Under-the-Tongue Pills for Grass Allergy

in Features, Grass & Ragweed, Outdoor Allergies
Published: June 30, 2011

From the Summer 2011 edition of Allergic Living magazine.

Spring and early summer present a constant dilemma for people allergic to grass. It’s a choice between dodging pollen behind tightly sealed windows, or engaging in a battle with the blades, hoping antihistamines, nasal sprays and eye drops will keep the worst of the symptoms at bay.

A lot of us are making this daily choice between nose-streaming suffering and indoor boredom. It’s estimated that about 26 percent of North Americans are sensitized to either Timothy or rye grasses, and 18 percent to Bermuda grass, often used on golf courses.

Allergy shots have long been an option for those who can’t bear all the congestion and mucus any longer, but they require a serious commitment to needles and doctor’s visits, week after week, allergy season after allergy season, for several years.

For the moment, those shots are the only game in town. But that may be about to change. Needles may soon give way to small tablets, placed under the tongue and allowed to dissolve for about a minute. And, impatient people, rejoice: the tablets – called sublingual immunotherapy or SLIT – may significantly improve hay fever symptoms within a month. The best news? Two SLIT pills have recently completed the final phase of testing in the U.S. and their makers getting ready to apply for regulatory approval.

Dr. Linda Cox, a Fort Lauderdale, Florida allergist who organized a large study for one of the drugs, has spent years looking at the limitations and safety of immunotherapy for environmental allergens like grasses. She points to European research that followed patients who took grass SLIT tablets to note how life-changing the drug can be. Years after patients stopped taking the tablets, the protective effects still lingered. “No [other] medication does that,” Cox says. “You can’t take a drug for a season and expect the next season it will have [still] fixed your problem.”

With pollen seasons becoming longer in many areas, such therapies could be all the more important, as allergy sufferers are faced with the threat of even longer stretches of congested misery.

The Contenders

One of the SLIT drugs is called Oralair in Europe, and is produced by the French company Stallergenes. It contains extracts from five northern grasses, including orchard grass, Kentucky bluegrass, perennial ryegrass, sweet vernalgrass and Timothy grass, most of which are found in nearly every North American state and province. Like other immunotherapies, the drug works by repeatedly exposing the body to tiny amounts of allergen over several months, which helps to desensitize the allergy sufferer just in time for a spring blast of pollen.

In a U.S. study of Oralair, 473 grass-allergic adults in several northern and central states got either the drug or a placebo for six months. Researchers found a 28 percent improvement in allergy symptoms and medication use compared to the group getting the sugar pills. Oralair was particularly good at relieving itchy and watery eyes, and patients also said they slept better.

The other tablet that could soon be on North Americans’ relief radar is known as Grazax in Europe (where SLIT tablets have been on the market since 2006). Danish company ALK makes the tablet, but drug-manufacturer Merck is spearheading the American research and push for approval. Unlike Oralair, Grazax focuses its immunological attack on just one pollen: Timothy grass, which is found everywhere in North America except Nunavut and Puerto Rico.

In one U.S. study of Grazax, adults showed about a 20 percent improvement in symptoms. In another, children’s allergy symptoms improved by 26 percent. “If somebody takes Grazax, and uses nasal steroids and antihistamines on top of it, then this would be by far the most effective