Allergy Tablets (Sublingual Immunotherapy or SLIT)

You may have seen our discussions on allergy drops and allergy shots as part of the continuum of allergy care using immunotherapy. Much like allergy drops, tablets can also help with specific allergens. Like drops, these tablets are dissolved under the tongue and enter the bloodstream to support the immune system, eventually desensitizing the patient to the allergen. Unlike subcutaneous injections or allergy shots, your provider does not need to supervise their use beyond the first/initial treatment as there is minimal risk of severe reaction. However, patients are prescribed epinephrine (EpiPen) with these tablets in case they experience anaphylaxis at any time during therapy.

The FDA has approved four allergy tablets. The first, known as Ragwitek®, is approved for short ragweed, Grastek® is approved for timothy grass pollen, Odactra® for dust mites, and Oralair® for several types of northern grass pollen. While the number of allergies treated by tablets is limited, there are ongoing studies on a broader range of allergens. We expect that the FDA will approve new tablets for more allergens in the future.

Tablets are very safe, and their effectiveness approaches that of an allergy shot. Of course, as with any medical therapy, there is the possibility of side effects, including itching or burning of the mouth or lips. Some patients will develop gastrointestinal issues. Fortunately, most symptoms are temporary and diminish over days or weeks. Some tablets (pollens) can be taken seasonally or year-round depending on the desired result.

What About Dosing?

We still have much to learn about the optimal dosing of these allergy tablets. Some are recommended to be started between two and four months before the allergy season. Others, as allergy season begins. Further research is being done on whether these allergy tablets should be taken year-round to achieve a durable response much like shots or drops would.