Allergic Rhinitis
Allergic rhinitis affects 15-20% of adults. It affects 40% of children. As many as 50 Million of us have allergic rhinitis in the US. Allergic rhinitis accounts for 12 Million doctor-visits per year. Allergic rhinitis causes 2 Million lost days of school per year. And allergic rhinitis contributes to worse problems - 55% of those with sinusitis have a history of allergic rhinitis (AR).
Treatments
- Treatment of AR should focus mostly on avoidance of allergens - the triggers that we react to. When avoidance is not enough, the other 2 main treatments are:
Antihistamines: Allergens cause a histamine release. Many of the symptoms of allergies are due to histamines. This is the reason so many of us, including children, are taking antihistamines - to try to reduce the allergic response.I am pretty strongly opposed to use of antihistamines in children. Even newer antihistamines have numbing effects on their little brains, even if we don't notice.
Steroid Sprays: Topical steroid nasal sprays can help reduce the inflammation of AR. All of them are absorbed into the body to some extent. There have been no well-executed medical studies on how effective these sprays are in children. Despite this, we spend hundreds of millions on these sprays for our children every year in this country.
Regardless of the medication, the effects of all allergy medications are temporary.
Immuno-therapy
For a long-lasting reduction in allergy symptoms, we need to change how our immune system reacts to allergens - immuno-modulation. The only treatment that has proven long-term immune modification is immunotherapy (IT).
The idea is to expose your immune system to very low amounts of your allergens over a long time, and build tolerance to these antigens.
Traditionally, subcutaneous immunotherapy (SCIT) involves frequent injections of allergens. Nobody likes needles. This makes SCIT unpopular: most children stop going to their allergist for "allergy shots" before they achieve the full benefits.
Sublingual Therapy - Drops Under the Tongue
One alternative to SCIT has been sub-lingual (below the tongue) immunotherapy, or SLIT. SLIT has been used in Europe for over 20 years. It has been successful in Europe. It has been popular in Europe.
Unfortunately, it has also been bad-mouthed in the U.S., delaying its acceptance here. Despite this slow acceptance here in America, SLIT has been reported to be safe for both adults and children in multiple clinical trials.
Does SLIT Work?
To date (2010), 19 out of 22 clinical studies have found that SLIT was successful in reducing allergic rhinitis (common allergens: grass, dust mites, trees). Some studies also showed a significant positive effect on asthma. The estimated clinical improvement ranged from 20%-50%. For one clinical trial that included children with asthma treated for 2 years with SLIT against dust mite allergies, symptoms decreased by 60% at the 2nd year of treatment.
Like the Europeans a couple decades ahead of us, I conclude that SLIT can work to reduce allergic rhinitis and other allergic symptoms.
Side Effects of SLIT
As with SCIT, SLIT can result in severe, serious reactions. There have been cases of anaphylaxis (life-threatening allergic reaction) linked to SLIT. To be fair, there have also been cases (more, actually) of anaphylaxis linked to SCIT, too. However, the common reactions to SLIT include itching of the mouth, throat irritation, nausea and other GI complaints. As with ANY immunotherapy, SLIT is not without risks. As with ANY immunotherapy, SLIT therapy should be used with caution and with close medical attention.
SLIT in the United States
Most of the medical studies have been conducted elsewhere in the world, not in the US. The US Food and Drug Administration (FDA) has not approved SLIT. Several clinical trials are ongoing at this time in the US. If, as one would expect, the results here in the US are similar to those obtained in studies done worldwide, the FDA will likely approve SLIT sometime in the future.
Despite the lack of FDA approval, physicians are already providing SLIT therapy in the US, and some have been offering this therapy for many years. For many patients, treatment without the approval of the FDA is not a concern.
To find a physician in your area who is skilled in SLIT treatment of allergic rhinitis and asthma, do an online search for sublingual immunotherapy. Also check out the guidelines from the World Allergy Organization (WAO) on SLIT. For more details on controlling allergies, rhinitis, and sinusitis, please visit my blog.
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