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Q&A Topic: What is Sublingual Immunotherapy (SLIT)?


Q: What is Sublingual Immunotherapy (SLIT)?

It is a method of treating allergies without injections. We give patients small, increasing amounts of the allergens that they have an established allergy to. They put the drops under the tongue and it boosts tolerance to those particular allergens and subsequently reduces symptoms. The drops come in a small pump container.

Patients start with a more diluted solution and work their way up.

Q: How is SLIT more effective than traditional allergy treatments?

The difference between immunotherapy and traditional over-the-counter or prescribed allergy medicines are that, immunotherapy, whether sublingual drops or shots, is able to change the immune system from allergic to non-allergic over time. It’s a disease-modifying drug, as opposed to just controlling symptoms. Medications are not customizable at all—they are blanket treatments for symptoms. Both allergy shots and sublingual immunotherapy use similar immune responses, but allergy shots need to be done in the office, under observation. Drops can be done at home. If you have a more rigorous schedule, you don’t have to come into the office every week for the first six months, unlike with the shots. We also can do them on younger people—kids are more tolerant to the drops than shots.

Q: What allergies and symptoms can SLIT treat?

Right now it’s being used predominantly for environmental allergens—dust mites, ragweed, grass, tree pollen. We are also using it for peanut allergies. These are the predominant allergens that cause symptoms—it will help improve sneezing, red, itchy eyes, coughing, or asthma that seems to be allergen driven. It typically takes six to 12 months to see benefits and three to five years for long-term control. During the first six to 12 months, patients use their traditional symptom-control medicine in conjunction with SLIT. The hope is that over time the other medications can fall off and they just use SLIT. After the three to five year period, we try to wean patients from the therapy—the majority will have long-term control going forward for five to 10 years.

Q: Who is a good candidate for SLIT? Who isn’t?

Anybody—a child or adult—who has significant allergy symptoms—runny nose, congestion, cough—that are skin-test positive to particular allergens is a good candidate. This would be a good treatment strategy for somebody who isn’t able to do traditional medications—they have side effects or aren’t getting enough benefits from the symptom-control medicine. SLIT isn’t a good option for those who aren’t good about taking something everyday. It should be used daily, but if you consistently miss three out of seven days, you’re not going to get the benefits you’re looking for.

Q: How does the process work?

If somebody comes in for an evaluation—complains of runny nose, sneezing, congestion—the first step would be to skin test them. We have these skin test applicators where we put a small amount of the allergen that we’re concerned about—cats, dust mites, dogs, species of trees, grasses, mold, ragweed—on an applicator and rock them on the patient’s back. It allows a small amount of the allergen to penetrate under the skin. If a patient is allergen-positive, he will get a mosquito-bite like lesion. We typically test for 48. We want to look at everything the patient could possibly be allergic to. If they’re skin test positive, and has tried allergy medication before, the next step would be immunotherapy. The SLIT drop extracts are customizable and we can treat for multiple allergen sensitivities with a single drop. The allergist creates an individual extract for each patient based on their allergy testing.

Allergy & Asthma Specialists
Caring for patients in eight locations

Annie Khuntia
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