Sublingual Allergy Drops versus Sublingual Allergy Tablets; what are the similarities and what are the differences?
The FDA has approved sublingual immunotherapy tablets for seasonal grass and short ragweed allergy (Oralair, Grastek and Ragwitek). This approval confirms what we have known for decades: that the sublingual (under the tongue) route is a safe, effective, convenient route of administration to treat environmental allergies, and their associated medical conditions.
Environmental allergies have been treated by multi-antigen liquid drops taken under the tongue (through the sublingual route) for decades all over the world. The newly approved single-antigen tablet with one “standard” dose unfortunately treats only a very small group of patients; specifically, patients with allergies to only the grass and/or ragweed represented in that tablet. In reality, most people have multiple allergies (or antigens). With custom mixed sublingual allergy drops, allergies to many allergens are effectively treated simultaneously (i.e. tree pollen, grass pollen, ragweed, cat and/or dog dander, dust mites, molds, etc.).
Most allergy patients benefit from customized treatment for multiple allergies. Each individual’s sublingual immunotherapy drops are designed to maximize their therapeutic benefit and minimize any risk of reaction and unnecessary symptoms in a cost-effective way.
Sublingual tablets offer another option for patients, which is good. You should compare the pros and cons of sublingual immunotherapy tablets versus sublingual immunotherapy drops in deciding which treatment would be better for you.
| Sublingual Immunotherapy Drops | Sublingual Immunotherapy Tablets | |
|---|---|---|
| Delivery Method | FDA-approved liquid antigen under the tongue. Currently considered “off label” use of FDA-approved antigens. | FDA-approved antigens in tablet form delivered under the tongue. Approved for grass and ragweed only. |
| Customized to Patient Sensitivity | Yes. Dose is based on individual patient sensitivity, dosed to provide maximum therapeutic benefit with minimal risk of reaction. | No. Standardized dosing for all patients. |
| Treats Multiple Sensitivities Simultaneously | Yes, multi-antigen treatment used to address sensitivities based on patient test results. Most flexible protocol available. | No, focused on individual pollens (grass & ragweed). |
| Patient Ages Treated | Treats patients 5 years of age and older. | Indicated for ages starting at 5, 10 or 18, up to 65. |
| Insurance Coverage | Not currently. Patients typically pay using their Flexible Savings Account (FSA), their Health Savings Account (HSA) or simply out of pocket. | Will likely be once reviewed by Insurers/PBM formularies, subject to Tier 3 or 4 co-pays (co-pay estimates of $50-100 month; varies by carrier). |
| Contraindications/Safety | Extremely safe and adjustable for virtually any condition or level of severity, dosing escalated based on patient tolerance. Estimated over 1 billion doses taken by patients with no severe adverse events. | Variety of contraindications including uncontrolled asthma, eosinophilic esophagitis, those currently on beta blockers, immunotherapy, and pregnancy. Adverse event profile is high with rapid escalation. |
| Require Emergency Epinephrine Device | Not required for general use. Only required for those with a known history of anaphylaxis to their underlying allergic conditions. | Required with all prescriptions. |
| Long-term Efficacy | Majority of patients enjoy a significant and sustained improvement after treatment conclusion (and a decrease, or elimination, of the need to take allergy medications). | Inconclusive evidence of ongoing sustained efficacy after two seasons of treatment. |