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Allergy Clinic Location:
City Centre 1
Unit 710
13737 96 ave
Surrey, BC
Tel: 604-498-1655
Fax: 604-498-1656

Dust Mite Sublingual Immunotherapy

Acarizax

Allergen extract  administered under the tongue (sublingual) to treat house dust mite induced nasal inflammation (allergic rhinitis), with or without eye inflammation (conjunctivitis), in people 18 through 65 years of age.

Acarizax provides patients an alternative treatment to allergy shots to help address their symptoms.

House dust mite allergies are a reaction to tiny bugs that are commonly found in house dust. Dust mites are too small to be seen without a microscope. They are found in bedding, upholstered furniture and carpeting. Individuals with house dust mite allergies may experience a cough, runny nose, nasal itching, nasal congestion, sneezing, and itchy and watery eyes.

Acarizax exposes patients to house dust mite allergens, gradually training the immune system in order to reduce the frequency and severity of nasal and eye allergy symptoms. It is a once-daily tablet, taken year round, that rapidly dissolves after it is placed under the tongue. The first dose is taken under the supervision of an Allergist with experience in the diagnosis and treatment of allergic diseases. The patient is to be observed for at least 30 minutes for potential adverse reactions. Provided the first dose is well tolerated, patients can then take Acarizax at home. It can take about 8 to 14 weeks of daily dosing for the patient to begin to experience a noticeable benefit.

The most commonly reported adverse reactions were nausea, itching in the ears and mouth, and swelling of the lips and tongue. 

Sublingual Grass Immunotherapy (Grastek and Oralair)

There are currently 2 treatment options for sublingual grass immunotherapy

1. GRASTEK® (Standardized Allergen Extract, Timothy Grass (Phleum pratense) Sublingual Tablet) is an allergy immunotherapy tablet for the treatment of signs and symptoms of grass allergy. It is formulated as an orally disintegrating tablet designed to rapidly dissolve under the tongue. The active substance is a natural grass pollen extract which is purified and standardized from Timothy Grass. Each sublingual tablet has a strength of 2800 BAU.
INDICATIONS AND CLINICAL USE GRASTEK®  is indicated for reducing the signs and symptoms of moderate to severe seasonal Timothy and related grass pollen induced allergic rhinitis (with or without conjunctivitis) in adults and children 5 years of age and older confirmed by clinically relevant symptoms for at least two pollen seasons and a positive skin prick test who have responded inadequately, or are intolerant to conventional pharmacotherapy.Treatment with GRASTEK® should only be prescribed and initiated by physicians with adequate training and experience in the treatment of respiratory allergic diseases.Pediatrics (less than 5 years of age): Safety and efficacy in pediatric patients below 5 years of age have not been established.




2. ORALAIR® (Sweet Vernal, Orchard, Perennial Rye, Timothy, and Kentucky Blue Grass Mixed Pollens Allergen Extract) is a prescription medicine used for sublingual (under the tongue) immunotherapy prescribed to treat sneezing, runny or itchy nose, nasal congestion and itchy watery eyes due to grass pollen allergy. 

This formulation contains a mixture of all 5 types of grass pollen proteins

ORALAIR may be prescribed for people 10 to 65 years old.

Food Allergies

Allergy to egg, milk, soy, wheat, peanut and tree nuts represents 90% of all food allergies in children. Fish and shellfish are two other commonly seen food allergies, usually more common in adults. Each of these individual foods is discussed, including the prevalence, severity and potential outgrowth of the food allergy.

1. MilkAllergy to cow’s milk is common in children, affecting about 2.5 percent of all infants. These children tend to also react to other milks, such as goat and sheep milk. The allergy is usually directed against one or both major milk proteins, casein and whey. While 85% of children will outgrow milk allergy by age 5, being allergic to milk is a risk factor for developing other food allergies, as well as nasal allergies. Up to 10% of cow's milk allergic children will be allergic to beef. The sugar in milk, lactose, does not cause allergy, but can cause food intolerance if the person lacks a certain enzyme called lactase required for its digestion. This is termed lactose intolerance.

2. EggAllergy is the most common food allergy in children, affecting about 2.5 percent of young children. Children may be allergic to the white, yolk, or both. Many will outgrow the egg allergy by age 5, although these children are at increased risk of developing nasal allergies and asthma.The influenza vaccine is a routine immunization which may be given safely to egg allergic children.

3. Soy is a legume, and related to peanut, although cross-reactivity rarely exists between the two. Allergy to soy affects approximately 0.3 percent of children, is usually outgrown at a young age, and rarely causes life-threatening reactions. Because soy is a common food allergy, and can occur in children also allergic to milk, infant formulas using hydrolyzed proteins are preferred in infants allergic to cow’s milk.

