NICE recommends first under the tongue immunotherapy for severe birch tree pollen allergy  

The National Institute for Health and Care Excellence (NICE) has released its final draft guidance recommending Itulazax® (Betula verrucosa)—the first sublingual (under the tongue) tablet immunotherapy, which could help up to 27,000 people in England with moderate to severe birch tree pollen allergies. This is an important step forward for people whose allergy symptoms don’t improve with usual treatments, as it offers a long-term way to manage the condition rather than just short-term symptom relief.  

What is birch tree pollen allergy? 

Birch tree pollen allergy occurs when your body reacts to the pollen released by birch trees, treating it as a threat. This causes hay fever symptoms like sneezing, a runny or blocked nose, itchy or watery eyes, and sometimes coughing or tiredness.  

Some people with this allergy may also get an itchy mouth or throat when they eat certain raw fruits, vegetables, or nuts, like apples, carrots, or hazelnuts. This is known as pollen food syndrome and happens because these foods contain proteins similar to those in birch pollen.  

Symptoms usually peak in the spring (March to May) but can start as early as January. Even small amounts of pollen can cause serious symptoms and in severe cases, people might have trouble breathing or notice sensitivity to light.  

What is Itulazax®? 

Itulazax®, is a Sublingual immunotherapy (SLIT) tablet that works by gradually increasing the body’s tolerance to tree pollen. It does this through controlled daily exposure to small amounts of pollen in a tablet taken under the tongue, with treatment typically lasting at least three years. 

This approach addresses the root cause rather than symptoms, offering hope of long-term relief. It provides a new treatment option for individuals whose symptoms persist despite antihistamines and nasal sprays.   

Why is this important? 

The recommendation of this treatment is the first NICE approval for an under the tongue immunotherapy for birch tree pollen allergy. It has the potential to help many individuals to better manage their condition, leading to a significant improvement in their quality of life.  

Helen Knight, director of medicines evaluation at NICE, has expressed support, recognising it as a major advancement in allergy care:   

“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 treatment will be made available through the NHS in England within three months of NICE publishing its final guidance. To qualify, patients must have a positive skin prick test or blood test confirming birch tree pollen allergy. 

For more information, you can read the full NICE announcement here.