We’re approaching summer’s finish line and we all want to soak up as much sun and fun as possible before the weather turns chilly. Unfortunately, in addition to marking the end of summer, August hails the beginning of the ragweed pollen season. Ragweed allergy, classically known as Hay Fever, is recognized by allergy suffers far and wide as the “summer cold” that lasts through Labor Day — and sometimes beyond.
I have vivid memories of my father suffering from Hay Fever. I was 10 years old and hopeful that my dad would play catch with me when he got home from work. But one look at his red nose and watery eyes and I knew I’d have to wait for another day… or another season. My father would head straight to his bedroom where he would turn on the air-conditioner and close the door. When my dad stayed outside for an extended period, he had to “pop” Spantial, an ornate combination of sedating antihistamine and decongestant. That helped the symptoms but he struggled to stay awake with the old-fashioned antihistamine, and fought agitation from the decongestant. We’ve come a long way since my childhood in the 70s.
Today, state-of the-art symptom control treatment is available to provide relief for ragweed allergy sufferers but a well-planned approach to treatment is necessary. That means starting a program several weeks before ragweed season peaks. For appropriate candidates, I recommend Nasalcrom spray twice daily starting in early August. This allows time to build up the necessary protection. Nasalcrom is composed of cromolyn sodium, a mast cell inhibitor, and it is extremely safe with virtually no side effects. However, early prophylactic use is the key to success since it takes several weeks to reach effective levels. This is in contrast to steroid nasal sprays which work immediately but, if used for long periods, can have adverse effects.
The new exciting breakthrough in treating Hay Fever is sublingual immunotherapy. The FDA has recently approved Ragwitek, the pharmaceutical-grade sublingual tablet to treat ragweed allergy. The medical studies have shown the efficacy of this product and validated the benefit of sublingual immunotherapy. My concern is that this product is only available as a high dose tablet without the build-up recommended for desensitizing patients to allergens. 50% of patients had adverse reactions to Ragwitek — such as sublingual irritation from the tablet, itchy throat, sneezing and nasal congestion. Also, Ragwitek is approved only for adults 18 years and older. Since the tablet treats only ragweed allergy, it’s usefulness does not extend to patients with allergy to other weeds or to allergens in the other antigen categories.
Based on my clinical experience, I believe that a better option is the use of sublingual immunotherapy drops, also known as allergy drops. These liquid drops are made from the same allergen extracts used for injections. They can be used to treat multiple allergens at the same time, so they are not limited to ragweed, they are easy to use at home, and they actually taste good. The AllerVision program promotes the safe buildup of allergen doses to achieve tolerance to the allergen for safe, successful treatment. The AllerVision program uses FDA-approved allergens in an off-label method, which is a common practice in medicine.
I’m sure many of your patients have their final summer vacation days planned. Make sure that your ragweed sensitive patients are protected so they can create summer memories that DON’T revolve around allergic disease!
Dr. Dean Mitchell