4. Wheat: Children and adults can experience a variety of immunologic reactions to wheat protein, only some of which are allergic. Wheat allergy is commonly outgrown at an early age, and it is rare for children with wheat allergy to be clinically allergic to other cereal grains (such as rice, oat and barley), although skin testing to these other grains may be positive. Wheat allergy should not be confused with Celiacs disease which is a different type of immune reaction against gluten which is found in certain grains such as wheat and rye and barley. The treatment for Celiacs disease is strict avoidance of any food containing gluten.

5. Peanut Allergy occurs in approximately 0.6 percent of all people, and tends to cause a severe form of food allergy. Peanut allergy can be associated with life-threatening allergic reactions, particularly in children with asthma. Only about 20 percent of children outgrow peanut allergy, making it the most common food allergy seen in adults. Accidental exposure to peanut containing foods is a common problem, so it is important for peanut allergic children to follow a strict peanut-free diet, wear a medical alert bracelet and always have injectable epinephrine(epi pen) available.

6. Tree Nut allergy occurs in approximately 0.5 percent of all people, tends to be severe and is less likely to be outgrown. There is a high likelihood that if a child is allergic to one type of tree nut, he or she will be allergic to another type of tree nut. While tree nuts and peanuts are unrelated foods and dont cross react, cross-contamination is a concern, so some experts recommend a complete “nut free” diet in children with either peanut or tree nut allergy.

7. Seafood Allergy includes both fish and shellfish. While fish and shellfish are not related foods, these foods are usually found in the same place (restaurants). Reactions to seafood can be severe and potentially life-threatening. Allergy to either of these foods is less likely to be outgrown, and therefore is commonly seen in adults. Since patients with allergy to one shellfish are at a high risk of being allergic to other shellfish, complete avoidance of this category of foods is advised. The same is true for allergy to fish; however, exceptions exist for both.

Outdoor Allergens and Pollens

Seasonal allergic rhinitis, often referred to as "hay fever," affects more than 35 million people in the United States. These seasonal allergies are caused by substances called allergens. Airborne pollens and mold spores are outdoor allergens that commonly trigger symptoms during the spring and fall. During these times, seasonal allergic rhinitis sufferers experience increased symptoms-sneezing, congestion, a runny nose, and itchiness in the nose, roof of the mouth, throat, eyes and ears-depending on where they live in the country and the exact allergen to which they are allergic.

Pollens are the tiny, egg-shaped male cells of flowering plants. These microscopic, powdery granules are necessary for plant fertilization. The average pollen particle is less than the width of an average human hair. Pollens from plants with bright flowers, such as roses, usually do not trigger allergies. These large, waxy pollens are carried from plant to plant by bees and other insects. On the other hand, many trees, grasses and low-growing weeds have small, light, dry pollens that are well-suited for dissemination by wind currents. These are the pollens that trigger allergy symptoms.

Seasonal allergic rhinitis in the early spring is often triggered by the pollens of such trees as oak, western red cedar, elm, birch, ash, hickory, poplar, sycamore, maple, cypress and walnut. In the late spring and early summer, pollinating grasses-including timothy, bermuda, orchard, sweet vernal, red top and some blue grasses-often trigger symptoms. In addition to ragweed-the pollen most responsible for late summer and fall hay fever in much of North America-other weeds can trigger allergic rhinitis symptoms. These weeds include sagebrush, pigweed, tumbleweed, Russian thistle and cockleweed.

Each plant has a period of pollination that does not vary greatly from year to year. However, weather conditions can affect the amount of pollen in the air at any given time. The pollinating season starts later in the spring the further north one goes. Depending on where you live in the United States, the pollen season can begin as early as January (in the southern states).

Generally, the pollen season lasts from February or March through October. Trees pollinate earliest, from late February through May, although this may fluctuate in different locations-starting in April in the northern United States to as early as January in the south. Grasses follow next in the cycle, beginning pollination in May and continuing until mid-July. Weeds usually pollinate in late summer and early fall.

Molds Molds are microscopic fungi-related to mushrooms-but without stems, roots or leaves. Their spores float in the air like pollen, and are present throughout the year in many states. Unlike pollens, molds do not have a specific season, but are affected by weather conditions such as wind, rain or temperature. Outdoor mold spores begin to appear after a spring thaw and reach their peak in July in warmer states and October in the colder states. Molds can be found all year long outdoors in the South and on the West coast. Common airborne molds include alternaria, cladosporium and aspergillus. Molds are present in almost every possible habitat. Outdoors, they can be found in soil, vegetation and rotting wood. Molds can also be found indoors in attics, basements, bathrooms, refrigerators and other food storage areas, garbage containers, carpets and upholstery.

