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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 NameCompositionIndicationsContraindicationsPregnant/Nursing WomenDosageAdministrationAdverse 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 mother100 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-UTreatment 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-HDMTreatment 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
  1. * Index of reactivity
  2. ** Bioequivalent allergy units