Dissolvable Tablets and Severe Allergies: Exploring Better Treatment Options

Introduction

Grass pollen allergies are a common issue, affecting millions of people worldwide. These allergies can lead to severe symptoms, ranging from sneezing, itchy eyes, and a runny nose, to more serious reactions such as asthma. For many, grass pollen allergies are a seasonal nuisance, but for others, particularly those with severe allergic reactions, they can significantly reduce the quality of life.

In recent years, dissolvable tablets (also known as sublingual immunotherapy tablets or SLIT tablets) have emerged as an alternative to traditional allergy treatments like antihistamines or allergy shots (subcutaneous immunotherapy or SCIT). These tablets are designed to be placed under the tongue, where they dissolve and introduce the body to small amounts of the allergen, aiming to reduce sensitivity over time.

However, for individuals with severe allergies to grass pollen, dissolvable tablets may not be effective, and in some cases, they could exacerbate symptoms or pose risks. This article will delve into why dissolvable tablets may not work for this group, explore the nature of grass pollen allergies, and discuss alternative treatments that could offer better results.

What Are Grass Pollen Allergies?

Grass pollen allergies, also known as hay fever or allergic rhinitis, occur when the immune system identifies harmless pollen particles as a threat. Pollen from grasses, trees, and weeds is a significant contributor to seasonal allergies, but grass pollen is especially notorious for triggering allergic reactions.

When a person with a grass pollen allergy breathes in pollen, their immune system reacts by releasing histamines and other chemicals, leading to the typical symptoms of an allergic reaction. Common symptoms include:

• Sneezing
• Itchy eyes, nose, and throat
• Runny or congested nose
• Coughing
• Watery eyes
• Fatigue
• Wheezing or difficulty breathing (in severe cases)

In more serious cases, individuals may experience asthma exacerbations, which can be life-threatening if not managed properly.

The Mechanism Behind Dissolvable Tablets (Sublingual Immunotherapy)

Sublingual immunotherapy (SLIT) is an alternative form of allergen immunotherapy that has become more popular in recent years due to its convenience. SLIT involves placing a dissolvable tablet or liquid containing allergen extracts under the tongue, where the allergen is absorbed through the mucous membranes. The goal of SLIT is similar to traditional allergy shots: to desensitize the immune system to specific allergens over time.

SLIT tablets for grass pollen allergies typically contain extracts of Timothy grass (Phleum pratense), which is one of the most common types of grass associated with allergic reactions. The treatment process usually begins months before the grass pollen season and continues for several years.

Why Dissolvable Tablets May Not Work for People with Severe Grass Pollen Allergies

1. Dosage Limitations

SLIT tablets are formulated with a fixed amount of allergen, which may not be sufficient for individuals with severe allergic reactions to grass pollen. People with extreme sensitivities often require higher doses of allergen exposure to effectively desensitize their immune system, which is difficult to achieve with SLIT due to its standardized dosage. In contrast, SCIT (allergy shots) can be tailored to each patient, allowing for dose escalation over time, making it more suitable for individuals with severe allergies.

1. Localized Reaction Risk

Dissolvable tablets can cause localized reactions in the mouth, throat, or stomach, especially in individuals with high sensitivity to allergens. These reactions can include itching, swelling, and irritation of the oral mucosa, which may be uncomfortable or even intolerable for people with severe allergies. In rare cases, SLIT can trigger systemic allergic reactions, including anaphylaxis, which is a medical emergency.

1. Ineffectiveness in Treating Severe Symptoms

Studies have shown that SLIT is generally more effective for individuals with mild to moderate allergic rhinitis. For those with severe symptoms, including those who experience asthma attacks triggered by grass pollen, SLIT may not provide sufficient relief. In these cases, traditional methods like SCIT or more aggressive treatments such as biologics (e.g., omalizumab) may be necessary to control symptoms.

