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The FDA is considering approval of sublingual immunotherapy for hayfever, a method already used in Europe and Canada to administer "allergy shots" without the shots. There sheer number of different kinds of pollen in the USA, however, is the problem.

Hay fever is a surprisingly large burden on health. In the United States, about 40 million people a year buy over the counter medications or get prescriptions filled to treat seasonal nasal allergies. In Europe, about one person in 6 has to deal with hay fever every summer, the greatest concentrations of hay fever sufferers in Denmark and Sweden. 

Summer allergies often start at about the age of 2, and cause their most intense symptoms in younger adults aged 21 to 30. The percentage of the population that suffers seasonal allergic rhinitis differs from place to place and from year to year depending on weather conditions.

Hay Fever Treatment Often as Bad as the Disease

Hay fever makes life miserable. It causes sneezing, wheezing, copious production of clear, runny mucus, and itchy eyes. It inflames sinuses. It aggravates asthma and eczema, and a recent study found that in children, it increases the risk of ADHD (attention deficit hyperactivity disorder). Allergic inflammation of the nose and throat can interfere with hearing and stuffy nose can make social interaction difficult. Sneezing on people, of course, is not a good way to make friends.

The treatments for hay fever are almost as bad as the disease itself, especially if you are involved in one of the 100,000 car crashes per year (just in the United States) caused by drowsy driving or if you are one of the 27 million people every year who miss work because their allergy medicines make them too tired to come in.

Almost Every Hay Fever Medication Has Side Effects

Benadryl (diphenhydramine), one of the oldest antistamines on the market, is inexpensive but makes nearly everyone who uses it sleepy. Claritin (loratidine) induces drowsiness in only about 8% of users, but causes headaches in 10%. The third-generation antihistamine Allegra (fexofenadine) doesn't cause drowsiness, but can cause nausea, vomiting, and diarrhea.

Even the newest medications for hay fever are problematic. Nasonex (mometasone) and Omnaris (ciclesonide) are steroids. They can shrink nasal polyps (at the time this article is being written, only Nasonex is FDA-approved for this purpose) but they interfere with normal immune response to infection.

Nasalcrom (cromolyn sodium) acts on the same principle as eating an apple a day, providing a chemical that keeps the mast cells that release histamines into the nose from breaking down, but it takes several days to begin to work. Atrovent (ipratropium) "dries up" nasal passages but can also "dry up" the bladder. Sudafed (pseudoephedrine) can be used to make methamphetamines, so buyers have to wait in line while their purchases are reported to a monitoring system used by the police (at least in the United States). Allergy shots, while effective, require going to the doctor's office once a week for three years or more.

Modern medicine, however, has created a medication you only need to take once in your lifetime to develop permanent immunity to nasal allergens--if the nasal allergens that trigger your symptoms are ragweed or timothy grass.

Continue reading after recommendations

  • Nelson HS. Is sublingual immunotherapy ready for use in the United States? JAMA. 2013 Mar 27.309(12):1297-8. doi: 10.1001/jama.2013.2739. PMID: 23532248.
  • Tsai JD, Chang SN, Mou CH, Sung FC, Lue KH. Association between atopic diseases and attention-deficit/hyperactivity disorder in childhood: a population-based case-control study. Ann Epidemiol. Apr 2013. 23(4):185-8.

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