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Got Hay Fever? New Tablets vs. Allergy Shots

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A. Grastek’s label says you should begin taking the tablets 8 to 12 weeks before and then during the pollen season. Grastek may be taken for up to 3 years.

Oralair’s label says you should start taking the tablets 4 months prior to and through the pollen season. Ragwitek’s label says you should begin treatment 12 weeks before and then during the pollen season.

Some studies suggest that people with allergies who take the tablets only during pollen season still benefit, Cox says.

With all three pills, you’re supposed to take the first tablet in your doctor’s office in case you have a severe reaction. Such a reaction, called anaphylaxis, is thought to be less likely with the tablets than with the shots. But because anaphylaxis can happen later with the tablets, the labels call for patients to have injectable epinephrine at home to treat it. Epinephrine can slow down or stop the reaction.

Q: What about other side effects?

A. For Grastek and Oralair, the most common side effects are an itchy mouth, throat irritation, and mouth swelling. Side effects for Ragwitek include mouth itching, and ear and throat irritation.

Q. Can children take Oralair, Grastek or Ragwitek?

A. Oralair is approved for ages 10 to 65, while Grastek is approved for ages 5 to 65. Ragwitek is approved only for adults ages 18 to 65.

Q. How much do the tablets cost?

A. The wholesale price of both Grastek and Ragwitek will be $8.25 per pill, or $247.50 for a 30-day supply, says Merck spokeswoman Pamela Eisele. The wholesale price of Oralair will be $10 per pill, or $300 for a 30-day supply, says Andrea Moody, a spokeswoman for Greer Laboratories, which is marketing the drug in the United States. 

Both Eisele and Moody note that actual costs will vary, depending on your insurance coverage. Allergy shots cost about $25 each.

Q. Even before Oralair, Ragwitek, and Grastek became available, weren’t some U.S. doctors using similar treatments for allergies?

A. Doctors have been using under-the-tongue drops for “off-label” use. Off-label means a medication is being used in a way not specified in the FDA's approved packaging label. 

A 2011 survey by the American College of Allergy, Asthma, and Immunology found that more than 11% of those polled said they used under-the-tongue drops, nearly double the percentage from a 2007 survey. The drops have the same extracts used in allergy shots.

Lin says she mixes the extracts according to patients’ allergy test results. She sends them home with a metered vial so they know how much to take each day. There is no standard dose; Lin says she bases the size of the doses on research published by European doctors. Cox says she hasn’t prescribed the drops because “we don’t know what the effective dose would be.”

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