Some of the patients we see have completed courses of allergy shots, or “subcutaneous immunotherapy” (SCIT). They know the time involved: driving to the place where the shots are administered, receiving the injection, then waiting to ensure that there isn’t an adverse/allergic reaction. Adherence is naturally a big struggle not only because of the difficulty of this process but also because travel becomes difficult when expected to be at the doctor’s office weekly and because it is painful. Allergy treatment doesn’t have to be this complicated.
On the flip side, some of the patients we see are regularly taking prescription or over-the-counter allergy medications that may temporarily resolve the symptoms, but don’t address the underlying root cause. Over time, these medications are expensive, and may have undesired side-effects.
Sublingual immunotherapy (SLIT) offers the best of both of these two scenarios – the convenience of something that can be taken orally while addressing the root cause – immune dysfunction. SLIT uses drops that are made with antigen [allergen] extracts in a liquid base, typically with glycerin. SLIT allergy drops are shipped directly to your home in three month supply containing vials. Every three months the dose is increased in order to continue the immune modulating desensitization process. Every vial is compounded specifically to address your personal allergens, in one solution that is administered three times daily for up to two to five years.
Not only does SLIT offer you a convenient way to address your allergies but it is also affordable, effective, and safe. Age does not appear to be a limitation to treatment.
SLIT is growing in popularity in the US, and is already popular in Europe (with some countries reporting up to 50% use).1 Clinical use in the US dates back more than 100 years, so this treatment modality isn’t new. Until now, though, thorough research hasn’t existed to demonstrate SLIT’s efficacy. Hundreds of studies have been compiled over the past 20 years establishing its safety and effectiveness. Over 340 articles are referenced in the World Allergy Organization Journal and cited in their 2013 Position Paper on SLIT.
After we complete food and inhalant allergy/sensitivity testing, results are sent to our compounding pharmacy partner and a customized oral formulation is created, addressing each of your identified food and inhalant allergies. SLIT drops are administered under the tongue and held there for 30 seconds, typically two to three times daily. Your case is re-evaluated every 90 days, and dosages are increased as tolerated with every new 90-day supply of formulation.
Just like allergy shots, the SLIT treatment protocol is a long-term solution and doesn’t take full impact until months or years from the start of the protocol. That’s because allergen doses are slowly increased over time to gradually develop your tolerance.
|Initial Oral Intolerance||Symptom Relief||Long Term Tolerance|
|0-2 months||3 months to 2 years||2 to 5 years*|
|Your body adjusts to treatment & symptoms may improve||As symptoms decrease, your body is changing your allergen tolerance||Symptoms improve & your tolerance increases. Length of treatment determined by doctor.
*Varies based on allergy complexity and adherance. Foods may take longer.
Are you a good candidate for allergy drops? When our patients want to gain foods back that they are allergic to, or when allergy season is expensive and impacts overall lifestyle, they often choose SLIT. Check out this list of candidates that SLIT is impactful for.
According to the World Allergy Organization 2013 Position Paper on SLIT, to be eligible for this treatment, one should have a history of symptoms related to allergen exposure documented positive allergen-specific IgE test. Additionally, appropriate candidates for SLIT would meet one or many of these selection criteria:
- The allergen used for immunotherapy must be clinically relevant to the clinical history.
- Use of SLIT for latex allergy, atopic dermatitis, food allergy, and Hymenoptera venom is under investigation; more evidence is needed to support its clinical use for these indications.
- SLIT may be considered as initial treatment. Failure of pharmacological treatment is not an essential prerequisite for the use of SLIT.
- SLIT may be proposed as an early treatment in the therapeutic strategy for respiratory allergy.
- SLIT may be particularly indicated in the following patients:
- Patients whose allergy is uncontrolled with optimal pharmacotherapy (that is, those with severe chronic upper airway disease).
- Patients in whom pharmacotherapy induces undesirable side effects.
- Patients who refuse injections.
- Patients who do not want to be on constant or long-term pharmacotherapy.
Have other questions about SLIT? Check out FAQs here, or contact our office at 317.989.8463.
- Sublingual Immunotherapy Research Bibliography. Allergy Choices. https://www.allergychoices.com/research/bibliography/
- Morris, M., Lowery, A., Theodoropoulos, D., Duquette, R.D., Morris, D. Quality of life improvements with sublingual immunotherapy: a prospective study of efficacy. Journal of Allergy (2012). doi: http://www.hindawi.com/journals/ja/aip/253879/
- Nelson, H. Allergen immunotherapy: Where is it now?The Journal of Allergy and Clinical Immunology, 2007: 769-777.
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