Betula verrucosa for treating moderate to severe allergic rhinitis or conjunctivitis caused by tree pollen

Betula verrucos (Itulazax) is a once daily immunotherapy tablet for people with moderate to severe allergic rhinitis or conjunctivitis (hay fever) caused by birch tree pollen:

• tablet contains birch pollen allergen extract
• is a new sublingual immunotherapy (SLIT) tablet
• noted that a phase 3 placebo controlled trial involving 634 patients aged 12 to 65 with birch induced rhinoconjunctivitis showed that those taking betula verrucos had 33% fewer symptoms than those taking a placebo (1)
• Birch pollen is the major allergenic tree pollen in parts of Europe, and is also listed among the key pollen allergens in North America (2)
  • Birch pollen contains the major allergen Bet v 1, which is homologous with allergens from other trees in the Fagales order
    • the birch homologous group includes alder, beech, hazel, hop/hornbeam, oak, and chestnut
      • cross‐reactive nature of allergens and the sequential flowering of trees in the birch homologous group can result in individuals with birch pollen‐induced allergic rhinitis experiencing symptoms for a prolonged period, extending beyond the birch pollen season

NICE have stated that:

Betula verrucosa can be used as an option to treat moderate to severe allergic rhinitis or conjunctivitis caused by pollen from the birch homologous group of trees in adults with:

• symptoms despite using symptom-relieving medicines
• a positive sensitisation test (skin prick test or specific immunoglobulin E) to a member of the birch homologous group

The NICE committee note that:

• "..Clinical trial evidence shows that betula verrucosa reduces the severity of allergic rhinitis and conjunctivitis symptoms compared with placebo (both when given with symptom-relieving medicines).."

Reference:

1. Bowie K. Sixty seconds on . . . pollen immunotherapy. BMJ 2025; 390 :r1633
2. Rønborg SM et al. ITULAZAX® versus Alutard SQ® in the treatment of allergic rhinitis induced by pollen from the birch homologous group: A cost-minimization modeling analysis from the Danish societal perspective. Clin Transl Allergy. 2022 Nov;12(11):e12196.
3. NICE (August 2025). Betula verrucosa for treating moderate to severe allergic rhinitis or conjunctivitis caused by tree pollen.