Allergic Asthma: Oral Allergy Drops Are a Pretty Good Option?

Sandra Lin, M.D., holds a test vial of allergy drops. 

Credit: Keith Weller, Johns Hopkins Medicine

A scientific review of 63 published studies affirms that putting small amounts of purified grasses, ragweed, dust mites, pollen and mold, in liquid drops under the tongue is a safe and effective alternative to weekly injections of those allergens or the use of other medications, in treating symptoms of allergies and allergic asthma in some people.

Results of the review, conducted by researchers at Johns Hopkins, are contained in a report to be published in the Journal of the American Medical Association online March 27.

The report is believed to be the largest synopsis of its kind, reviewing previous research comparing various therapies designed to stop the wheezing, sneezing and runny nose that accompany allergic rhino-conjunctivitis and allergic asthma, researchers say.

Specifically, the Johns Hopkins team analysed 63 studies, involving some 5,131 participants, almost all in Europe, where allergy drops, or so-called sublingual immunotherapy, have been widely available for nearly two decades.

Sublingual therapies have not been approved for use by the U.S. Food and Drug Administration (FDA), but physicians in the United States do use the drops "off-label" for some patients.

In eight of 13 studies evaluated, researchers found what they say is "strong evidence" that drop therapy produced a 40 percent or greater reduction in coughing, wheezing, and tightness in the chest compared with other treatments, including inhaled steroids.

In nine of 36 studies comparing allergy drops to other allergy treatments, including antihistamines and nasal steroid sprays, researchers found that allergy drops produced a 40 percent or greater reduction in symptoms of runny nose, sneezing and nasal congestion, results which they describe as "moderate evidence" in support of using sublingual immunotherapy.

"Our findings are clear evidence that sublingual immunotherapy in the form of allergy drops are an effective potential treatment option for millions of Americans suffering from allergic asthma and allergic rhinoconjunctivitis," says senior study investigator Sandra Lin, M.D.

According to Lin, an associate professor of otolaryngology-head and neck surgery at the Johns Hopkins University School of Medicine, allergy drops are more convenient for many people because they can be taken at home, and allow such individuals to avoid the discomfort and travel time needed for regularly scheduled trips to the physician's office for an allergy shot.

Lin says that, according to current estimates, as many as 40 percent of Americans suffer from some form of allergic rhinitis or allergic asthma.

Lin cautions that drop therapies may not be for all sufferers of allergic rhinoconjunctivitis and allergic asthma, but that many will want to weigh the risks and benefits of sublingual immunotherapy before deciding on long-term treatment options.

Reference 
Sublingual Immunotherapy for the Treatment of Allergic Rhinoconjunctivitis and AsthmaA Systematic ReviewImmunotherapy for Rhinoconjunctivitis and Asthma. JAMA, 2013; 309 (12): 1278 DOI: 10.1001/jama.2013.2049

Aberdeen Scientists claim artificial light is key to treating Multiple Sclerosis

Aberdeen scientists have found that artificial sunlight can have a “striking effect” in helping treat sufferers of diseases such as multiple sclerosis.

Researchers from Aberdeen University studied patients in the north of Scotland – which has the highest rate of MS in the UK - who were being treated during winter with artificial UV (ultraviolet)-B light therapy for skin diseases caused by their immune systems acting inappropriately.

The research - published in the Journal of Allergy and Clinical Immunology – shows how UV-B light boosts vitamin D, as well as cells in our body that are responsible for regulating or balancing the immune system. Vitamin D is made in our bodies by UV-B light from the sun.

Some studies have suggested a link between vitamin D deficiency and autoimmune diseases such as MS.

This possible link might also explain the increasing prevalence of autoimmune disease among those living far from the equator, where there are lower levels of winter sun.

Autoimmune diseases - like MS and type 1 diabetes - are diseases where the immune system mistakenly attacks the body’s own tissues or harmless substances that enter the body.

Dr Anthony Ormerod, clinical reader in dermatology at the university, said: “Our study shows that UV-B light, which mimics sunshine, can have a striking effect on the immune system of patients.

“We found that UV-B light boosted the production of vitamin D, and of regulatory T cells, which play an important role keeping our immune systems in check.

“Our findings have important implications for future interventions including the recommendations for healthy lifestyle and a possible role for phototherapy and/or vitamin D supplementation in the prevention or treatment of autoimmune and inflammatory diseases.

“While too much exposure to sunlight is harmful and increases skin cancer risk, these results suggest that subjects in our study would have some benefits from small amounts equivalent to summer exposure in the winter but more work needs to determine the role of sunlight and the role of supplementing the diet with vitamin D.”

Dr Helen Macdonald, senior lecturer in nutrition and translational musculoskeletal research at the university and chair of the National Osteoporosis Society Nutrition and Lifestyle forum, said: “There are risks associated with high levels of both therapies, so it is important that we get the balance right.

“We would also want to stress that we are not advocating sun bed use since this is not the same type of radiation produced by sun beds which already have well-documented health risks.

“The average dose of UV light that the volunteers received was the equivalent to sunlight exposure in Aberdeen over spring and summer and further work is required to determine if lower doses are effective.”

Professor Mark Vickers, chair in applied medicine at the university, added: “Ours is the first study to demonstrate in patients a cause and effect between UV light, vitamin D and systemic immune function in people.”