The iconic cherry blossoms in Washington, DC, are in full bloom on March 28 this season, earlier than most years. Mild winters lead to longer pollen seasons, and that’s bad news for allergy sufferers.
Drew Angerer/Getty Images
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Drew Angerer/Getty Images
The iconic cherry blossoms in Washington, DC, are in full bloom on March 28 this season, earlier than most years. Mild winters lead to longer pollen seasons, and that’s bad news for allergy sufferers.
Drew Angerer/Getty Images
If you’re sniffling and sneezing, you’re not alone. Mild winters, like the ones the US has had, can carry allergy season is longerbecause warmer temperatures promote some plants produce more pollen.
For the millions of Americans battling allergies, taking over-the-counter antihistamines, often associated with a steroid nasal sprays, is enough for temporary relief of symptoms. But Abigail Bortnick, 41, wanted a way to prevent long-term allergic reactions.
“I have very severe seasonal allergies,” says Bortnick. Tests revealed she was allergic to grasses and weeds, and she recalls feeling bad when the pollen count increased. “I would have a runny nose, itchy eyes, everything,” said Bortnick, who lives in the Washington, DC area.
Allergy shots are an option, but with young children and busy jobs, driving to the doctor’s office each week for an injection is inconvenient. So her allergist recommended her an alternative, called sublingual immunotherapy, called SLIT, a form of exposure therapy. She was given drops of liquid that she could administer on her own. “I like the idea of not having to go to the shoot and being able to do it at home,” says Bortnick.
Five drops, individual serum
The serum comes in a small bottle with a pump on top. Once a day, she puts five drops under her tongue. “It makes it easy,” Bortnick said. She can’t eat or drink for 30 minutes, so she tries to take them at the same time each day so they don’t interfere with her meals.
She started taking allergy medication a few years ago and has seen significant improvement. “I have absolutely noticed that my allergies are much better,” says Bortnick. She also noticed she had more energy, perhaps because she slept better due to less congestion and inflammation. When she starts a new vial, she sometimes gets a “slightly itchy” in her mouth, but that subsides quickly. And at the height of grass pollen season, she still takes Claritin, but her symptoms are much less severe.
Both allergy shots and SLIT are forms of allergy immunotherapy. Patients are exposed to very small amounts of specific things they are allergic to with the goal of training the immune system to tolerate them gradually over time. Doctors make SLIT allergy drops the same way they make allergy shots, mixing extracts from allergens. For each patient, the serum was individually tailored to include the specific mix of irritants that trigger their allergy.
“Part of the beauty of therapy is its convenience,” says Dr. Rachel Schreiber, an allergist in Rockville, Maryland who treats Bortnick. Patients often stay in SLIT for several years, says Schreiber. “We reassess every year to determine if treatment should be continued,” she explains. Sometimes patients stop too soon and symptoms can recur. “It’s easy to start over,” in those cases, says Schreiber, and many of her patients have improved over time.
Tablets too
There are two types of sublingual immunotherapy, liquid drops mixed with the allergens that Bortnick takes by mouth, as well as soluble tablets, for single allergens. The Food and Drug Administration has approved four pills, including one for ragweedone for dust mitesand two grass pollen allergy tablets, including one for Timothy grass. The tablets melt within a minute or two of being placed under a person’s tongue. The American Academy of Allergy, Asthma, and Immunology says the pills have been shown to provide long-term improvement.
The most common side effects of the pill are temporary itching or burning in the mouth, which usually goes away quickly. Studies show that tablets have good safety, although serious allergic reactions can occur, so patients using SLIT tablets are also prescribed an epinephrine auto-injector, called an auto-injector. Epi-Pen. Usually, insurance covers the cost of these tablets.
“They are very effective,” says Dr. Howard Boltansky, an allergist at Johns Hopkins, but the main downside is that each SLIT tablet targets only a single allergen. Since most people are allergic to many things, many patients prefer the option of quitting.
Off-label use
Boltansky has been in practice for more than 35 years and recently started offering allergy relief SLIT. (He meets the patient at Hopkins’ otorhinolaryngology Center in Lutherville, Maryland.) “The use of sublingual immunotherapy drops has increased due to the potential to include many allergens that are not present in the currently FDA-approved pill,” Boltansky said. And, as patients learn about this option, they enjoy the flexibility and convenience, which also helps explain the growing interest, he said.
The drawback is that SLIT allergy drops are not approved by FDAso they are not covered by most insurance, Medicare or Medicaid.
When making allergy drops, Boltansky explains, he uses the same FDA-approved extracts that he uses to make his allergy shots. The only difference is that, instead of injecting the serum into a person’s arm, it is put into a dropper bottle for the patient to use at home. So the drops are an ‘off-label’ use of the extract. “I am completely comfortable using FDA-approved anti-allergy extracts in an ‘off-label’ fashion,” says Boltansky.
In Europe, many doctors have been using the method for years, Boltansky said. And, like with the SLIT tablet, doctors also prescribe Epi-Pen to patients taking allergy drops, although he says serious allergic reactions are rare.
When a patient begins sublingual immunotherapy, allergen exposure is tightly controlled. “We started giving people small amounts of what they were allergic to,” says Boltansky. “Gradually, when their body says it’s okay, we increase the dose a little bit,” he says. The drops are made from pure extracts, so Boltansky has one bottle of ragweed pollen, another for tree pollen, as well as an extract for dust mites and cats. So if a person is allergic to all four of these, “we mix them together into a custom allergy dropper,” he explains.
“When we start an immunotherapy treatment for someone, whether it’s a drop or an injection, we initially approach it as an experiment,” says Boltansky. They try it for about six months, and if they’re doing well, they’ll continue the treatment. He said about 80% of patients respond well and the course of treatment usually lasts 3 to 5 years.
Not all allergists offer SLIT allergy relief, due to “off-brand” conditions and lack of insurance. “This is a Wide range of effects and ineffective dosages of SLIT liquid formulations,” according to the American Academy of Allergy, Asthma and Immunology. That’s why everyone should Find a doctor with experience in testing and formulating immunotherapy treatments, such as a board-certified allergist. In addition, some board-certified otolaryngologists (otolaryngologists, known as ENT’s) have expertise in SLIT.
Abigail Bortnick pays about $600 a year for her allergy medication. “I don’t like that it’s not covered by insurance, but I think the convenience factor outweighs the cost,” she said.
Boltansky says he wants to see more research to prove the effectiveness of allergy reliever SLIT in preventing symptoms. “I hope that over time the studies will be completed and the FDA will review them and they will be approved,” Boltansky said. In the meantime, doctors will continue to give off-label drugs to patients who are suitable for immunotherapy.
