Aaaaa-choo!

At least a quarter of the U.S. population has allergies. Billions of dollars are spent on treatment and lost workdays. Sufferers often endure agonies of sneezing, runny noses, itchy eyes, coughing, and other symptoms.

These reactions can be brought on any time of year by dogs, cats, molds, cockroaches, dust mites, and much, much more, alas. In summer, grasses can be a major culprit. In fall, weeds. Right now, we're in the season of tree pollen.

Keep the tissues handy.

But there are promising new treatments. Allergy specialist Gurston Nyquist, associate professor of otolaryngology and neurological surgery at Thomas Jefferson University, recently spoke to us about them.

What are the standard treatment options for allergies?
They consist of a triad. The first is avoidance of what you may be allergic to. The second is medications. Over-the-counter antihistamines and nasal steroids are available. There also are prescription medications for allergies.

The third is immunotherapy. With that, we give small doses of what people are allergic to in order for their bodies to develop tolerance. As a result, they develop a less inflammatory reaction to those stimuli.

We usually begin by giving smaller doses and then increase the dose slowly until the patient reaches a maintenance phase. They continue getting treatment after that, for varying lengths of time, but it's at the same dose.

Generally, immunotherapy is recommended for patients who continue to have symptoms despite avoidance and medical therapy, or who want to treat the underlying cause of their allergy and change their reactivity.

The traditional form of immunotherapy is allergy shots, administered in the arm.

What's new?
We now have the option of sublingual tablets or drops - meaning they're administered under the tongue. The main benefit is the convenience of doing it in the home or elsewhere outside a physician's office.

In 2014, the U.S. Food and Drug Administration approved the tablets. So far, these are only for very specific allergens that include grasses and ragweed. But researchers are developing tablets that would treat for additional allergens, including dust mites and trees. Hopefully, they'll be available in the near future.

Now, we also have the option of sublingual drops. We are able to mix patient-specific solutions in the office, so these are recommended for patients who have multiple sensitivities to different allergens. People who are allergic to dust mites, cats, dogs, and multiple pollens can have symptoms all year round.

This treatment is in a gray area right now, where the FDA has not yet formally approved it but has said it's OK for practices to be administering it. In general, otolaryngology practices, including Jefferson, have adopted this therapy more than general allergists have.

The sublingual drops have been used for decades in Europe, Asia, and Australia. And the safety profile is excellent. There have been no reported deaths with the drops or tablets, and the most common side effect is itching under the tongue.

This is in contrast to allergy shots, which pose the risk of anaphylaxis - rare, but it can happen - where the patient has a life-threatening reaction. That's why they're administered in a physician's office.

One can expect that their symptoms from allergies and their use of medication will be significantly decreased while on immunotherapy. General benefits can continue for two to 10 years after a patient has completed the shots, drops, or tablets.

Who are the best candidates for the newer drops or tablets?
Here's what I tell patients: The best form of immunotherapy is the one they can be most compliant with. Both forms - the shots and the sublingual drops or tablets - are about equally effective and safe.

In general, shots are administered weekly for about two years, then every other week for another two years. The advantage of the drops or tablets is that if it's difficult to get into a physician's office every week because of work or travel, the drops or tablets can be administered at home.

Is insurance an issue?
More and more insurance companies are covering treatment with the sublingual tablets. However, the sublingual drops are not covered by insurance at this point. Although the cost is dependent on each individual and his or her allergies, it ranges between about $40 to $90 a month. That's similar to what a co-pay would be.

The Obama administration's recent report on the health effects of climate change found that allergies have increased. Why? And why do we have allergies in the first place?
When the weather is warmer, there's a longer season of blooming, so there's more exposure to allergens. That's one explanation for why allergies tend to be getting worse.

The other is that, for tens of thousands of years, parasites and other infections unusual in modern society were a major problem in humans. The body developed a defense mechanism - inflammation - to fight them. Now, there aren't as many of these infectious diseases for our bodies to deal with, but we still have this defense mechanism. It has begun to target other things, such as allergens in the environment. Immunotherapy helps teach the body to better tolerate these harmless parts of our environment.

People can develop allergies at almost any time of life. Some people have a strong family history of allergies, and they are more predisposed. Some people have allergies while they're young and it continues throughout their lives. Others are able to "grow out of allergies" with time. And other people develop allergies as adults. So no one is free. The good news is that there are medications and immunotherapy to help.