Seasonal allergies can be irritating not just for the upper airways, but also for the eyes. Seasonal allergic rhinitis (hay fever) is an allergic response to airborne pollens such as trees, grasses, and weeds, which can be particularly bothersome as it spans from early March to the first frost, here in the tri-state area.
According to the Asthma and Allergy Foundation of America, in 2021 some 81 million people in the U.S. were diagnosed with seasonal allergic rhinitis – equal to about 26% (67 million) of adults and 19% (14 million) of children.
The “seasonal” part of the equation can be defined by these simple facts: Tree pollen is common in spring; grass pollen in late spring into summer; and ragweed pollen in late summer into fall. And as unpleasant as dust mites and cockroaches sound, these allergens, along with animal dander, are present year-round, and are considered triggers for perennial symptoms.
Once diagnosed, allergic rhinitis treatment options include avoidance (if possible) and eliminating or decreasing your exposure to the triggers. This can of course be difficult to achieve in the case of pollen unless one lives roughly three quarters of the year indoors. Alternatively, with regards to dust mites, no matter how clean your home is, it is probably still a little dusty.
Treatments that patients initially rely on for their allergies include antihistamines (oral, intranasal, ocular), and intranasal corticosteroids, which provide temporary symptomatic relief. Allergen immunotherapy (also known as allergy shots) has been shown to be effective in treating patients with allergic rhinitis. Unlike allergy medications, allergy shots modify the underlying cause of the disease and can provide long-term benefits. However, patients can find it challenging to commit to the recommended allergy regimen: weekly injections for about six months to build their tolerance to the allergen(s), followed by a maintenance schedule of once monthly injections for the next three to five years.
Fortunately, there is another type of treatment available: sublingual immunotherapy (SLIT). This involves allergy tablets and has emerged as an effective, safe, and possibly more feasible alternative to allergy shots for some individuals. Currently in the U.S., the FDA has approved four allergy tablets: two are directed at grass pollen (Oralair and Grastek); one is for short ragweed (Ragwitek); and one is for dust mites (Odactra). Oralair, Grastek, and Ragwitek are approved for children 5 years old and above. Odactra is approved for children 12 years old and above.
The tablets are placed under the tongue for at least one minute, then swallowed as they dissolve. They are generally taken once a day during therapy. The dosing regimen varies depending on the targeted allergen, where one could benefit from starting SLIT several months before the season (as with pollens), while others may benefit from year-long SLIT (as with dust mites). Treatment typically is continued for around three years for continued effectiveness.
Side effects of allergy tablets are usually mild for all ages: itchy mouth (if present, would occur early in treatment and usually is transient) and, less commonly, an upset stomach. Severe allergic reactions are rare; however, as there is the possibility of severe allergic reactions in patients receiving immunotherapy (whether allergy tablets or allergy shots), for safety purposes, an epinephrine autoinjector is always prescribed.
SLIT is only appropriate to consider for certain patients who have allergic rhinitis to the allergen contained in the allergy tablet of choice. As such, patients with multiple allergies would likely benefit from allergy shots instead.
Knowing that they may be able to “breathe easier” without injections is an attractive option for many patients; however, whether these tablets are adequate or recommended for you is a matter for discussion with an allergist.