Which is the right preseasonal allergy treatment choice?
For those who are interested in just treating seasonal allergies, preseasonal treatment through allergy drops and tablets are available to take the sting out of the season. How do you know which might be a better choice for you?
Patients who test positively to seasonal allergies and experience strong symptoms may benefit from high dose preseasonal allergen drop therapy, which begins eight weeks before the allergy season starts, and continue treatment into the season. The intent is to build the body’s tolerance to pollens before the season hits, so that when pollens are at their worst, the body doesn’t have as strong a reaction. Typically, preseasonal allergy drop treatment is considered an add-on to year-round inhalant sublingual immunotherapy. Some patients find that adding preseasonal treatment to their year-round therapy can reduce the time it takes to complete their year round allergy drop therapy. For those with seasonal allergies only, preseasonal drops alone can reduce symptoms as well.
FDA approval of sublingual immunotherapy tablets for seasonal grass and short ragweed allergy confirms what we’ve experienced for decades: that the sublingual route is a safe, effective route of administration to treat allergic rhinitis and asthma.
The single-antigen tablet with one “standard” dose addresses a narrower range of patients and allergens that are not typical of most of the patients seen in the U.S., as most allergy patients are impacted by and treated for multiple allergies. Many have related conditions (moderate/severe uncontrolled asthma, need for beta blockers), or may be younger than the package insert recommends for treatment with tablets.
The La Crosse Method Protocol recommends that an optimal way to treat patients is to consider the patient’s total allergic load and level of sensitivity through comprehensive yet specific testing, followed by sublingual immunotherapy treatment that is tailored to each patient’s unique allergies and sensitivity levels. The La Crosse Method™ Protocol offers treatment options not only for the seasonal sufferer, but also for the wide range of patients who would benefit from custom treatment that’s designed to maximize therapeutic benefit and minimize risk of reactions and unnecessary symptoms in a cost-effective way.
Sublingual allergy tablets offer another option for patients, but it might also be helpful to compare the two treatments to help make a decision on what is right for your patients:
- Ages treated — allergy drops can be prescribed for all ages; sublingual allergy tablets have age limitations.
- Number of people treated — the La Crosse Method has been used to treat more than 195,000 patients over 46 years; allergy tablets have been used for US populations since approval in 2014.
- Cost — preseasonal allergy drops cost about $1.85 per day; tablets cost $4-10 per day.
- Contraindications/Safety — custom allergy drops are safe and adjustable for virtually any condition or level of allergy severity; tablets may not be recommended for those with uncontrolled asthma, eosinophilic esophagitis, those currently on beta blockers, immunotherapy, and pregnancy. Patients also need to weigh the rate of reactions that are indicated in studies to decide if it’s the right route for their individual situation.
- An emergency epinephrine device is required with all allergy tablet prescriptions. It is up to the provider and patient if epinephrine is prescribed with custom drops, based on patient history, allergic severity, and testing results.
Another consideration is how long the benefits of treatment last. Many patients treated with year-round allergy drops see sustained improvement after treatment is done (typically 3-5 years, but longer for those with more complex allergies). With tablets, there is still inconclusive evidence of ongoing sustained tolerance.
The good news is that there are treatment options available to help seasonal pollen sufferers put their symptoms behind them for the long term – and patients should speak with their providers about how they can match a treatment to their condition and treatment goals.