New treatments may take sting out of spring allergies
Dr. Lee Miller, an allergist, goes over records pertaining to nasal allergies in one of the patient rooms.
Dr. D. Lee Miller, an allergist, prepares an allergy shot.
Allergy and asthma specialist Dr. D. Lee Miller checked the pollen count from his practice at Allergy and Clinical Immunology Associates in South Strabane Township on a warm afternoon in early March. He was surprised to see grass pollens measuring zero.
That’s unusual for Southwestern Pennsylvania since trees here normally start to pollinate in late February. Miller said that may signal a late start to the onset of spring allergy season but isn’t a predictor of how bad a season it will be.
Many of Miller’s patients rely on allergy shots to desensitize them to grass and tree pollens, ragweed and other triggers. But improvements in prescription and over-the-counter antihistamines and nasal sprays have made it possible to control allergy symptoms without resorting to shots.
“We usually opt for the conservative measures like modification of environment and symptomatic medicines. Immunotherapy in most instances is not a primary choice,” Miller said.
Shots have never been a choice for allergy sufferer Inge McShane of Upper St. Clair. As she enjoyed shopping at Tanger Outlets on a recent warm afternoon, McShane said her annual onset of runny nose and itchy eyes has never been severe enough to require allergy shots.
“I just have seasonal allergies and hay fever in the fall, that’s all,” she said. Dust and her dog do bother her allergies indoors a bit. “I just take Claritin, that’s it,” she added. Claritin and other newer, long-acting antihistamines like Zyrtec and Allegra are available over the counter.
Miller said they’ve been a great help in managing allergic patients because the majority of them do not cause significant drowsiness or nasal and mouth dryness like older formulas such as Benadryl. McShane said as her seasonal allergies worsen, “Sometimes I do the allergy eye drops and a nasal spray, too. But I did that one season and it gave me nosebleeds.”
If you do use nasal sprays, you’ll be glad to know one of the most popular ones, Nasacort, is now available without a prescription. Nasacort (triamcinolone intranasal glucocorticoid) is an inhaled corticosteroid that helps relieve congestion and stops symptoms like runny and itchy nose and sneezing. It’s approved for use in patients older than 2.
Miller says other prescription nasal sprays will likely now become available over the counter, and he has mixed feelings about that. With no input from physicians, he warned users to read the recommended dosage and remember that using the sprays more often won’t make them work better.
“Our fear, of course, would be abuse of the nasal steroid and overdosing, particularly in young children,” he said. “On the other hand, it is very effective therapy and will be helpful for a lot of folks. I would urge people to follow the directions.”
The biggest news in allergy treatment is that shots may soon be replaced by tablets and drops you take under your tongue. In December, a U.S. Food and Drug Administration advisory panel gave the green light to sublingual treatments from two different companies to treat grass allergies – a method that Europeans have used for a decade. The panel decided that studies support the efficacy and safety of sublingual immunotherapy in patients older than 5. The FDA normally follows these recommendations when deciding whether to approve drugs.
Dr. Deborah Gentile, director of research for Allegheny Health System’s Division of Allergy, Asthma and Immunology, worked as an investigator during clinical trials of the under-the-tongue tablets. She sees this as the allergy treatment of the near future.
“I think it’s going to be a nice addition,” Gentile said. “However, we’re going to have limited allergens which we can start with. If a person has year-round allergies, they may not be a candidate for grass sublingual therapy alone.”
Unlike injectible serum extracts that can be mixed to treat several allergens in one shot, sublingual tablets or drops currently only treat one allergen at a time. Gentile explained the treatment entails taking extract in tablets or drops under your tongue. “You basically start right off the bat at maintenance,” she said. “Some of the studies are suggesting you have protection as early as two weeks after starting treatment. It can be two weeks to two months depending on the patient.”
Grass season in our region typically starts in June, so interested patients may be able to start sublingual treatment with their allergist in time to get some protection from this season’s pollens. Gentile predicted the sublingual tablets and drops will start to catch on next year once insurance companies begin covering the treatment. Once they do, patients will likely take the first dose at the doctor’s office then get a prescription to use at home.
Gentile realizes this may drastically change allergists’ practices since patients won’t need to return for weekly shots. “I think a lot of the older doctors are resistant to it to some degree. But they’re actually going to see now that they will have more patients come in for testing … people who wouldn’t have considered it before.”