When you have allergies, budding spring only looks like budding misery. For many people with allergies —seasonal or not–allergy shots are a boon, albeit an inconvenient, expensive one, requiring weekly shots at the doctor’s office for months, followed by monthly shots for several more years.
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Now, researchers are coming up with needle-free alternatives that, while not rendering allergy shots obsolete, could be breakthroughs some patients. “Shots are good and will stay around,” says Dr. David Skoner, director of the division of Allergy, Asthma, and Immunology at Allegheny General Hospital in Pittsburgh. “But some people can’t tolerate shots, they’re costly, and sometimes—rarely–you have the added problem of anaphylaxis,” an extreme life-threatening reaction to the allergen in the shot.
Below, experts explain what may be coming soon to an allergist near you.
Allergy tablets or drops. Sublingual Immunotherapy (SLIT), a fancy term for applying tablets or drops that contain an allergen (the substance that you’re allergic to) under your tongue, has not yet been approved by the U.S. Food and Drug Administration. But some allergists already use the drops off-label, says Skoner: “They take the same extracts used in the shots and give them under the tongue. Tablets are under development and may be approved within the next two years.”
How they work: “The drops and tablets get absorbed under the tongue and go to the lymph nodes like the shots do, telling the immune system to shut off the allergic process,” Skoner says.
Advantages: “Shots have the danger of creating a reaction so they have to be given in a doctor’s office,” says Dr. Robert Bush, emeritus professor of medicine at the University of Wisconsin School of Medicine and Public Health in Madison. “Drops and tablets may have to be given once in a doctor’s office but then can be taken daily at home.” Although anaphylaxis can happen with drops and tablets, it’s far less likely, says Bush.
Disadvantages: You may have a slight itching in your mouth or stomach upset, says Bush. You also have to take the drops or tablets every day for about three years, says Skoner. It’s also unclear whether the reduced reaction to the allergen is permanent.
Cost: Drops cost about $100 a month, says Skoner, and insurance is not likely to pay until the drops are FDA approved. It’s not clear what the tablets will cost, Bush says. But because drops and tablets use about 32 times the amount of allergen as do the shots, the expense of production will rise. “So the cost difference between shots and [oral remedies] may be a wash,” says Bush.
Allergy patches. Epicutaneous immunotherapy, dermatology-speak for therapy applied in a skin patch, is in development for grass pollen and peanut allergies, but only patches for grass pollen have been tested on humans.
How it works: A patch containing a specific allergen is placed on the skin, releasing the allergen to immune-system cells, which distribute the allergen to the lymph nodes to suppress the allergic process, says Dr. David Bernstein, professor of clinical medicine and environmental health at the University of Cincinnati. In a 2012 study at the University Hospital Zurich in Zurich, Switzerland, 132 patients with grass pollen allergies received six weekly patches, two before pollen season and four during. Hay fever symptoms were reduced by 30 percent the first season among those who received the highest dose of allergens and by 24 percent the second season, although no patches were worn in season two.
Advantages: Over time, the exposure to the allergen lessens the reaction to it, just as occurs with shots. ”But no one knows the effectiveness beyond the study length of two seasons,” says Bernstein.
Disadvantages: Patients still have to be observed because of possible systemic reactions, Bernstein says: “And there was a high frequency of itching and redness at the patch site.” Patients can’t yet be treated for more than one allergy, although theoretically, once patches are approved, patients could wear several simultaneously, each for a different allergen, says Bernstein.
Cost: Although it’s not yet clear what the cost will be, Bernstein speculates that a seasonal allergy patch of six weekly doses would be considerably cheaper than weekly and monthly shots taken over several years.