For the first time in the U.S., the Food and Drug Administration (FDA) has approved the use of daily tablets to treat hay fever, particularly allergies to grass and ragweed pollen.
It’s estimated that more than 17 million Americans suffer from hay fever, many of whom are aggravated by grass pollen in the spring and summer and by ragweed in the fall.
“This is a great change in the approach to immunotherapy,” said Harold Nelson, MD, who helped study the effectiveness of the tablets at National Jewish Health in Denver. “This tablet does the same thing as an allergy shot. It delivers large amounts of antigens to the immune system and aims to convert the immune response to these pollens back to normal,” he said.
The tablets are placed under the tongue and dissolve almost immediately. Antigens then enter the body and are engaged by the immune system. “You wind up getting about as much antigen every day as you would once a month in an allergy shot,” said Dr. Nelson.
The primary difference is that, because absorption is much less efficient under the tongue than it is through injections, the tablets will have a much higher concentration of antigens. Compared to a shot, “it’s about 30 times as much extract that you receive,” said Dr. Nelson.
The idea of simply taking a tablet each morning to control her allergies is something Melissa Lilly of Highlands Ranch, Colo., has dreamed about. “I would love a pill. That would make my life so much easier,” she said.
Currently, Lilly has to get two different allergy shots every other week, which can be a challenge. “It’s easily an hour and a half to a two hour process for me to take time out of my day to go get my shots,” she said. “To try to fit that in between work, getting the kids to their school activities, having dinner at a reasonable hour and getting homework done, it’s tough to fit it all in,” she said.
Many other patients are in similar situations, which is where the convenience of a tablet would help. Although Dr. Nelson is quick to point out that while the tablet may be easier to take, there is no evidence to suggest they work any better than a shot.
“Direct comparisons of shots and tablets have not been done, so there really isn’t anyway to say that one is more effective than the other,” he said. “But we are moving in a new direction with immunotherapy, and this is likely just the beginning.”
In fact, tablets are already in development to treat other popular allergies, like those to cat dander and dust mites. “Those are a few years away still, but they’re coming,” said Nelson.
For now, the tablets will only treat grass and ragweed pollen and may not give patients any relief this year.
“These tablets have to be started about four months before the beginning of pollen season in order to get benefit,” said Dr. Nelson. “So, it’s probably much more likely that patients will really begin to appreciate their effectiveness in 2015.”