Table 2 Detailed summary of approved sublingual immunotherapy options available in Canada
From: Towards definitive management of allergic rhinitis: best use of new and established therapies
Product Name | Composition | Indications | Contraindications | Pregnant/Nursing Women | Dosage | Administration | Adverse Drug Reactions |
|---|---|---|---|---|---|---|---|
Oralair® | Cocksfoot (Dactylis glomerata) Sweet vernal grass (Anthoxanthum odoratum) Rye grass (Lolium perenne) Meadow grass (Poa pratensis) Timothy grass (Phleum pratense) | Moderate to severe seasonal grass pollen AR suffered for at least two pollen seasons Between 5–50 years old Positive skin prick test and positive specific IgE titre to Poaceae grass pollen Unresponsive to conventional pharmacotherapies | Extreme sensitivity to the allergen based on prior anaphylactic experience under exposure β-blockers ACE inhibitors Severe/unstable asthma (FEV1 < 70%) Severe immune deficiency or autoimmune disease Malignant diseases (cancers) Oral inflammation | Should be used only if the potential benefit justifies the potential risk to the fetus and mother | 100 IR* 300 IR* | Three-day escalation phase (Day 1: 1 × 100 IR; Day 2: 2 × 100 IR) followed by maintenance phase consisting of 1 × 300 IR until the end of treatment Treatment should be initiated 4 months before the onset of the pollen season and maintained throughout the season For adult patients (18–50 years old): discontinue if no improvement is seen after three seasons | Itching and swelling localized to the mouth and throat |
Grastek® | Timothy grass (Phleum pratense) | Moderate to severe seasonal Timothy and related grass pollen induced AR Between 5–65 years old Clinically relevant symptoms for at least two pollen seasons Positive skin prick test and/or positive specific IgE titre to Phleum pratense Unresponsive to conventional pharmacotherapy | Hypersensitive to any non-medicinal ingredients Previously had severe systemic reaction to Timothy or related grass immunotherapy Unstable/severe chronic asthma (FEV1 < 70% after pharmacologic treatment; < 80% in children) β-blockers Active inflammatory conditions in the oral cavity | Treatment should not be initiated in pregnant women No clinical data are available for use during lactation | 2800 BAU** | Treatment can be initiated at any time during the year but should be at least 8 weeks before the grass pollen season and maintain throughout the season First dose should be administered under the supervision of an experienced physician with a 30-min observation period One 2800 BAU tablet daily | Throat irritation |
Ragwitek® | Short Ragweed (Ambrosia artemisiifolia) | 18 to 65 years old Clinically relevant symptoms for at least two pollen seasons Positive skin prick test and/or positive specific IgE titre to Ambrosia artemisiifolia Unresponsive to conventional pharmacotherapy | Unstable/severe chronic asthma (FEV1 < 70% after pharmacologic treatment) Previous reaction to ragweed allergy shots, tablets, or drops β-blockers Active inflammatory conditions in the oral cavity Allergic to the non-medicinal ingredients | Treatment should not be initiated in pregnant women No clinical data are available for use during lactation | 12 Amb a 1-U | Treatment should be initiated at least 8 weeks before the grass pollen season and maintain throughout the season First dose should be administered under the supervision of an experienced physician with a 30-min observation period One 12 Amb a 1-U tablet daily | Throat irritation Itching of the mouth, ears, and eyes Swelling or numbness of the mouth |
Acarizax® | House Dust Mites (D. farinae and D. pteronyssinus) | 18 to 65 years old Moderate to severe house dust mite-induced allergic rhinitis Positive skin prick test and/or positive specific IgE titre to D. farinae or D. pteronyssinus Unresponsive to conventional pharmacotherapy | Severe/unstable asthma Previous reaction to house dust mite allergy shot, tablets, or drops Beta-blockers Swelling or sores in mouth Mouth injury or surgery If diagnosed with eosinophilic esophagitis Allergic to the non-medicinal ingredients | Treatment should not be initiated in pregnant women No clinical data are available for use during lactation | 12 SQ-HDM | Treatment can be initiated at any time during the year First dose should only be taken in the doctor’s office, followed by a 30-min monitoring period One 12 SQ-HDM tablet daily | Throat irritation Itching, burning, or tingling of the mouth Swelling of the lips or tongue |