Over 25% of Canadians suffer from Allergic Rhinitis, or "Hay Fever", affecting Quality of Life (QoL), healthcare costs & productivity while putting this population at a 2x higher risk of uncontrolled asthma. McMaster University researchers found that 46% of those who suffer from Allergic Rhinitis experience chronic fatigue, while 32% have trouble concentrating.

Uncontrolled Asthma caused by Allergic Rhinitis costs Canadians $2B annually, with costs expected to double by 2030. This unnecessary cost is partly due to the 70,000 emergency room visits caused by allergy-triggered asthma emergencies that could be prevented. 80% of asthmatics are diagnosed with Allergic Rhinitis or Chronic Sinusitis as triggers, which can be treated.

The status quo for Canadian allergy and asthma sufferers is to take symptom suppression medications such as antihistamines or corticosteroids. These medications do not treat the cause of allergic rhinitis and are intended for short-term use, with 61% of users reporting poor or "somewhat" control of their symptoms and 44% experiencing decreasing efficacy within the first month of use.

Allergy immunotherapy, the only long-term treatment for allergies, has been proven in clinical trials and in practice globally. However, only 5% of Canadian allergy sufferers are aware of this treatment. Access is heavily hindered in Canada due to the limited availability of this treatment, with only 200 allergists offering it and significant affordability barriers.

Allergies are an overreaction of your body's immune system to a harmless foreign substance that enters your body, like pollen, dust, or animal dander. An allergic reaction occurs when an allergen enters your body and your oversensitive immune system overreacts by producing antibodies to fight the allergen. These antibodies release histamines that result in symptoms commonly associated with allergies, such as runny nose, irritated eyes, sneezing, or swelling.

Allergies typically develop in childhood and may re-emerge later in life. Diseases and conditions such as allergic rhinitis, asthma, anaphylaxis, eczema, or hives are commonly triggered as part of an allergic reaction in the body. Allergies are typically diagnosed with the assistance of diagnostics such as Skin Prick Tests (SPTs) or an IgE blood test such as the ImmunoCAP ISAC.

Most Canadian allergy sufferers manage their allergies through over-the-counter or prescribed symptom suppression medications, such as antihistamines and corticosteroids (i.e. Flonase®). In 2020 alone, Canadians spent over $190M on over-the-counter antihistamines. These medications only suppress symptoms caused by allergies rather than addressing the disease itself.

Antihistamines such as Benadryl®, Claritin® or REACTINE® work by attempting to block the attachment of histamines to the allergen. They do not stop antibodies or histamines from being created in your body in the first place. Corticosteroids such as Flonase® and Nasacort® work acutely by countering nasal passages' swelling and mucus accumulation. While initially effective, 44% of Corticosteroid users report Tachyphylaxis within their first month of use.

Allergy immunotherapy involves the administration of allergen extracts into the patient's body to achieve clinical tolerance of allergens that cause symptoms. It has been proven to be effective in patients with allergic diseases and also in those who do not respond well to symptom suppression medications. The concept of immunotherapy for allergies has been around for over 100 years.

Biologically, allergy immunotherapy works by inciting a change in T cell subset distribution with the generation of allergen-specific T regulatory (T-reg) cells while decreasing Th2 cells. Repeated and controlled allergen exposures stimulate IL-10 and TGF-β, creating type 1 peripheral T regulatory (Tr1) cells, resulting in peripheral tolerance and a decrease in IgE production by B cells, resulting in long-term amelioration of allergy reactions.

Unlike symptom suppression medication, allergy immunotherapy has been shown to modify the underlying cause of the disease, with proven long-term benefits. Although Subcutaneous Immunotherapy (SCIT) has been the gold standard, Sublingual Immunotherapy (SLIT) has emerged over the past 30 years as an effective and safe alternative with lower barriers to treatment.

Allergy Immunotherapy can be administered in two ways: Subcutaneously (SCIT), where allergens are injected by a clinician, and Sublingually (SLIT), where allergens are self-administered through drops sprayed under the tongue. Both SLIT and SCIT have been proven to be effective in practice.

A recent cost minimization analysis estimated typical SCIT treatment costs in Ontario at $1,432.22 per year, amounting to $4,233.47 over three years. Beyond cost, the commitment to weekly office visits during build-up and monthly visits during maintenance is reported as another significant barrier.

Due to the nature of self-administration, resulting in cost and time savings, SLIT has the opportunity to make allergy immunotherapy more accessible for 9.5M Canadians.

SLIT has been proven to have a better safety profile with fewer systemic reactions, and to date, no reported fatal reactions — compared to 3.4 deaths per year in SCIT and 46.7% of SCIT patients encountering at least one systemic reaction throughout their treatment.

With regards to efficacy, multiple studies have found SLIT to be either as effective or more effective than SCIT in the reduction of symptoms and induction of long-term remission.

Asthma is expected to affect over 400 million people globally by 2025 and is one of the most common chronic inflammatory disorders that develop during infancy. Although not exclusively associated with allergies/atopy, 75% of children with asthma are atopic. Although asthma pharmacotherapy can effectively control symptoms, it cannot affect the underlying immune response. Allergy immunotherapy is the only way to interfere with the underlying immune pathophysiology causing asthma.

In a study of children between the ages of three and five, researchers concluded SLIT to be both safe and effective in the reduction of symptoms relating to both allergic rhinitis and asthma. In contrast, SCIT is not recommended in children below the age of 5 due to safety reasons.

Adherence is primarily measured through dropout rates in allergy immunotherapy. Data from a German allergy clinic indicated dropout rates for SLIT at 39%, while 32.4% of SCIT patients dropped out within the first year of treatment. Feedback demonstrated that 31% dropped out due to relocation, and 22% due to difficulty remembering to continue their daily regimen.

In a recent survey of patients at a sublingual immunotherapy clinic in the US, patients expressed daily reminders and regular check-ins with coaches as the best ways to support the required daily regimen. 67% of patients reported that a mobile app for daily reminders and dosage tracking would help them remain adherent.

A review of 11 studies found adherence enhanced by up to 40% when a mobile app was used in conjunction with treatment. Additionally, missed doses were reduced by an average of 28%, reducing treatment time.

In conclusion, patients and the Canadian healthcare system stand to benefit from a wider-spread adoption of Sublingual Immunotherapy (SLIT). There is clear evidence that SLIT is an effective treatment against allergies and associated diseases such as asthma, with the potential to reduce the $190M spent annually on unsatisfactory symptom suppression medication and the $2B burden on Canadian healthcare systems due to uncontrolled asthma.

Substantial evidence shows SLIT as effective or more effective than SCIT in some instances. Initial evidence shows SLIT combined with a mobile app could result in much higher adherence. Additionally, evidence suggests SLIT is the only safe and effective curative treatment for atopic asthma in children below the age of three.