NEW YORK | Thu Dec 9, 2010 4:19pm EST

NEW YORK (Reuters Health) – Under-the-tongue tablets may be a safe alternative to allergy shots for people who don’t get enough relief for their itchy eyes and runny noses with standard drugs, according to scientists who reviewed 60 studies on the treatment.

Allergy shots build up the immune system’s tolerance by exposing it to increasing amounts of the substance that’s bothering it, such as pollen, dust mites or cat dander.

But the shots can be uncomfortable and lead to itching, swelling or other more serious reactions. So researchers have been testing needle-free alternatives, either in a daily tablet or as drops left under the tongue, which patients can self-administer at home — so-called sublingual immunotherapy.

“Sublingual immunotherapy seems to be as effective as other treatments such as antihistamines and nasal steroids,” senior researcher Dr. Stephen Durham of the Royal Brompton Hospital in London said in an e-mail. “And it has the added value of long-term benefits after its discontinuation.”

Pooling the results of earlier studies, including some 5,000 patients, Durham and his colleagues found “allergy tablets” worked better for both adults and children than a dummy tablet lacking the immune triggers, or allergens.

Patients on the active therapy required less medication and reported fewer allergy symptoms than those given the placebo, especially when taking the tablets for 12 months or longer.

And none of them experienced any serious or life-threatening reactions, report the British researchers in the Cochrane Library.

The findings update a 2003 review, which also concluded that allergy tablets may be a good option for some of the 10 to 25 percent of Westerners who struggle with seasonal or chronic allergies.

Dr. Sandra Lin of Johns Hopkins University, in Baltimore, who was not involved in the review, said her patients generally tolerate the new treatment very well. she has, however, seen some minor side effects such as tingling or itching under the tongue.

“Both routes are effective, but it appears that sublingual may be safer than injections,” she told Reuters Health. “Of course, you still need to take precautions.”

Both Lin and Durham note the need for more head-to-head comparisons of the needle and under-the-tongue therapy routes.

The costs of allergy tablets generally range from $1 to $2 a day, but can vary widely depending on the dosage and number of allergens included, Lin noted. since the U.S. Food and Drug Administration has not yet approved the treatment, insurance companies usually won’t pay.

Injections, on the other hand, may be covered, although some patients can still pay between $15 and $30 for their weekly injections. After the first year of treatment, however, patients can generally cut back on the frequency.

“And then there’s the hidden costs, like having to take time off from work, drive and park to come into the office,” said Lin.

“I think the convenience of the (sublingual) therapy is really appealing. And I don’t think there are a lot of kids below 6th grade that are willing to tolerate the weekly injections,” she added. “This is opening it up to children.”

SOURCE: link.reuters.com/hyp49q Cochrane Database of Systematic Reviews, December 2010.

“They’re really just catching a lot of colds from kids,” he says.

But there’s another possibility, one that many people have never heard of. It’s called nonallergic rhinitis. People with nonallergic rhinitis have many of the same symptoms as people with nasal allergies — the runny noses, congestion and annoying post-nasal drip. Some sneeze, too. But “when we do allergy testing on them, we don’t find anything,” Shulan says.

These patients often have no personal or family history of allergy, are older than the usual new allergy patient, averaging about age 35, and are more often women than men, says Dr. Jonathan Bernstein, an allergy researcher at the University of Cincinnati.

Patients often say they have symptoms year-round or are bothered by irritants that are not known to cause the immune system responses associated with a true allergy, says Dr. Michael Blaiss, an allergist at the University of Tennessee Health Science Center in Memphis. The possible triggers include:

? Perfumes and other substances with strong odors.

? Cigarette smoke and car exhaust.

? cold air, wind and humidity.

? Foods — and not just the spicy ones. This variation is called gustatory rhinitis.

? just lying down triggers symptoms in some people, Blaiss says. Though these people don’t have allergies, “this is a real condition,” he says.

Says Bernstein: “It can have an impact on sleep and concentration, cause headaches and lead to sinus infections.”

The underlying causes aren’t well understood. with some, the problem seems related to changes in the nose that occur with aging, says Dr. Stanley Fineman, vice president of the American College of Allergy, Asthma & Immunology. Older noses tend to be drier, Fineman says, so sometimes simple saline nose sprays can help.

Doctors also often recommend certain antihistamines, decongestants, steroid nasal sprays and drying agents. But the popular non-sedating antihistamines that are sold in drugstores often don’t work, Blaiss says. Patients also won’t benefit from allergy shots — unless they also have allergies, which is still also possible, he adds.

It should be noted that adults can, at any age, develop allergies, says Dr. Jacqueline Eghrari-Sabet, an allergist in Gaithersburg, Md.

Gannett News Service