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Oral alternative to allergy shots improves hay fever

Rating

4 Star

Oral alternative to allergy shots improves hay fever

Our Review Summary

This story reports on a recent meta-analysis that suggests immunotherapy tablets and drops that dissolve under the tongue are effective for reducing symptoms related to hay fever. This story met many of our criteria; included a discussion of costs, and interviewed an independent source, compared this therapy to existing alternatives. This story was also appropriately cautious in its tone, reporting that the outcome was “modest.” However, it also contained a few important omissions.  For example, we wish it had included data regarding adverse events, a discussion of the limitations of meta-analyses, and a presentation of the results data in absolute terms. 

 

Why This Matters

Allergic rhinitis (hay fever) won’t kill you, but it can make you quite uncomfortable. Allergy sufferers have been buying an increasing amount of over the counter and prescription medication. In the meantime, the drug industry has been watching its profits fall. Make no mistake, hay fever treatments are big business. It is estimated that existing products, including antihistamines and intranasal steroid sprays are a $5-6 billion market worldwide. However, the size of the market has been shrinking in recent years due to loss of patent exclusivity and the introduction of both generics and over the counter products. There are between 8 to 20 million allergy sufferers in the U.S. who rely on the available treatments, so the market potential for a new class of drugs to treat hay fever is large. The use of the body’s immune system to reduce symptoms in people with known allergy has been around for a long time, but the treatments are time consuming, expensive and require dozens of injections over time. While this form of immunotherapy has been shown to reduce symptoms for long periods of time and is arguably one of the best treatments, most allergy sufferers shy away from it for a variety of reasons. The development of a sublingual form of immunotherapy would be welcomed by many sufferers as well as the shareholders in the pharmaceutical industry. This story is likely to draw a good deal of interest.

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

The story concedes that the “ultimate cost-effectiveness of sublingual immunotherapy has…yet to be determined.” Based on cost in the U.K., the story reports that treatment may be $3.50 per day, adding that it should be “taken daily, starting several months before the start of the next grass-pollen allergy season and continuing for three years thereafter.”    

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story only presents the benefits of therapy in terms of relative risk compared with placebo, rather than absolute risk.  The reader is not given any information about what a 20% reduction in symptoms would mean for them. The benefit may be statistically significant, but is it clinically significant? The story should have also reported that the same benefit was not seen in children.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story provides a list of the most common side effects associated with sublingual immunotherapy; however, a more complete report would have also mentioned more serious, albeit rare, reactions. It would also be useful for readers to know that in the 1518 patients who received sublingual immunotherapy, there were 3286 reported adverse events (2.6 per person), compared to 1570 reported adverse events in the placebo group (1.34 per person). Furthermore, 54 (3%) patients in the sublingual immunotherapy group dropped out of the studies due to adverse events, compared to 12 (1%) in the placebo group.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story describes the study, noting that it was a meta-analysis of 19 trials and included nearly 3000 patients with grass-pollen allergies, and mentions that trials varied in duration (3 month to 3 years). However, the story should have included a discussion of how meta-analyses, like this one, have drawbacks, particularly regarding heterogeneity between the trials. The story should have also noted that the trials included were randomized and compared sublingual immunotherapy to a placebo.

Does the story commit disease-mongering?

Satisfactory

Given the number of allergy sufferers in the U.S., the story could have easily engaged in disease mongering, but that was not the case.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story includes an interview with an allergist not affiliated with the research. 

Does the story compare the new approach with existing alternatives?

Satisfactory

The story discusses alternative approaches for treating grass-pollen allergies, specifically antihistamines and allergy shots. 

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

This story makes it clear that sublingual immunotherapy is not available in the U.S.; however, this might have been mentioned sooner in the text.  

Does the story establish the true novelty of the approach?

Satisfactory

By mentionsing that trials from 1995 were included in the meta-analysis, the story lets readers know that sublingual allergens are not novel. The concept of administering allergens orally has been proposed as early as 1900.

Does the story appear to rely solely or largely on a news release?

Satisfactory

This piece does not rely on a press release.

Total Score: 7 of 10 Satisfactory

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