Thanks to an unusually mild winter, spring allergy season is already in full swing in the US, which means countless cases of sniffling, sneezing and watery eyes. Antihistamines and steroids can provide cheap and safe relief for the more than 35 million Americans who suffer from pollen allergies. But these medicines wear off quickly, and the allergy injections that confer longer lasting results are painful, inconvenient and carry a risk of lifethreatening anaphylactic reactions. “A lot more people will be willing to take a therapeutic approach that is safer and easier to administer,” notes Peter Creticos, an immunologist at the Johns Hopkins Asthma and Allergy Center in Baltimore. Enter the allergy tablet. After six years of sales in Europe, these ‘sublingual immunotherapy’ drugs, which can be dissolved under the tongue to provide long-term allergy relief without the pain of a shot, are finally nearing approval in the US. At last month’s American Academy of Allergy, Asthma & Immunology annual meeting in Orlando, Florida, Creticos reported results from a 565-person phase 3 North American study showing that a ragweed allergen tablet being developed by the pharmaceutical giant Merck reduced allergy symptoms by 21–27%, depending on dose, compared to dummy tablets. At the same time, Creticos and his colleagues reported the findings of two late-stage trials involving another Merck tablet, this one for allergies to Timothy grass. In those studies, which included almost 800 children and adults, the experimental grass allergen tablet yielded similar improvements in nose and eye symptoms over the course of a year. The efficacy of both drugs, which work by sensitizing individuals to their allergens, was only slightly below the 35% average improvement typically observed for allergy injections. And, importantly, both had only minor side effects, such as mouth itchiness and throat irritation. According to Rupert Vessey, head of respiratory and immunology research at Merck, the New Jersey–based company plans to submit both products for US regulatory approval in 2013. The US prescription allergy drug market is estimated to reach $15 billion by 2015, according to Global Industry Analysts, a California-based market research firm, and many other companies are similarly hoping to cash in with sublingual immunotherapies, too. For example, North Carolina–based Greer Laboratories currently has an ongoing phase 3 study testing ragweed pollen extract administered under the tongue, and the company has completed phase 1 studies for dust mite, Timothy grass and cat hair tablets. Meanwhile, the French firm Stallergenes, Europe’s second largest maker of allergy medicines, completed a US phase 3 trial for a five-grass pollen allergy tablet called Oralair in 2010.