My son has allergic rhinitis. Are sublingual tablets better?

Hello,

Welcome to icliniq.com.

I understand your concern.

For your 15-year-old son with severe allergic rhinitis significantly impacting his quality of life, there are several newer treatment options beyond traditional antihistamines and nasal steroids.

Newer second-generation antihistamines such as Fexofenadine (Allegra), Desloratadine (Clarinex), and Levocetirizine (Xyzal) are less likely to cause drowsiness and may provide better control of nasal congestion symptoms compared to older antihistamines.

Among these, Levocetirizine (Xyzal) has shown higher effectiveness in allergic rhinitis symptom relief with a lower sedative effect compared to first-generation drugs.​ Some antihistamines can be combined with nasal decongestants like pseudoephedrine for short-term relief of severe nasal congestion, but these require caution due to side effects.​

Sublingual immunotherapy (SLIT) tablets have emerged as a safe and effective alternative to traditional allergy shots. SLIT involves placing allergen extracts under the tongue daily to build tolerance gradually.

Studies have shown SLIT to be effective in reducing symptoms and medication use with fewer adverse reactions than subcutaneous immunotherapy (allergy shots). It works well for allergens like dust mites, tree and grass pollens, and mold, which are all relevant to your son's allergy profile.​

SLIT offers the advantage of home administration and better adherence, though it still requires a multi-year commitment (typically three to five years) to achieve long-term benefit.​

SLIT is approved for use in adolescents 12 years and older; some preparations may have a lower age limit of five years. Candidates should have persistent allergic rhinitis with symptoms not fully controlled by medication, or those who experience medication side effects.

Patients should not have severe, unstable, or uncontrolled asthma. Informed consent and assent processes are important, with involvement of caregivers and the adolescent.​

SLIT has shown significant symptom reduction and improved quality of life in adolescents with allergic rhinitis from allergens like dust mites, grass, and tree pollen.

The treatment reduces nasal and non-nasal symptoms, medication usage, and biomarkers such as IgE (immunoglobulin E) and eosinophil counts. SLIT has a favorable safety profile in adolescents, with most adverse reactions being mild and local (like oral itching).

Clinical studies demonstrate sustained benefits during treatment and some lasting effects after discontinuation, typically after a three to five-year course.​

Thus, your son, being 15 years old with confirmed allergies to multiple common allergens, is an appropriate candidate for SLIT, and it can effectively improve his symptoms and quality of life over the treatment period.

It is important to have this managed by an allergy specialist to select appropriate allergen extracts, monitor response, and ensure adherence.​

For severe, difficult-to-treat allergic rhinitis, biologic therapies (such as Omalizumab, an anti-IgE monoclonal antibody) have shown promise in reducing symptoms and reliance on steroids and antihistamines.

These are usually considered when conventional treatments and immunotherapy fail.​

I hope this helps you.

Thank you.