For much of her adult life, Shirley Hickey received two injections a week in an effort to tame severe allergies that caused frequent sore throats and sinus infections. Now she uses a less painful method.
“One drop under the tongue every morning, and that’s it,” said Hickey, 65, who lives in Beaver Falls, Pa. She is free of symptoms and sinus infections from her allergies to ragweed and tree pollens, she said.
Injections have been used to treat allergies from inhaled substances — often known as hay fever — for 100 years, and the basic formula has changed little. But an alternative is emerging — liquids or tablets placed under the tongue.
Both Merck and Stallergenes, a French company, are seeking marketing approval for tablets to treat grass pollen allergies. An advisory committee to the Food and Drug Administration will discuss the drugs next week.
The drugs are available in Europe. If they are approved in the United States, they could make this type of therapy more broadly available, by allowing people to treat themselves at home rather than going for frequent shots. Children, who tend not to like needles, might also find such treatment more acceptable.
But there are drawbacks. The shots can be tailored to match the patient’s allergies while the liquid drops and tablets are standardized.
An estimated 30 million to 60 million Americans, including up to 40 percent of children and 10 to 30 percent of adults, suffer nasal congestion, runny nose, sneezing, itchy eyes or other symptoms from allergies to something they inhale.
The typical treatments are antihistamines or nasal steroids. But those drugs merely alleviate symptoms.
Immunotherapy, as allergy shots and under-the-tongue treatments are called, involves giving controlled doses of the allergen to teach the immune system to tolerate it. That can lead to longer-lasting relief. Some studies have shown that three years of immunotherapy provides substantial relief for two years after treatment is stopped, in some cases for longer. Some studies also suggest that immunotherapy can reduce the risk of developing asthma.
But only a small percentage of people with respiratory allergies get the shots. One reason is that people have to visit the doctor for shots at frequencies ranging from twice a week to once a month for several years.
The companies have not said how much the drugs will cost, but some doctors think it will be about $150 a month. Oralair sells for about that much in Canada. Shots cost about $25, higher if they contain more allergens, according to Cox, who has been a consultant to Stallergenes and other companies.
Mark Schoenebaum, an analyst at ISI Group, projects that Merck’s tablets for grass and ragweed will have peak annual sales of about $350 million combined. That is not much for a giant like Merck, but it bolsters the company’s allergy and asthma business.