Short Ragweed Pollen Allergen Extract, Sublingual Route

Short ragweed pollen allergen extract is a sublingual drug (dissolved under the tongue) taken in the lead-up to ragweed pollen season to prevent symptoms of allergic rhinitis caused by ragweed allergy.

Overview

Short ragweed pollen allergen extract, known in the US under the brand name Ragwitek, is an immunotherapy treatment for symptoms of ragweed pollen allergic rhinitis. It alleviates symptoms of allergic rhinitis such as runny or itchy nose, stuffy nose and congestion, and itchy and watery eyes (conjunctivitis).

It does not provide immediate relief from ragweed allergy symptoms like antihistamines do. Instead, it is designed to be taken for around 12 weeks before ragweed pollen season and throughout the season. The drug contains extracts of ragweed pollen which causes the body’s immune system to get used to the allergen so that it doesn’t respond with allergic symptoms once exposed to the pollen during ragweed season.

Ragwitek is only available with a doctor’s prescription and should only be taken by individuals who have been diagnosed with ragweed pollen allergic rhinitis via a skin prick test or blood tests. It is approved for use in people between the ages of 18 and 65. It is administered in tablet form in order to be taken sublingually, which means that the tablet is placed under the tongue to dissolve.

Conditions Treated

  • Ragweed pollen allergic rhinitis (with or without conjunctivitis)

Type of Medicine

  • Immunotherapy allergen extract

Side Effects

The most common side effects associated with Ragwitek are dry mouth and nausea. Some people also experience mild tingling, numbness or irritation in the mouth, tongue or ear. Usually, these effects are minor and don’t require medical attention. They may go away once your body gets used to the medicine. However, if they become particularly bothersome you could ask your doctor about them.

There are also more serious side effects associated with Ragwitek that require urgent medical attention. If you notice any of the following symptoms, consult your doctor immediately or, if your doctor isn’t available, go to A and E:

More common:

  • Severe numb or tingling sensation around the mouth
  • Swelling of the mouth

Less common:

  • Red, swollen or sore tongue or mouth
  • Itchy skin
  • Difficulty swallowing
  • Discomfort in the chest

Incidence not known:

  • Puffiness or swelling of eyelids, face, lips or tongue
  • Hives or skin rash
  • Sweating
  • Cough
  • Tightness in chest
  • Fast heartbeat
  • Dizziness
  • Abdominal pain

If you notice any other side effects not listed here, consult your doctor as soon as possible. You could also report them to the FDA.

Dosage

The recommended dose of Ragwitek is one tablet taken once each day. However, your doctor may adjust this depending on your medical history and personal circumstances; always follow the instructions given to you by your doctor.

It is usually recommended that you begin taking Ragwitek at least three months before ragweed pollen season is expected to start. You should then continue to take the medicine until the pollen season has finished.

Doctors usually require that you take the very first dose of Ragwitek in a clinic or hospital setting where medical professionals can monitor you for at least 30 minutes. This is so that they can look out for signs of severe allergic reaction, which is a risk associated with Ragwitek. If it appears that you tolerate Ragwitek well after the first dose, you can continue to take the medicine at home from then on out.

How to take Ragwitek

Wash your hands before and after taking Ragwitek. Make sure your hands are thoroughly dry before you remove the tablet from the blister pack. Immediately place the tablet underneath the tongue. Do not swallow the tablet whole or chew it. It will take around one minute for the tablet to fully dissolve. You should then avoid drinking or eating anything for five minutes to ensure the medicine has been fully absorbed.

Missed dose

If you miss a dose of Ragwitek, simply skip it and take your next dose at the usual time. Do not double up on doses to make up for missed doses. Doing so could increase the risk of side effects or severe allergic reaction. Contact your doctor if you miss multiple doses of Ragwitek.

Interactions

Concurrent use of other immunotherapy treatments

Having multiple immunotherapies at the same time as Ragwitek could increase your risk of severe allergic reaction. This includes allergy shots (injections under the skin) and other sublingual medicines. Make sure your doctor is aware of all immunotherapies you are having. They should also be aware of other anti-allergy medicines or treatments you are currently using, including those purchased over the counter.

Interactions of epinephrine

Doctors usually prescribe epinephrine at the same times as Ragwitek. Epinephrine is an emergency injectable treatment for severe allergic reaction. Some medicines can increase or inhibit the effects of epinephrine, such as:

  • Alpha-adrenergic blockers and beta-adrenergic blockers
  • Antihistamines
  • Cardiac Glycosides
  • Diuretics
  • Ergot alkaloids
  • Levothyroxine sodium
  • Monoamine oxidase inhibitors
  • Tricyclic antidepressants

If you are taking any of these medications, your doctor may change them while you take Ragwitek, or they may not prescribe Ragwitek since you will be unable to use epinephrine injections in the event of a severe allergic reaction.

