Allergy study skips shots and goes for the tongue


Finally some good news on Allergy treatment. Sublingual Immunotherapy instead of shots. No more skin penetrating and direct injections into the blood. The allergen will go via "normal" way, i.e. the immune system will get proper warning and will act accordingly

"I have to remember to take it every morning," Mrs. Pilarski said. "Other than that, it's very convenient."

Ok, I understand that there's a price to pay for the safe medicine - a need to remember to take it. However, I think it's not that hard.

Anyways, I think this is a great start.

Read more below

Ragweed season is coming to a close, and so is a study at Allegheny General Hospital evaluating a method of nipping in the bud allergies to the flowering plant.

Instead of getting allergy shots to build up their tolerance, patients put small amounts of the allergen, meaning the substance to which they react, under the tongue.

It's called sublingual immunotherapy, or SLIT, explained study leader Dr. Deborah Gentile, a pediatric allergist.

Like shots, "what this does is it slowly retrains your immune system," she said. "We're very excited about this."

Although the results aren't in, study participant Christine Pilarski, 41, of Robinson, is happy with the experiment, too.

She became allergic to ragweed in her 20s and developed more allergies within a few years.

"On a bad day, I have sneezing and watering and itchy eyes," Mrs. Pilarski said. "My nose is stuffy, but it also runs. I have to have a Kleenex with me at all times."

She takes antihistamines to treat the symptoms, which now occur so regularly that she can only forgo the drugs from about December to February.

"There are times I've had to leave work early because I've been feeling so horrible," said Mrs. Pilarski, who works at Allegheny General. "There are times I have to sleep sitting up" because of the congestion.

After skin testing to verify her ragweed allergy, she was asked to participate in Dr. Gentile's study. During the initial appointment, the researchers determined the starting dose of allergen by assessing her reaction to placing ragweed serum in her mouth.

Then, they gave her a vial of the agent so she could administer it to herself at home. Every two weeks, she was checked and the dosage adjusted upward to build her tolerance to ragweed exposure.

"I have to remember to take it every morning," Mrs. Pilarski said. "Other than that, it's very convenient."

That's a big advantage of the technique, Dr. Gentile said. Patients must go to the doctor's office weekly for allergy shots, at least in the beginning.

Sublingual immunotherapy, sometimes known as allergy drops, is attractive also because it is safe, said Dr. B.J. Ferguson, director of the sinonasal and allergy division at UPMC Eye and Ear Institute. She is not involved in the study.

"It's very safe and it appears to be effective," Dr. Ferguson said. But "I don't know that it's as effective as allergy shots."

Most of studies of the sublingual method treat only one allergen, but most patients are allergic to several things, she pointed out. For them, it might be more practical to get shots that combine multiple antigens.

It's also not yet clear how best to take the drops.

"There are two camps," Dr. Ferguson said. "One is hold it under your tongue and then spit. The other is hold it under your tongue and swallow."

If swallowed immediately, the drops will degrade in the stomach acid, rendering them useless, she explained.

Dr. Ferguson isn't offering sublingual immunotherapy to patients yet, but she has considered it. It is still considered experimental in the United States, and therefore is not covered by health insurance, but it has been available for years in Europe.

Some allergy specialists, including Dr. Kenneth Skolnick, who has offices in Sewickley, Wexford and Center, have patients who pay out of pocket for allergy drops.

"I used to do sublingual therapy many years ago," he said. "It was considered voodoo. [And] because of insurance concerns, the legal aspects and lack of good scientific documentation, we tended to get away from doing it."

Now it's making a comeback as American trials explore its benefits and risks.

"Do I believe in my heart that it works? Yes," Dr. Skolnick said. The studies have been positive, too, but most allergists administer more than allergen, unlike the experimental protocols.

He's not sure whether drops or shots are more effective because he hasn't seen or done a side-by-side comparison.

Sublingual immunotherapy, Dr. Skolnick said, is "a reasonable alternative to injections, but the economic issues are the big driving force of which therapy patients get."

Three to five years of allergy shots can lead to significant symptom relief. A similar effect might be possible with the sublingual method, but so far it seems that the shots work a bit better, Dr. Gentile said.

Although the ragweed study is wrapping up, the Allegheny General team will be starting another round of tests early next year. The therapy must begin several months before the allergen's season comes around.

So, "we will be recruiting for the grass season," Dr. Gentile said. "We'll enroll those people and start them in January or February."