By Jeremy Appleton, ND, CNS

Healthnotes Newswire (June 22, 2006)—When pollen season comes, people all around the world are afflicted with hay fever. Grass allergy and the symptoms it causes—stuffy, runny nose; itchy, watery eyes—are among the most common health problems that hamper quality of life and increase spending on healthcare. Unfortunately, the most widely used medicines for hay fever (antihistamines and steroid drugs) are not especially effective: nearly 40% of all people who use these drugs only get partial relief.

New research suggests that grass pollen has met its match: The allergens in timothy grass (Phleum pretense), when concentrated in an under-the-tongue (sublingual) tablet and taken daily before and during pollen season, may prime the immune system against future grass-induced hay fever attacks.

“People who have not responded to conventional drug treatments for allergies can often get relief from allergy shots, also known as immunotherapy,” said Stephen R. Durham, MD, of the National Heart and Lung Institute in London and lead researcher on the new study, published in the Journal of Allergy and Clinical Immunology. “But these shots require frequent hospital or clinic visits, the injections are uncomfortable, and they require specialist supervision.”

So Durham and colleagues investigated a more convenient alternative: sublingual grass allergen tablets. In a large clinical trial, spanning across 55 centers in eight countries, they studied the effects of grass immunotherapy in 855 hay fever sufferers, ages 18 to 65. All had a history of grass pollen–induced allergies and positive tests indicating reactivity specific to timothy grass.

Those who took the sublingual tablets (providing approximately15 mcg of the major allergens present in timothy grass) daily for an average of 18 weeks had significantly reduced hay fever symptoms compared with those who took a placebo. They also used less allergy medication and had improved quality of life and an increased number of well days. Even better results were obtained in volunteers who completed the recommended preseasonal treatment of at least eight weeks before the grass pollen season.

Allergy shots are a common, if unpopular, treatment in the United States. Placing an allergy medicine under the tongue instead of giving it as a shot is emerging as a viable and attractive alternative, especially to children (and their parents). It may eventually displace shots as the standard of care.

“Clinical improvement from injection immunotherapy has been shown to persist for years after discontinuation of treatment,” Dr. Durham said. “Today, it’s the only treatment able to induce prolonged remission and prevent disease progression. Our study shows that the grass allergen tablets are also effective for severe hay fever.” Durham and colleagues are currently performing a follow-up study to assess whether long-term improvement can also be obtained by using the sublingual tablets.

One potential conflict of interest should be kept in mind when considering these results: the lead author of the study is a grant recipient, speaker, and paid consultant for the company that manufactures the product used in the study.

(J Allergy Clin Immunol 2006;117:802–9)

Jeremy Appleton, ND, CNS, is a licensed naturopathic physician, certified nutrition specialist, and published author. Dr. Appleton was the Nutrition Department Chair at the National College of Naturopathic Medicine, has served on the faculty at Bastyr University of Natural Health Sciences, and is a former Healthnotes Senior Science Editor and a founding contributor to Healthnotes Newswire. He has worked extensively in scientific and regulatory affairs in the supplement industry and is now a consultant through his company Praxis Natural Products Consulting and Wellness Services.

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