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.