Pollen and mold counts measure the amount of airborne allergens present in the air. Counts are compiled by a variety of methods. Pollen and mold spore counts can be determined daily, and are reported as grains per cubic meter of air. Certified aeroallergen counters at many universities, medical centers and clinics provide these counts on a volunteer basis. The National Allergy BureauT (NABT) is the nation's only pollen and mold counting network certified by the AAAAI. As a free service to the public, the NAB compiles pollen and mold counts from certified stations across the nation and reports them to the media three times each week. These counts are also available on the NAB page of the AAAAI's Web site, www.aaaai.org. Interpretation of pollen and mold counts and their relationship to symptoms is complex. Sampling techniques such as the type of device used and its location within the community can affect counts. While many patients develop symptoms when pollen counts are 20-100 grains per cubic meter, one's symptoms may also be affected by recent exposure to other allergens, the intensity of pollen exposure, and individual sensitivity. Pollen counts reported to the public are generally taken the preceding one to three days, and may vary widely from day to day during a season. Overall, the use of pollen counts in predicting symptom severity in a given individual is somewhat limited.

Weather can influence hay fever symptoms. Allergy symptoms are often minimal on days that are rainy, cloudy or windless, because pollen does not move about during these conditions. Hot, dry and windy weather signals greater pollen and mold distribution and thus, increased allergy symptoms.

If you are allergic to plants in your area, you may believe that moving to another area of the country with different plants will help to lessen your symptoms. However, many pollens (especially grasses) and molds are common to most plant zones in the United States. Additionally, other related plants can also trigger the same symptoms. Many who move to a new region to escape their allergies find that they acquire allergies to new airborne allergens prevalent in their area within one to two years. Therefore, moving to another part of the country to escape allergies is often ultimately disappointing, and not recommended. Appropriate treatment-not escape-is the best method for coping with your allergies.

If your seasonal allergy symptoms are making you miserable, see your allergist/immunologist, who will take a thorough history and conduct tests, if needed, to determine exactly which pollens or molds are triggering your symptoms. He or she will help you determine when these airborne allergens are most prevalent in your area. To lessen your symptoms, your allergist/immunologist may also prescribe an allergy nose spray, non-sedating antihistamine, decongestant or other medications. If your symptoms continue or if you have them for many months of the year, your allergist may also recommend immunotherapy treatment. This treatment involves receiving injections or sublingual tablets as determined by your allergist/immunologist-over a period of three to five years. This treatment helps your immune system to become more and more resistant to the specific allergen, and lessens your symptoms as well as the need for future medications. 

What Are Allergies?

Your body's immune system protects you from things that make you sick like bacteria, viruses and parasites. Allergies occur when the immune system mistakenly learns to recognize innocent foreign substances (allergens) as potentially harmful.

One may wonder why does the immune system make this mistake? It appears that the allergic response was once meant to protect the body against parasitic infections. No one really knows why the immune system would recognized non-harmfull substance as foreign in the same way. It appears that a number of factors predispose certain individuals to become allergic. The most important being genetics. A person's genetic makeup can put them at risk of becomming an allergic individual. This is why family history is one of the most important risk factors for allergies. Allergies can occur at any time during our lives, but are more common to occur during childhood or young adulthood.

When a person is exposed to an allergen, a series of events takes place:

1. The body starts to produce a specific type of antibody, called IgE, to bind the allergen.
2. The antibodies attach to a form of blood cell called a mast cell.
3. The allergens bind to the IgE, which is attached to the mast cell. This triggers a reaction that allows the mast cells to release a variety of chemicals including histamine. If the allergen is in the air, the allergic reaction will likely occur in the eyes, nose and lungs. This leads to runny nose,congestion,itchy watery eyes, sneezing and drainage in the back of your throat. If a patient has allergic asthma then this could also induce an asthma attack. If the allergen is ingested(for example a certain food or medication) the allergic reaction often occurs in the mouth, stomach, and intestines. Sometimes enough chemicals are released from the mast cells to cause a reaction throughout the body, such as hives, decreased blood pressure, shock, loss of consciousness or even death.

The allergic person can make allergic antibodies, to a variety of different foreign substances such as certain foods, drugs and airborn allergens. There are a number of different aeroallergens including outdoor(trees, grasses,weeds and molds) and the indoor allergens such as dust mites, animal dander(cat and dog),feathers and cockroach.