Best Menlo Park Allergist |Best Allergists in Redwood City, Palo Alto and Los Altos





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Published on May 16, 2012


This was around a long time ago and it got kind of tabled but now it's back again, and it's been studied more and actually been working a lot more. And it works pretty much in the same principle as sub cu. It induces antigen tolerance, same immunological mechanisms, very safe, it works in adults and children. But the studies have just shown some efficacy in some limited palms, not every palm... grasses, birch, dust mites and a few others.

It's expanding, and you can't treat with every antigen the patient's skin tests positive to. So even though there is some cross reactivity between tree species, grass species, you don't know if you're going to really cover everything. There are some side effects with the oral tablets, patients can get GI distress, and with the oral tablets you have to use a lot of the antigen. Then they changed it to sublingual drops where you use less of the antigen but then you may have local swelling and itching and stuff like that.

So it's still a work in progress. Since it's not FDA approved there's no standardized protocols and practice parameters out there but there's a lot of data and doctors and allergists have put together very nice protocols on how to do this, and are using it very successfully in some patients. So it's definitely the wave of the future. Another thing the therapy has shown is that it decreases Eosinophil cationic protein and then decreases serum Eosinophil.

Instead of the skin mast cells it uses the oral Langerhans cells for its use. It also does help with asthma as well as atopic dermatitis but not as well as well sub-cu. Now does sub-cu work better than sublingual? That debate is still going on. There's still more data that needs to be done, more studies that need to be done, it's all over the board, but it's definitely the wave of the future. It's easy. The patients can do it at home. It's convenient and it's more cost effective. So I'm sure they're going to perfect it and make it better and better and better.

With adjuvant usage... there were just the allergy meetings in Orlando last week... a lot of great data out on food... oral tolerance for eggs as well as peanuts and hazelnuts. So that's really very hopeful. And then there are other routes of administration that people are working on between nasal, intra-bronchial, but again those routes do not produce the systemic immunological changes, but they can decrease Eosinophils.

Lastly, Xolair, the anti IgE antibody. It's been around for a while primarily for asthma, but that's where it's FDA approved. It is another way to treat I think allergic conditions and again there are some really exciting data out of the allergy meetings in Orlando where a combination of Xolair plus immune therapy really helped to gather it better than IV alone, etc. But it's not approved yet, to get Xolair is a pain, but that's the wave of the future.

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