The National Institute for Health and Care Excellence (NICE) has issued its final draft guidance recommending Itulazax® (Betula verrucosa) — the first sublingual immunotherapy tablet designed for people with moderate to severe birch tree pollen allergies. This decision could benefit up to 27,000 people in England who struggle with symptoms that don’t improve with standard medicines. Unlike typical treatments that only ease symptoms, this therapy aims to provide long-term control of the condition.
Understanding birch pollen allergy
Birch tree pollen allergy happens when the immune system overreacts to pollen from birch trees. This triggers hay fever symptoms such as sneezing, a runny or blocked nose, itchy or watery eyes, coughing, and fatigue.
Some people also experience pollen food syndrome, where eating certain raw fruits, vegetables, or nuts — such as apples, carrots, or hazelnuts — causes itching in the mouth or throat. This is because the proteins in those foods resemble birch pollen proteins.
Symptoms are most common in spring (March–May) but may begin as early as January. Even tiny amounts of pollen can set off strong reactions, and in severe cases, people may have breathing difficulties or increased sensitivity to light.
YOUR QUICK GUIDE TO POLLEN FOOD (ORAL ALLERGY) SYNDROME – Allergy UK
What is Itulazax®?
Itulazax® is a sublingual immunotherapy (SLIT) tablet that helps the body gradually build tolerance to tree pollen. The treatment works by delivering controlled daily doses of pollen under the tongue. A typical course lasts at least three years.
Unlike antihistamines or nasal sprays that only ease discomfort, this method tackles the underlying cause of the allergy, offering the potential for lasting relief. It’s particularly valuable for people whose symptoms persist despite usual treatments.
Why this approval matters
This is the first time NICE has recommended an under-the-tongue immunotherapy for birch pollen allergy. The approval marks an important step forward, with the potential to improve daily life for many sufferers.
Helen Knight, director of medicines evaluation at NICE, highlighted the impact:
“This treatment will help improve people’s quality of life. Severe tree pollen allergies trap people indoors during beautiful weather and disrupt their work, education, and family life. The daily tablet offers genuine long-term relief rather than just managing symptoms.”
The therapy will be rolled out through the NHS in England within three months of NICE publishing its final guidance. To be eligible, patients must have a confirmed diagnosis of birch pollen allergy through a skin prick or blood test. Molecular allergen testing from your blood is the most appropriate form of testing for diagnosing this type of allergy.
For full details, see NICE’s official announcement.
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