Eyeworld

EW NEWS & OPINION 32 April 2016 by Vanessa Caceres EyeWorld Contributing Writer there is a dust mite tablet, Dr. Cox thinks. Dr. Cox prescribed SLIT tablets to a handful of patients in the past year. Those patients reported that the tablets seem to have helped their symptoms with the target allergy and with other allergies as well. She thinks they may have helped other allergies as the body was less primed to have an allergic response. The downsides Despite enthusiasm over SLIT, one downside is that in the U.S., patients also must be given an epinephrine auto injector when they receive a SLIT prescription in case they have a bad reaction, said Leonard Bielory, MD, principal in- vestigator, U.S. Environmental Pro- tection Agency on climate change and allergic airway disease, Rutgers University, and attending, Robert Wood Johnson University Hospital, New Brunswick, New Jersey. "There's nowhere else in the world where that is done," Dr. Cox said. Another downside is that the tablets treat only 1 kind of allergy. "People are rarely allergic to just 1 seasonal or perennial allergen," Dr. Bielory said. Doctors may prescribe SLIT in a few different ways—for example, with the grass tablets, patients may use them year-round, or they may use them only right before and during grass allergy season, Dr. Cox said. Physicians are reporting mixed results with insurance coverage for the SLIT tablets; some have noticed companies usually cover the SLIT tablets approved by the FDA, while others say coverage is spottier. Aque- ous SLIT has more variable coverage. "One significant consideration of aqueous sublingual immunotherapy is that it takes more than 50 times the same allergen as subcutane- ous immunotherapy, and this can significantly increase the cost of this treatment," Dr. Miller said. Allergists in the U.S. have an interest in using SLIT, but the dust is still settling on how many are actu- ally offering it. A 2011 survey (prior to the FDA approval) found that 11.4% of allergists reported using SLIT—compared with 78.2% using subcutaneous therapy (injections). 1 "Recent approvals of standardized tablets will significantly accelerate the popularity and use of SLIT in the future," Dr. Miller said. The tipping point in the U.S. may come when Ear, Nose and Throat, Roseville, California. The SLIT tablets approved in the U.S. treat just 1 allergy at a time. Oralair (Greer Allergy, Lenoir, North Carolina) includes a 5-grass combi- nation. Grastek (Merck, Kenilworth, New Jersey) contains Timothy pollen grass extract. Ragwitek (Merck) has short ragweed pollen. There are more diverse SLIT therapies on the way, eventually. "Multi-allergen aqueous sublingual immunotherapy has been reviewed. Other standardized pharmaceutical- grade formulations of sublingual im- munotherapy are available outside the U.S.," Dr. Miller said. Researchers are also investigating SLIT for a variety of allergy types, including cat and dog allergies. A patient takes his or her first dose of SLIT at the doctor's office. If there are no unusual side effects after 30 minutes, the patient receives a prescription for tablets that he or she can take at home. About 70% of patients will experience mild itchi- ness, tingling, and discomfort from SLIT, said allergist Linda Cox, MD, Asthma and Allergy Center, Fort Lauderdale, Florida. SLIT is a newer option in the U.S. to fight allergies A s patients rub their eyes and sneeze their way into your office this spring due to seasonal allergies, you can fill them in on a rel- atively new way to relieve allergies called sublingual immunotherapy, or SLIT. Sublingual immunotherapy works similarly to other forms of therapy, including allergy shots. However, instead of receiving injections, a patient takes tablets at home that contain an allergen. With aqueous SLIT, the patient receives a concentrated drop of the allergen under the tongue at the doctor's of- fice for the first use, after which they use SLIT at home. Although SLIT has been around for more than 3 decades and is already popular in Europe, it's just now gaining popularity in the U.S., thanks to the recent U.S. Food and Drug Administration (FDA) approval of several SLIT tablets, said Travis Miller, MD, medical director, the Allergy Station at Sacramento Fighting allergy with sublingual immunotherapy The starter set for custom SLIT includes 2 dropper bottles for 10 buildup phases after which the patient would use the maintenance drops. Source: Howard Loff, MD Allergy facts and figures • Allergic disease has increased in the industrialized world over the past 50 years. • Allergic rhinitis affects 10–30% of the population around the globe. • In 2012, 17.6 million U.S. adults were diagnosed with hay fever in the previous 12 months. In that same time period, 6.6 million children were diagnosed with hay fever. • More than 11 million visits to physicians in 2010 had a primary diagnosis of allergic rhinitis. • Ocular allergy symptoms occur in 64% of people with nasal allergies. Source: American Academy of Allergy, Asthma, and Immunology

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