Pharm

Sublingual Immunotherapy

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Sublingual Immunotherapy, Grastek, Oralair, Ragwitek, Odactra

  • Indications
  1. Allergy Immunotherapy
    1. For allergic symptoms refractory to standard allergy medications
  • Precautions
  1. Not to be used without formal Allergy Testing first
  2. Observe in office for first sublingual dose
  3. All patients should receive Epinephrine auto-injector in case of Anaphylaxis reaction
  • Preparations
  1. Grass allergies
    1. Timothy Grass Pollen cross reacts with 6 other grass pollens (Grastek)
    2. Five Grass Pollen Extract (Oralair)
  2. Ragweed allergy
    1. Short Ragweed pollent extract (Ragwitek)
  3. Dust mites
    1. House Dust mite Allergen Extract (Odactra)
  4. Peanut Allergy
    1. Peanut Allergen Oral Powder (Palforzia)
  • Dosing
  • Protocol
  1. Start medication 3-4 months prior to allergy season and continue throughout the season
  2. Have Epinephrine auto-injector readily available in case of Anaphylaxis reaction
  • Advantages
  1. More convenient, possibly safer, and without the pain of standard allergy Immunotherapy injections
  2. Efficacy approaches that of standard allergy Immunotherapy injections
  • Disadvantages
  1. More expensive than standard allergy Immunotherapy injections
  • References
  1. (2014) Presc Lett 21(6):35
  2. Koberlein (2013) Immunotherapy 5(1):13-21 [PubMed]
  3. Maloney (2014) Ann Allergy Asthma Immunol 112(2):146-153 [PubMed]
  4. Nolte (2013) Ann Allergy Asthma Immunol 110(6):450-456 [PubMed]