Interactions with other medical conditions

Ragwitek is not recommended for use in individuals with the following conditions:

  • Gelatin, mannitol or sodium hydroxide allergy
  • Severe, unstable or uncontrolled asthma
  • Eosinophilic esophagitis (allergic esophagitis), or a history of
  • Severe systemic allergic reaction, or a history of

Ragwitek poses the risk of severe allergic reaction. Certain medical conditions can make it difficult to treat allergic reaction which means that patients are at a high risk of serious harm if they do experience a severe reaction to the drug. Ragwitek is therefore used with great caution in people with the following medical conditions:

  • Unstable angina
  • Arrhythmia (heart rhythm problems)
  • Breathing problems or lung problems (such as COPD or bronchitis)
  • Recent heart attack
  • Uncontrolled hypertension (high blood pressure)

Warnings

Risk of severe allergic reaction

Since Ragwitek contains an extract of ragweed pollen, which is what the patient is allergic too, it poses the risk of severe allergic reaction. Usually, if a severe reaction occurs, it does so after the very first dose of the drug, which is why doctor’s request for the first dose to be taken in a clinic or hospital setting. However, there is still a risk of severe allergic reaction no matter how far into the course of Ragwitek immunotherapy you are. You should therefore familiarize yourself with symptoms of severe allergic reaction so that you can seek emergency care as soon as possible. Symptoms include:

  • Rash
  • Hives
  • Shortness of breath
  • Wheezing
  • Coughing
  • Swelling of face, mouth, tongue or throat

Epinephrine injections

Your doctor may prescribe you epinephrine injections which are designed to be administered in the case of severe allergic reaction. Usually, these will be auto-injectables, which allow you, or someone else, to quickly and simply administer epinephrine in an emergency. Your doctor should instruct you on how to use the drug correctly, but make sure to read the instructions provided with the medicine so that you can be prepared in an emergency. You should carry the epinephrine with you at all times. In the event that you have to use the injector, call your doctor or visit the emergency room as soon as you have administered the injection.

Inform doctor of all allergies

Make sure your doctor knows about all the allergies you suffer from, including pollens, foods, dyes, chemicals, animals and other medicines. You should make sure they understand all the symptoms you suffered from when you had an allergic reaction. This is particularly important if you’ve had a very severe allergic reaction or anaphylaxis in the past.

Asthma

You may not be able to take Ragwitek if you suffer from very severe or uncontrolled asthma. This is because the drug poses a risk of severe allergic reaction which could cause tightness of the chest, wheezing, and swelling of the airways which may be worsened by asthma. If your asthma is under control and your doctor has prescribed Ragwitek, tell your doctor right away if your asthma symptoms worsen, you have sudden trouble breathing or you struggle to control the asthma.

Mouth injuries or surgeries

Since Ragwitek is administered sublingually, it should not be taken by individuals who are recovering from an injury to the mouth, such as:

  • Dental extractions
  • Mouth ulcers
  • Thrush in the mouth
  • Oral surgery

Taking Ragwitek with open wounds or sores in the mouth could cause serious irritation or other complications which could affect the successful healing of the wounds. Instead, patients should wait until the condition or injury is fully healed before they take the medicine. If you develop an oral condition while taking Ragwitek, ask your doctor whether it is safe to continue taking it and, if not, how long to wait before taking it again. If possible, you may want to avoid dental extractions or oral surgeries while undergoing immunotherapy with Ragwitek.

Storage

Ragwitek should be stored in the packaging it is provided in and away from direct light, heat or moisture. It should also be kept from freezing. Keep this medicine out of reach of children and pets by storing it up and away from the ground.

Do not hold onto any unused Ragwitek. Instead, ask your healthcare provider how to dispose of it appropriately. They may have a medicine take-back program that you could use. Do not store leftover Ragwitek tablets in readiness for the next ragweed pollen season, as the medicine could expire during this time.

Summary

Short ragweed pollen allergen extract, known in the US as Ragwitek, is a preventative treatment for allergic rhinitis in those who are allergic to ragweed pollen. It is a form of immunotherapy treatment and works by forcing the immune system to tolerate small amounts of ragweed pollen extract. It should be taken daily for three months before ragweed pollen season, and throughout the pollen season itself. It does not offer immediate relief from the symptoms of allergic rhinitis.

The biggest risk associated with Ragwitek is severe allergic reaction. Doctors will usually request that patients take the first dose of the drug in their office or in another clinic or hospital environment in order that they can be monitored for severe reaction. It’s also common for patients to be prescribed epinephrine injections at the same time as Ragwitek in order that they can receive emergency treatment for anaphylaxis should the drug cause it.

Ragwitek is administered sublingually, which means that the tablets are placed under the tongue where they can dissolve. This process usually takes around one minute, but patients should avoid eating or drinking for five minutes afterwards. They may experience dry mouth and mild tingling or numbness in the mouth and throat, but unless these side effects become severe they do not usually require medical attention.

 

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Last Reviewed:
January 31, 2018
Last Updated:
January 27, 2018
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