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Sublingual Immunotherapy

Posted on: 06/11/2014

An exciting development is the approval by the FDA of under–the–tongue (sublingual) treatments for grass or ragweed pollen allergies: Grastek, Oralair and Ragwitek.


For years, some practices have used the allergy extracts designed to be used for injection, as drops given under the tongue.  The FDA has never approved this and insurance has never covered it.  Because of these important issues, we do not offer sublingual drops.


Our practice, AAIR, has several years’ experience with sublingual therapy, because we have taken part in multiple clinical trials of multiple agents, including some of the newly-approved ones.


The new therapies are proven to work.  Would one of them be right for you?
Each of them is a sublingual tablet to be held under your tongue for 30 seconds every day.  Each needs to be started 3 months before the pollen appears in outdoor air. These dates vary by region, but for our area they are as follows:  For grass pollen, this means that for any given year, treatment needs to start by February 1.  For ragweed pollen, treatment needs to start by May 1.  Later starts are not effective.  Treatment must be continued through the appropriate pollen season--until about June 30 for grass and September 30 for ragweed.  Treatment would be repeated the year thereafter, often for three years in total.  If you swallow the tablet, it will be digested and not work.


You can only use one treatment at a time, so you can only use one therapy in any given year because the seasons overlap.


For patients with single sensitivities to grass or ragweed pollen, this might be an excellent choice. 


At this time, whereas traditional allergy shots are widely covered by insurance, the new sublingual tablets are not yet.  We anticipate that this may change at some point.
We prescribe these new sublingual tablets because these new therapies are effective and approved for use. Are sublingual tablets right for you? If you feel that your allergy is right for one of these treatments, please make an appointment with your allergist to discuss it.

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