Are Sublingual Immunotherapy Tablets for You?

It used to be that shots were the only form of allergy immunotherapy available to patients. Then came sublingual immunotherapy (SLIT), which involves liquid antigen droplets under the tongue. (This is the primary form of treatment prescribed through the AllergyEasy program).

Sublingual Immunotherapy Tablets

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But what about those prescription sublingual immunotherapy tablets you’ve been hearing about—those little pills that dissolve in the mouth such as Oralair® for grass pollens?

A Closer Look at Immunotherapy Tablets

In 2014, the Food and Drug Administration approved the first SLIT tablet (Oralair). Since then, the FDA has approved three others—one more for grass allergies (Grastek®), one for ragweed (Ragwitek®), and one for dust mite allergies (Odactra®).

The tablets are taken daily in the lead up to the appropriate allergy season (except in the case of Odactra, which is taken year round because dust mites aren’t seasonal).

Allergy shots, allergy drops, and tablets have all been shown to be similar in their effectiveness. However, tablets and drops are safer than allergy shots and produce very few (if any) side effects. Because of this elevated safety profile, they can be taken at home rather than in a medical setting. This makes them an attractive alternative to shots, which must be administered at the doctor’s office—usually a couple of times per week.

Can’t I Just Take Allergy Pills Like Antihistamines?

Tablets—along with all forms of immunotherapy—get to the source of the allergy, desensitizing the immune system to the allergens that once elicited undesirable immune responses. This is why, for many people, they are a better choice than drugs such as antihistamines, which merely treat the symptoms in the short-term and don’t address the underlying allergy.

Immunotherapy involves a complex process, but one of the outcomes is that when you take the shot, drops, or tablets, your body can produce regulatory cells that suppress the immune response. With ongoing treatment, immunotherapy can restore the balance in the immune system so that it functions like the system of a non-allergic person.

In a nutshell, medications such as antihistamines, decongestants, and steroids may be a good solution for people who have minor, short-term bursts of allergy symptoms. However, the results only last as long as the medications do; stop the meds and the symptoms return.

Immunotherapy, on the other hand, retools the immune system so that it can stop reacting once and for all to allergens in the environment.

Are there Drawbacks to Tablets?

The primary shortcoming of these immunotherapy tablets is that they are limited in their scope. As mentioned earlier in this article, Ragwitek only covers ragweed pollens. Most people with allergies react to multiple triggers, however. So let’s say that you are allergic to timothy grass, ragweed, and oak trees. You could take Grastek in the spring when grasses are pollinating and Ragwitek in fall for ragweed season. But you’re out of luck for oak, because there is not yet a sublingual immunotherapy tablet for trees.

Thus, if you‘re like many Americans who suffer from multiple allergies, your best bet may be to stick with allergy shots or—for greater safety and convenience—sublingual immunotherapy (under-the-tongue) allergy drops. These options can fortify your immune system against dozens of the most prevalent allergens with one consistent treatment so that you’re not pinging back and forth between different pills depending on the season.

How do the Costs Compare?

The best thing to do here is to talk to your insurance provider and your doctor, but we can give you some basic information:

  • Allergy shots. Shots are covered by most insurances, but you’ll still need to cover the co-pays. You also have to account for the time and resources devoted to traveling to the doctor’s office a couple of times per week for injections. This may include gas money, time off of work, time away from family, etc.
  • Allergy drops. The cost of sublingual immunotherapy varies depending on your insurance plan. Most plans cover allergy testing and doctor visits, but only some cover the cost of allergy drops. Keep in mind, though, that you’re not having to pay co-pays like you do for allergy shots and that you have the added convenience of at-home administration.
  • Allergy tablets. Most insurances cover sublingual immunotherapy tablets, but some won’t cover multiple types at once. So if you’re taking a tablet for grass pollens and want to add in one for dust mites, you may be out of luck for insurance defrayal for the second type of tablet.

What’s on the Horizon?

Even though the U.S. has not yet approved a tablet for tree pollen immunotherapy, Europe and Japan have. Europe has a birch pollen tablet, and Japan has one for Japanese cedar that could work for U.S. varieties of juniper and cedar. U.S. drug companies are hopeful that there will be a tree tablet available in the U.S. within a few years.

If you think sublingual immunotherapy may be for you, talk to your doctor about prescribing sublingual immunotherapy—either through oral allergy drops or tablets.

About The Author

Stuart H. Agren, M.D.

Stuart H. Agren, M.D. completed his undergraduate studies at the University of Utah and went on to earn his Doctor of Medicine from Tulane University School of Medicine in 1974. He completed additional training at L.D.S. Hospital in Salt Lake City, Utah and then established his private medical practice starting in 1975. Dr. Agren completed a mini-residency in Industrial Medicine at the Robert Johnson School of Medicine at Rutgers University and also completed training to become a certified Medical Review Officer.

Dr. Agren was the Medical Director at TRW and McDonnell Douglas in Mesa, Arizona and at Stauffer Chemical and Kennecott Copper in Salt Lake City, Utah. He also served as an adjunct faculty member at Arizona State University.

In his private medical practice, Dr. Agren specialized in family practice and allergy. In his work as a private practice allergist, he was one of the first doctors in the country to prescribe sublingual immunotherapy to his patients as an alternative to subcutaneous immunotherapy (allergy shots). He has also been a trailblazer in the field of food allergy treatment and research, developing a program to treat multiple food allergies simultaneously using sublingual immunotherapy. Dr. Agren has been featured on local CBS, NBC, and ABC news affiliates and won the peer-nominated “Top Doc” award from Phoenix Magazine.

After 20 years in private practice, Dr. Agren became the Founder and President of AllergyEasy, which helps primary care physicians around the country offer allergy testing and sublingual immunotherapy treatment to their patients. Over 200 physicians in over 32 states use the AllergyEasy program to help their patients overcome environmental and food allergies and asthma.