Oral drops can give kids needle-free relief from asthma, allergies

Allergy shots are commonly used to treat children with severe environmental allergies and asthma, but under-the-tongue drops may offer yet another beneficial - and stick-free - option for pediatric allergy sufferers, according to a Johns Hopkins Children’s Center review of existing scientific evidence.

The new research comes on the heels of another recent Hopkins study, which showed that oral drops provide a safe and effective alternative for adult allergy sufferers.

The new review, appearing May 6 in the journal Pediatrics, is an analysis of 34 previously published clinical trials and suggests that both drops and injections work well in alleviating the bothersome symptoms of allergic rhinitis and asthma, the research team says. In addition to being better tolerated by needle-averse children, the oral treatment can be given at home, sparing the family a visit to the doctor’s office.

“Our findings suggest the needle-free approach is a reasonable way to provide much-needed relief to millions of children who suffer from asthma or seasonal allergies,” says lead author Julia Kim, M.D., M.P.H., a pediatric research fellow at Johns Hopkins Children’s Center.

Allergy shots, which contain tiny amounts of proteins found in environmental allergens such as dust mites and pollen, are a standard treatment for severe seasonal allergies in children who do not get relief from medication. However, under-the-tongue drops are not approved for use by the U.S. Food and Drug Administration and are only offered off label by some physicians. The needle-free approach is widely available in Europe, where patients are commonly treated with sublingual pills and drops, the researchers say.

The new findings, Kim notes, are encouraging enough to prompt a second look at oral drops as a treatment option.

Asthma leaves some 15 million Americans gasping for breath. And asthma’s incidence has been steadily rising in the past four decades, more than doubling since 1980. Although the tendency to develop asthma can be genetic, both environmental and dietary factors are major causes for the increase.

For example, the incidence of asthma, especially in children, is much greater in urban areas where polluted air is more prevalent. Even more striking is that asthma is a new disease. Like coronary artery disease, asthma was virtually unknown 100 years ago, and is still rare in many developing countries.

Asthma is best described as a chronic inflammatory condition rather than a respiratory disease. In fact, asthma’s origins have more in common with arthritis than they do with emphysema or tuberculosis. Asthma is simply a chronic inflammation of the airway rather than the joints. People with asthma have inflamed, hyperreactive airways that produce excessive bronchial mucus. After repeated asthma attacks, the airway lining becomes scarred, and immune cells, which cause or exacerbate inflammation, proliferate there.  Asthma eventually damages the airway permanently, making it more prone to inflammation and less functional overall.

The Hopkins researchers first looked at 13 studies that involved 920 children and compared the efficacy of allergy injections to either placebo or standard allergy medication. Overall, the researchers found that injections provide better symptom relief than placebo and standard medication for children with asthma or allergic rhinitis. The team next analyzed 18 trials involving 1,580 children treated with oral-drop therapy, placebo or standard medication for asthma and rhinitis or either condition alone. In this group, the researchers also found that oral drops provided superior relief of asthma symptoms, compared with patients who got the placebo and/or standard drugs. Oral drops also provided better symptom relief than placebo and standard medication in children with allergic rhinitis or rhino-conjunctivitis, a condition marked by runny nose and itchy, red and swollen eyes.

Only three of the 34 studies in the review directly compared shots and drops and, the investigators say, more head-to-head comparisons may shed better light on the comparative effectiveness of the two treatments. However, the researchers add, the results of the 31 remaining studies they looked at indicate both oral drops and allergy shots can successfully rid children of coughing, sneezing, runny noses, itchy eyes and wheezing.

Asthma Prevention and Relief
Asthma is amenable to natural treatments. Asthmatics using medication should not discontinue them abruptly; instead they should work closely with a health care provider to design a plan best suited to the severity of their illness, and decrease medication doses under supervised care. Since asthma can be life-threatening, asthmatics should follow these common-sense precautions:

  Use hypoallergenic supplements.

  Avoid magnesium or vitamin C in excess of 3 g per day if kidney disease or dysfunction is present.

  Avoid fish, fish oil or shark-liver oil if fish allergies are suspected.

  Be cautious when supplementing medicinal herbs if fruits, vegetables, condiments, culinary herbs and spices or flower pollens trigger allergic reactions.

  Use one product at a time, and take one caspule daily, to slowly build up the dosage.

I recommend the following daily supplements to prevent or treat asthma. The supplements work synergistically, so to make the most of the plan, include them all.

  Antioxidants - including 400 IU vitamin E and 100 mcg selenium - counter the free radical damage incurred during inflammatory responses.  Vitamin C is a powerful antihistamine without side effects, and it enhances immune response. Take at least 1 g with bioflavonoids three times per day. For exercise-induced asthma, take 2 g 20 to 30 minutes before exercise.

  Fish oil is another anti-inflammatory. Take 2 to 4 g.

  Glutamine powder is indicated for patients with candidiasis and for food allergy recovery. Take 10 to 20 g.

  Magnesium levels are chronically low in asthmatics, and the mineral helps relax the bronchial tubes and smooth muscle of the esophagus. A therapeutic dose is 400 to 800 mg.

  Multivitamins/minerals that include 25 to 75 mg B complex, 400 to 800 mcg folic acid, 15 to 20 mg zinc and 400 mcg chromium picolinate can be helpful. Vitamins B6 and B12 are especially important and are most likely to be deficient.

  N-acetyl cysteine (NAC) is an antioxidant that increases glutathione levels and thins bronchial mucus.  Take 200 to 500 mg three times per day.

  Pantothenic acid (vitamin B5), helps form antibodies. Take 250 mg.

  Quercetin, a bioflavonoid, is antihistaminic and antiallergenic.  It is known to inhibit mast cells from releasing inflammatory compounds.  Take 500 mg twice daily.

The three studies that directly compared injections versus oral drops for symptom relief of dust mite-induced asthma and rhinitis showed no strong evidence that children given shots fared better than children who got oral drops, Kim said.

Both treatments, overall, caused relatively mild side effects, such as itching of the mouth, skin rashes or wheezing. A single severe reaction was reported following an injection.

More than 6 million children in the United States suffer from asthma, while allergic rhinitis affects 40 percent of American kids.


The research was funded by the U.S. Agency for Healthcare Research and Quality under grant number HHSA 290-2007-10061.

Co-investigators on the study were Sandra Lin, M.D.; Catalina Suarez-Cuervo, M.D.; Yohalakshmi Chelladurai, M.B.B.S., M.P.H.; Murugappan Ramanathan, M.D.; Jodi Segal, M.D., M.P.H.; and Nkiruka Erekosima, M.D., M.P.H., all of Johns Hopkins.


Ekaterina Pesheva
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Johns Hopkins Medicine

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