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.
by Albert S. Hartel, MD
The brutal winter has finally come to an end, but as the sunshine comes, so does the onslaught of outdoor pollen, bringing with it misery for the millions of Americans who suffer from nasal allergies and asthma. Even though it is impossible to completely hide from the bombardment, there are likely things you may be unknowingly doing that are making your allergies and asthma worse, and amplifying the effects of pollen exposure. Identifying and rectifying those can significantly reduce symptoms and help minimize medication requirements.
Getting the cheap air filters- We all love to save a few bucks, but skimping on your furnace filter can be costly in terms of symptoms. Studies show inexpensive central furnace/air conditioning filters are less effective than those HEPA certified, which are the most effective type of filter for reducing allergens, chemicals, and some viruses and bacteria as well. These systems were originally developed by the US military during WWII, and can filter out around 99.7% of all particulates in the air that pass through them. Unfortunately however, most allergens never pass through the furnace filter, and instead settles out in carpet and furniture, where it waits for you. Regular vacuuming, and using small room air purifiers will help, particularly in the bedroom and living room, where we spend most of our time indoors. With all purifiers, change the filters regularly, as clogged filters will reduce air flow, and also put strain on your furnace.
Getting a “Hypoallergenic” dog- The term “hypoallergenic dog” was a great marketing ploy by breeders, but unfortunately not true. There is no such thing. Hair vs fur makes no difference, as the allergen is not found in the fur, but comes from the skin, saliva, and urine. A recent study showed the average “hypoallergenic” dog made as much allergen per square inch of skin as any other dog. However, smaller dogs do have less skin surface area, and people who get these dogs are usually already aggressively cleaning, wash the dogs more, and more apt to have other allergen avoidance measures in place, which is the real reason they don't tend to suffer as much. Any dog means more allergen, and more pollen trucked in from outdoors on the fur (or hair).
Blaming it all on germs- If you need antibiotics for sinusitis or bronchitis every spring or fall, it's likely more than just bad luck. We all get sick, but if the cycle repeats itself the same time every year, it may be a pollen allergy and/or persistent allergies leading to chronic underlying inflammation, leaving you a sitting duck when an infection does come along. The feeling that antibiotics aren't working could also be a sign of allergy, as often by the time the second or third course of antibiotics finally “does the trick” coincidentally, the pollen has also often shifted.
Opening your windows – When your windows are open, the outdoor pollen drifts inside, and deposits all over your carpet, furniture and car upholstery, and continues to induce symptoms, even when you think you're safe. Air conditioning is an excellent filter, just make sure that its set to recirculate. In the car, while cruising with the windows down pollen is sucked in like a vacuum. Using an air conditioner in your car can cut the amount of pollen you breathe by as much as 30%. Vacuum your car and the house regularly, particularly with upholstered seats and furniture.
Washing with cold water- Everyone wants the sheets to look pretty forever, however to kill the millions of dust mites crawling on your bedding, warm water doesn't cut it. In a recent study, laundering cotton sheets at 140°F killed 100% of dust mites, while washing at 104°F destroyed just 6.5%. Some units heat water internally, but others use what flows through the pipes, so you may need to boost your water heater. Don't forget to wash the blankets and comforters too.
Ignoring the pollen count- Pollen counts can alert you when the allergy season is upon us, and help limit exposure. Grasses and trees start releasing pollen at sunrise, with levels peaking in the late morning and early afternoon, so its best to run or spend time outdoors in the late afternoon or evening on high pollen days. The Rochester pollen count is done by AAIR, and can be checked by clicking on our website www.aair.info , or following us on facebook.
Having stuffed animals- Stuffed animals are loaded with millions of dust mites, and when they are in bed, the dust mites are also getting cozy with your kids for 8 hours or more a night. Stuffed animals and pillow pets should be removed from the bed, and anything that truly can't be weaned right away, should be washed at least weekly in hot water (along with the rest of the bedding), or put in the freezer twice a week. Encasing the pillow and mattress also helps substantially reduce dust mites.
Smoking/Smokers in the house- We all know smoking increases risk of cancer, COPD/emphysema, and increases risk of asthma and breathing difficulties in children. But many people don't realize it also affects seasonal allergy sufferers. Studies show that exposure to smoke can enhance sensitivity to airborne substances like pollen and mold spores, which wreak havoc during spring and fall allergy seasons each year. Even second hand smoke will adversely effect people with asthma and allergies. Quitting is one of the best things you can do for your health, and the ones you love, allergic or not.
Letting Stress build up- Just this month an article was released which correlated persistent emotional stress with more frequent allergy flares. People with a negative mood also had more and allergy symptoms over the course of the study. Studies suggest that doing at least one hour-long yoga session weekly can help reduce allergy symptoms.
Having another drink- During fermentation of beer, wine, and liquor, yeast and bacteria produce histamine, which can cause or enhance allergy symptoms. A recent study showed that for each additional alcoholic beverage consumed each week, the the risk of allergic symptoms is raised by 3%. Limit alcohol when your symptoms are acting up, and keep in mind that white wine usually contains less histamine than red.
Plopping on the couch after spending time outdoors- It feels good to kick back and relax after an outdoor run, heavy yard-work, sporting events, or just coming in to beat the heat. Unfortunately however, when you come inside, you are covered with microscopic pollen, on your clothes and hair. Getting it off before diving into bed or sitting on furniture, helps reduce continued pollen exposure and perpetuating symptoms. Showering at night also helps reduce the reservoir inside your house. Keep in mind pets and even those family members who aren't allergic, are trucking in just as much as you are.
Overmedicating- The best allergy/asthma treatment plan is to reduce exposures, and minimize how much medication is needed. Afrin/OTC decongestant sprays often cause congestion to worsen when stopped if used for more than 3 days. Daily Sudafed (“D” preparations) can raise blood pressure, and contribute to anxiety if used excessively. Oral steroids (Prednisone, Orapred etc) can be necessary in a flare, but needing them even twice a year classifies someone as persistent asthma, and means there is inflammation present year round, even when someone is feeling good. Implementing environmental controls, and sometimes a daily low dose maintenance inhaler, can help reduce symptoms and flares. Even a high dose inhaler used twice daily for years is substantially less steroid than one course of prednisone. Even needing an Albuterol inhaler more than twice a week, is a sign asthma is not well controlled, and underlying inflammation is not being adequately addressed.
More symptoms shouldn't mean reflexively piling on more drugs. The best way to combat allergies is to find out exactly what you are allergic to, and take charge in reducing exposure to it. For those people who need chronic medications, but still feel like they are treading water, allergy desensitization shots can help fix the underlying problem, and teach your body not to overreact to begin with, leading to less suffering, and often less medication required.