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About Dr. Belinda Mantle

Dr. Mantle’s practice is focused on the diagnosis and management of pediatric patients with common ears, nose and throat disorders. She pursued sub-specialty training in pediatric otolaryngology at Children’s Hospital of Pittsburgh. Dr. Mantle is fellowship-trained in pediatric otolaryngology and is a board-certified diplomate of the American Academy of Otolaryngology/Head & Neck Surgery.

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About Dr. Hootan Zandifar

Dr. Hootan Zandifar is board-certified in Otolaryngology and fellowship-trained in Facial Plastics and Reconstructive Surgery. Dr. Zandifar is the director of the Skin Center at the Osborne Head and Neck Institute based at Cedars-Sinai Medical Towers.

In April, 2014, the FDA approved the first three sublingual (under the tongue) tablets for specific allergens. Patients with specific allergies to grasses and/or ragweed may consider this sublingual alternative for treatment. Patients are candidates for this therapy if they have a confirmed allergy to one of the grasses or ragweed and have symptoms. Typical allergy symptoms include sneezing, runny/itchy nose, nasal congestion, or itchy/watery eyes.

What sublingual allergy tablets are currently available?

There are three types of sublingual allergy tablets available:

• ORALAIR: the first approved sublingual allergy tablet. It contains a mix of 5 grass allergens. Oralair is approved for patients with grass allergies and is taken daily before and throughout the grass allergy season.
• GRASTEK is Timothy grass pollen allergen extract used to treat Timothy and related grass allergies. It is approved for adults and children (over 5 years old). It should be started before the beginning of grass season and continued through the season.
• RAGWITEK can be used for the treatment of ragweed pollen allergy in adults ages 18 – 65. It is taken for 12 weeks before and throughout ragweed pollen season.

Are there any side effects to allergy tablets?

The most common side effects of sublingual allergy tablets are itching of the mouth, lips, tongue or throat; swelling under the tongue; and throat irritation.

The first allergy tablet dose is given in the physician’s office where the patient can be observed for any signs or symptoms of an allergic reaction. Patients are also prescribed an Epi Pen (auto-injectable epinephrine) in the event that they develop anaphylaxis, a severe allergic reaction.

Who can use sublingual allergy tablets?

Sublingual allergy tablets are not recommended for patients with:

• Severe, uncontrolled asthma
• History of a severe allergic reaction in the past
• Prior adverse reaction to sublingual therapy
• History of eosinophilic esophagitis
• Allergy to any of the inactive ingredients in the tablets 

How do sublingual allergy tablets work?

Sublingual allergy tablets are taken daily by placing the tablet under the tongue where it dissolves within approximately 1 minute. Sublingual allergy tablets are not medications that provide immediate relief of allergy symptoms.

Sublingual allergy tablets are made from similar extracts used in allergy shots or SLIT drops. The goal of these therapies is to induce allergy tolerance over time.

Are sublingual allergy tablets as effective as SLIT or allergy shots?

While the tablets may be effective against the few items they target (grasses, for example), they only work against these specific items. Each tablet is made for a specific allergen and most people are allergic to more than one thing.

For patients with multiple allergies, sublingual immune therapy (SLIT) drops are a better treatment option. SLIT drops are individually formulated for each patient based on his/her specific allergy profile. Drops are created by diluting small amounts of each individual allergen that the patient is allergic to. The patient then administers the drops under the tongue daily, waiting 1-2 minutes before swallowing to allow for proper absorption.

If you suffer from allergies and are interested in learning more about sublingual immune therapy, contact our office to schedule an allergy evaluation with Dr. Mantle or Dr. Zandifar.

To learn more about Dr. Belinda Mantle or allergy treatments, please visit www.ohni.org.

Image Credit: By Michelle Tribe from Ottawa, Canada (500) [CC-BY-2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons