Grazax for hay fever?

Over 1 in 5 adults in the UK are estimated to have allergic rhinitis and around half of these people are allergic to grass pollen. Despite optimal use of intranasal corticosteroids and oral antihistamines, some patients continue to have troublesome symptoms. For example, in one general practice survey, 62% of patients taking both these treatments described control of their symptoms as partial or poor. UK professional guidelines recommend the use of allergen injection immunotherapy in patients with IgE-mediated seasonal pollen-induced rhinitis and/or conjunctivitis "whose symptoms respond inadequately to usual therapy". Such intervention by subcutaneous injection aims to modify the underlying cause of allergic rhinitis and can reduce symptoms, but may result in severe bronchospasm and anaphylaxis requiring resuscitation. Sublingual immunotherapy has been proposed as an alternative to the subcutaneous route. Grazax (ALK-Abelló) is the first product licensed in the UK for sublingual immunotherapy. Here we consider its role in the management of patients with hay fever.