Allergy Drops versus Sublingual Tablets

Which is the right choice for me?

With the FDA’s recent approval sublingual immunotherapy tablets for seasonal grass, short ragweed and dust mite allergy (Oralair, Grastek, Ragwitek, Odactra), many allergy sufferers ask what that means for them. The good news is that this approval confirms what we’ve experienced for decades: that the sublingual (under the tongue) route is a safe, effective route of administration to treat allergic rhinitis and asthma. And from our experience, the benefits don’t end there.

The concept of treating through the sublingual route isn’t new — we’ve used this method for more than 50 years through customized multi-antigen liquid drops taken under the tongue. Recently approved single-antigen tablets with “standard” doses address a narrower range of patients and allergens that are not typical of the U.S. patients who typically have multiple allergies.

Most U.S. allergy patients are treated for multiple allergies. Many have related conditions (moderate/severe uncontrolled asthma, need for beta blockers) or are not at an age where tablets are approved. Through our refined approach, we have found it to be more optimal to consider the patient’s total allergic load and level of sensitivity through thorough diagnostics, followed by patient-specific sublingual immunotherapy treatment that addresses their unique allergies and sensitivity levels. That’s the concept behind the La Crosse Method Protocol. The Protocol offers treatment options not only for seasonal sufferers as well as the broad range of patients who could benefit from tailored treatment that’s designed to maximize therapeutic benefit, minimize risk of reactions and unnecessary symptoms, and do it cost-effectively.

Sublingual allergy tablets offer another option for patients, which is good. But it might also be helpful to see a comparison of tablets versus customized drops via the La Crosse Method Protocol as you consider your treatment options.

	La Crosse Method Protocol Sublingual Immunotherapy	Sublingual Immunotherapy Tablets
Delivery Method	FDA-approved liquid antigen under the tongue. Currently considered “off label” use of FDA-approved antigens.	FDA-approved antigens in tablet form delivered under the tongue. Approved for grass, ragweed and dust mite only.
Customized to Patient Sensitivity	Yes. Dose is based on individual patient sensitivity, dosed to provide therapeutic benefit and minimize risk of reactions.	No. Standardized dosing for all patients.
Treats Multiple Sensitivities Simultaneously	Yes, multi-antigen treatment available to address sensitivities based on patient test results, most flexible protocol available.	No, focused on individual pollens (grass, ragweed, dust mite).
Patient Ages Treated	Protocol addresses all ages.	Indicated for ages starting at 5, 10 or 18, up to 65.
Addresses food allergy	Yes	No, treats only specific pollens indicated.
Patients Treated Clinically in the U.S.	250,000+	Patients treated since recent approval
Estimated Cost	Roughly $1.50 day for custom multi-antigen inhalant threshold treatment.	Roughly $4-10/day for single antigen prescriptions.
Insurance Coverage	Not currently in most cases; check with carriers, employer coverage is growing.	Subject to Tier 3 or 4 co-pays (co-pay est. $50-100 month, varies by carrier).
Contraindications/ Safety	Extremely safe and adjustable for virtually any condition or level of severity, dose escalated based on patient tolerance. Estimated over 1 billion doses taken by patients with no life-threatening reactions reported.	Variety of contraindications including uncontrolled asthma, history of severe systemic allergy reaction, eosinophilic esophagitis, those currently on beta blockers, immunotherapy, and pregnancy. Adverse event profile is high with rapid escalation.
Considerations	Developed based on clinical experience with multi-sensitized U.S. patients treated concurrently with a variety of related conditions including asthma, atopic dermatitis, food & mold allergies.	Developed by European manufacturers based on European patient profiles, not treated concurrently for asthma, AD, and related conditions.
Require Emergency Epinephrine Device	Not required for general use. Required for those whose underlying allergic conditions require it (anaphylaxis history).	Required with all prescriptions.
Long-term Efficacy	Majority of patients see sustained improvement after treatment conclusion.	Inconclusive evidence of ongoing sustained efficacy after two seasons of treatment.