called sublingual immunotherapy.

“Sublingual immunotherapy seems to be as effective as other treatments such as antihistamines and nasal steroids,” senior researcher Dr. Stephen Durham of the Royal Brompton Hospital in London said in an e-mail. “And it has the added value of long-term benefits after its discontinuation.”

Pooling the results of earlier studies, including some 5,000 patients, Durham and his colleagues found “allergy tablets” worked better for both adults and children than a dummy tablet lacking the immune triggers, or allergens.

Patients on the active therapy required less medication and reported fewer allergy symptoms than those given the placebo, especially when taking the tablets for 12 months or longer.

And none of them experienced any serious or life-threatening reactions, report the British researchers in The Cochrane Library.

The findings update a 2003 review, which also concluded that allergy tablets may be a good option for some of the 10 to 25 percent of Westerners who struggle with seasonal or chronic allergies.

Dr. Sandra Lin of Johns Hopkins University, in Baltimore, who was not involved in the review, said her patients generally tolerate the new treatment very well. She has, however, seen some minor side effects such as tingling or itching under the tongue.

“Both routes are effective, but it appears that sublingual may be safer than injections,” she told Reuters Health. “Of course, you still need to take precautions.”

Both Lin and Durham note the need for more head-to-head comparisons of the needle and under-the-tongue therapy routes.

The costs of allergy tablets generally range from $1 to $2 a day, but can vary widely depending on the dosage and number of allergens included, Lin noted. Since the U.S. Food and Drug Administration has not yet approved the treatment, insurance companies usually won’t pay.

Injections, on the other hand, may be covered, although some patients can still pay between $15 and $30 for their weekly injections. After the first year of treatment, however, patients can generally cut back on the frequency.

“And then there’s the hidden costs, like having to take time off from work, drive and park to come into the office,” said Lin.

“I think the convenience of the (sublingual) therapy is really appealing. And I don’t think there are a lot of kids below 6th grade that are willing to tolerate the weekly injections,” she added. “This is opening it up to children.”

SOURCE: Cochrane Database of Systematic Reviews, December 2010.