Treating Allergies With Tablets or Drops: What Every Allergy Patient and Doctor Should Know

Girl taking drops

Sublingual allergy drops have been available for a while. New sublingual tablets by pharmaceutical companies are poised to bring FDA approval to sublingual treatment. There are important differences between drops and tablets.

Last week, the FDA advisory committee reviewed two sublingual allergy tablets. Both tablets gained acceptance by the advisory committee, meaning that they will be recommended for approval by the FDA. While the tablets will be new to the U.S. market, they have been available in Europe and Canada for some time. The Sublingual method is an exciting alternative for allergy sufferers who have been waiting for decades for a definitive but shot-free solution to their allergies. Though the tablets present a new answer to that dilemma, physicians in the United States have long been successful in utilizing sublingual immunotherapy drops to help reverse their patients’ allergies. The drops are generally composed of FDA approved antigen in an “off label” route of administration.

While most physicians prescribe “off label” many times per day as part of their regular practice (such as offering a Beta Blocker for performance anxiety, or prescribing Albuterol for young children), FDA approval of the new tablets will provide physicians and patients an added level of comfort with sublingual route. Like many ENTs and several other allergists, I have been prescribing sublingual immunotherapy to treat my patients’ allergic disease for 15 years. In my book, Dr. Dean Mitchell’s Allergy and Asthma Solution, I dedicate a full chapter to discussing numerous medical studies which show that sublingual allergy drops reverse allergies and asthma and prevent future allergies from developing. Most of those studies are available for your review on the AllerVision website

There’s a Big Difference Between Tablets and Drops

The question patients and their doctors will be asking is “What’s the difference between these new sublingual tablets made by the pharmaceutical companies, and the liquid drops I get from my physician?” The answer: there is a big difference. The new sublingual tablets developed my Merck and Stallergenes are high dose allergy tablets covering only a single allergen or allergen category—grass. And, in fact, they only cover the grass(es) for a specific region of the country. The new tablets are clearly effective for patients in those regions who are allergic to only grasses. I have a concern, however, about side-effects with such a concentrated tablet which is taken at full dose from day 1 as opposed to utilizing the build-up phase that defines true immunotherapy. There will be many patients who are highly sensitive to grass pollen and the tablet may cause itching in the throat, rashes or difficulty breathing. In contrast, the sublingual drops available through AllerVision-affiliated providers, are custom-made for each patient to cover the categories affecting that specific patient. The treatment program includes a progressive ramp-up phase. This is important for several reasons…

First, the customized liquid drops enable you to treat multiple allergens simultaneously; most allergy patients suffer from several airborne allergens in multiple categories (most are poly-sensitized.) Interestingly, the cost might be more favorable with the drops compared to the pharmaceutical tablets, which will likely command a third-tier copay when they arrive on the market. Second, proper allergy desensitization protocol dictates starting with a low dose of allergen and carefully building the strength up over time while monitoring patient response. This is the way allergy desensitization has been practiced for decades, and the process accomplishes the goal of modulating the immune system by easing the body into acceptance.

Allergy treatment with the sublingual method may never have been as easy or as effective as it is today; and certainly it is fast becoming more widely available. Remember, not all sublingual options are equal. As always, it is important to do your research and educate yourself so you can rest assured that you are making the right choice.

– Dr. Dean Mitchell

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