New Treatments & Children’s Risks
Published on July 21, 2014
By Melissa A.M. Hertler, MD, Director of the Allergy Program at Wheaton Franciscan – Sinus Care Institute in Wauwatosa.
Are New Allergy Treatments Available to Replace Weekly Allergy Injections?
Yes. For treatment of allergy symptoms, there are now 3 FDA-approved sublingual tablets (tablets that dissolve under the tongue) that contain either grass pollen antigen or ragweed pollen allergen. These are taken at home, every day, rather than at the doctor’s office. They are designed as an alternative to injections of these pollen antigens (allergy shots), and are nearly as effective.
In Wisconsin, there are many people with allergies to more than just grass or ragweed pollens, because there is an abundance of different kinds of pollens from early Spring until late Fall. There are sublingual allergy drops (a liquid that is made by an allergist) that contain one or several different allergens and are given daily under the tongue at home as well.
These drops can contain pollen allergens, or dust, mold or even pet dander. Again, they are nearly as effective as allergy shots, and are a good alternative for adults who fear needles, or cannot make it to the doctor’s office for weekly injections, as well as for children.
Sublingual allergy drops have been used in Europe for many years, and have shown to be an effective alternative with more convenience and less risk of a reaction to the allergen than with injections.
Why is the First Year of Life Critical for Asthma and Allergy Risks?
The first year of life is a critical period in the development of the immune system, especially its ability to recognize the difference between self and non-self, as well as the development of allergies and asthma.
The biggest risk for the development of allergies and asthma seems to be your family history, in that there is a genetic predisposition to atopy, or an allergic state, which seems to arise only after exposure or sensitization.
The newest data available seems to support the protective effect of some allergen and bacteria exposures within the first year of life, on the later development of asthma and allergies. The allergens that were most protective were cockroach, mouse and cat in the house dust samples, as well as exposure to certain bacteria.
Previous studies have shown that children that are raised on farms have a lower risk of allergies and asthma, while children raised in urban environments (primarily inner-city) have much higher risks of developing asthma and allergies, but none was able to explain a straightforward relationship between allergen exposure and later development of allergies and asthma.
It is becoming evident that it is most likely a combination of the right exposures at a critical time in the development of the immune system that is most important in developing protection from allergies and asthma later in life. There is a scientific hypothesis or theory that is being studied that purports that there is an increasing rate of allergies and asthma as a direct result of decreased exposures as young children to bacteria, parasites and other infections because of our improved hygiene and cleanliness of our homes. This is called the “Hygeine Hypothesis.”
What Can Parents Do About Allergy Symptoms?
As a parent, one wishes to protect our children from infections and exposures to dirt and germs; however, it appears that there may be some benefit to early exposure to some pet and rodent dander, cockroach allergens and bacteria with respect to the later development of allergies and asthma.
There are many factors that contribute to the overall risk of a child, and there are some factors that may be more readily controlled. It is known that childhood exposure to tobacco smoke within the home is a risk factor for the development of asthma, as is exposure to indoor and outdoor pollutants. More studies need to be done to help figure out what the right combination of allergens and germs are to help shape the immune system to prevent allergies and asthma, but we don’t know that answer yet.
As practical advice to parents, it’s prudent to avoid exposing your child to tobacco smoke or significant pollution, and although we don’t know the exact mechanism or combination of allergens and bacteria, a little dirt won’t hurt!