WebMD Medical News
Louise Chang, MD
March 5, 2012 (Orlando, Fla.) -- For many allergy sufferers, getting shots is a pesky, even painful part of ragweed season. Now, researchers report success testing an under-the-tongue tablet as an alternative to injections in people with ragweed allergies.
In a study of more than 500 people with ragweed allergies, people who took the experimental tablets had less nasal congestion, eye tearing, and other allergy symptoms than those who took a placebo. Those given the new pills also needed fewer antihistamines and other allergy medications for relief.
The treatment is a type of immune therapy, the most common form of which is the allergy shot. Tiny amounts of the proteins to which you are allergic are injected to weaken the immune system's response to ragweed, grass, or other allergy triggers.
The new treatment works much the same way, but instead you put a tablet containing tiny extracts of allergens -- in this case ragweed proteins -- under the tongue each day until tolerance develops.
Immune therapy is the only treatment that's been proven to modify the natural course of the allergic disease, "actually turning it off and keeping it suppressed over time," says Johns Hopkins' Peter Creticos, MD, who led the new study.
Shots may work, "but some people are afraid of the needle or don't have time to go to the doctor's office [two to four times a month] during allergy season to get them," he says.
Also, "3% to 6% of people on allergy shots have systemic [throughout the body] allergic reactions that can be severe or life-threatening," Creticos tells WebMD.
That makes the tablets a welcome option, he says.
Merck & Co., which makes the new tablet and funded the study, plans to apply for FDA approval of tablets for both ragweed and grass allergies next year. The grass tablets are already in use in Europe.
The new study was presented here at the annual meeting of the American Academy of Allergy, Asthma, & Immunotherapy.
The new study involved 565 adults with ragweed allergy, some of whom also had asthma. They were given one of two doses of either the once-daily tablet or a placebo for 52 weeks.
During ragweed season, which runs for about four to six weeks in August and September, everyone recorded their symptoms and need for relief medications in electronic diaries.
During the peak two weeks of the season, the tablet reduced symptoms -- including sneezing, runny and itchy noses, congestion, and gritty and watery eyes -- by 17% and 14% at the higher and lower doses, respectively, compared with placebo.
It also reduced the need for standard allergy medications at the two doses vs. placebo.
The most frequent side effects were throat irritation and itching of the mouth. No one died.
Two patients did need epinephrine, an injectable drug used to treat serious allergic reactions. However, one case was due to an unrelated reaction to peanuts.
Asked whether the tablets are as effective as shots, Creticos says a head-to-head comparison of the two is needed to really answer the question.
Mitchell Grayson, MD, an allergy specialist at the Medical College of Wisconsin in Milwaukee, tells WebMD that he welcomes a tablet, as some of his patients find shots annoying or painful. "And the tablets seem to be less likely to cause [life-threatening] reactions than the shots," he says.
One advantage to shots is that many different allergies can be treated at once, Grayson says.
"Most Americans are allergic to many different things, and with injections, you can pretty much cover all of them. So far, the tablets are each directed at different allergies -- one for grass, one for ragweed, for example. That wouldn’t be very convenient for a person with [a lot of] allergies," he says.
Allergy shots typically are taken for about two to five years, after which many people can stop them and feel relief for years afterward, according to Grayson. It's not yet known for how long people will have to take the new tablets.
If approved, the tablets would only have to be taken for four months before, and during the four to six weeks of, ragweed season, Creticos says. They were given for 52 weeks in the study so the researchers could better assess their safety.
About 60 million Americans suffer from seasonal allergies, also referred to as hay fever and allergic rhinitis.
These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.
SOURCES:2012 Annual Meeting of the American Academy of Allergy, Asthma, & Immunology, Orlando, Fla., March 2-6, 2012.Peter Creticos, MD, associate professor of medicine, Johns Hopkins University, Baltimore; head, Creticos Research Group, Annapolis, Md.; consultant for Merck and other makers of immunotherapy products.
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