1. Time to Efficacy

While dissolvable tablets can start to reduce symptoms after several months of consistent use, individuals with severe allergies may not see noticeable improvements within this time frame. Grass pollen season is often short but intense, and SLIT may not desensitize the immune system quickly enough for it to be beneficial for severe allergy sufferers during peak pollen season. Allergy shots, on the other hand, offer a more customizable treatment plan that can be adjusted based on the patient’s response over time.

1. Compliance Issues

One of the key challenges with SLIT is patient compliance. For the treatment to be effective, it must be taken daily for several years. People with severe grass pollen allergies may find it difficult to maintain this strict regimen, particularly if they do not see immediate relief. The discomfort associated with local reactions in the mouth, coupled with the lengthy treatment period, may lead to discontinuation of the therapy before it can yield significant benefits.

1. Lack of Long-Term Efficacy in Severe Cases

While SLIT has been shown to be effective in reducing allergy symptoms for some patients, its long-term efficacy, especially in severe cases, is still a subject of ongoing research. Some studies suggest that while SLIT can offer symptom relief during the treatment period, its benefits may not be as long-lasting as those of SCIT once treatment is discontinued. For individuals with severe grass pollen allergies, this could mean a return of symptoms after completing SLIT, making it a less attractive option compared to other therapies.

Alternative Treatments for Severe Grass Pollen Allergies

For individuals with severe grass pollen allergies who do not respond to dissolvable tablets, there are several alternative treatments that may offer better results:

1. Subcutaneous Immunotherapy (SCIT)

SCIT, commonly known as allergy shots, has been the gold standard for allergen immunotherapy for decades. Unlike SLIT, SCIT allows for a more personalized treatment approach. Allergy shots are administered in a controlled medical setting, where the allergen dose can be gradually increased over time, reducing the risk of severe reactions. SCIT has been proven to be highly effective in treating severe allergic rhinitis and asthma triggered by grass pollen.

1. Biologic Therapy (e.g., Omalizumab)

Biologic therapies are a newer option for treating severe allergic asthma and rhinitis. Omalizumab, an anti-IgE antibody, is one such biologic that works by blocking the action of IgE, a key antibody involved in allergic reactions. By reducing the levels of IgE in the body, omalizumab can help prevent allergic reactions to grass pollen, offering relief to individuals who have not responded well to traditional immunotherapy or medication.

1. Antihistamines and Intranasal Corticosteroids

For patients who are unable to tolerate SLIT or SCIT, or who need additional symptom control during grass pollen season, antihistamines and intranasal corticosteroids can offer temporary relief. These medications work by reducing inflammation and blocking the action of histamines, the chemicals responsible for allergy symptoms. However, they do not address the root cause of the allergy and must be taken regularly to maintain efficacy.

1. Leukotriene Receptor Antagonists

Leukotriene receptor antagonists, such as montelukast, can be used as an adjunctive therapy for severe grass pollen allergies, particularly in individuals with asthma. These medications work by blocking leukotrienes, inflammatory chemicals that contribute to allergy and asthma symptoms. While not a first-line treatment, they can provide additional relief when used in combination with other therapies.

1. Environmental Control Measures

While medical treatments are essential for managing severe grass pollen allergies, environmental control measures can help reduce exposure to allergens and minimize symptoms. Some practical steps include:

• Staying indoors during peak pollen times (usually in the morning and early evening).
• Using air purifiers with HEPA filters to reduce indoor pollen levels.
• Washing clothes and showering after being outdoors to remove pollen from the skin and hair.
• Keeping windows closed during pollen season to prevent pollen from entering the home.

​

Conclusion

Dissolvable tablets may offer a convenient and effective treatment for mild to moderate grass pollen allergies, but they are not always the best option for individuals with severe allergic reactions. The fixed dosage, localized reaction risk, and limited efficacy in treating severe symptoms make SLIT less suitable for this group. For people with severe grass pollen allergies, alternative treatments like SCIT, biologic therapies, and environmental control measures may provide more comprehensive and lasting relief.