What is SLIT?
Sublingual (i.e. under the tongue) immunotherapy (abbreviated SLIT) is a method of treating allergies in patients who are sensitized to certain foods.
Patients must have a documented IgE mediated food allergy, such as food allergy to peanut, egg, or milk, but not for conditions such as celiac disease or lactose intolerance.
What is the goal of SLIT for foods and how long does it take?
Allergen immunotherapy (of any type) changes your underlying immune response to the allergen in question, essentially teaching your immune system tolerate it.
The goal of SLIT is NOT to allow for free-eating of the allergenic food. Maintenance doses are reached after two months. It may take a year or so to build tolerance to the food to a point where cross-contamination and accidental ingestion do not cause serious reactions.
How does SLIT compare to OIT?
SLIT provides several advantages and disadvantages when compared to OIT (Oral Immunotherapy)
Advantages:
- Safety – There is a low risk for serious, “whole body” allergic reactions (i.e. anaphylaxis)
- Convenience – SLIT does not require the same duration of rest time following doses (1 hour compared to 2 hours).
- Administration – Doses are lower in volume compared to OIT, which can be more easily administered and tolerated.
- Taste—The glycerin gives the drops a sweet taste, so taste aversion is less of a concern. This can also alleviate the psychological burden of sensing (smell/taste) an allergenic food the patient has been conditioned to avoid.
- Ease and safety make SLIT an attractive alternative to OIT for patients who are highly allergic, those who have struggled with OIT in the past, teens or adult patients.
Disadvantages
- Overall protection – SLIT doses are not increased to a level that would be considered safe for “free eating” of the allergenic food.
- Administration – Doses should be held under the tongue for several minutes, which can be more difficult for younger patient.
How is SLIT given?
Each day, you put the solution under your tongue and hold it there for 1-2 minutes, then swallow. You should not eat or drink anything for at least 5 minutes following administration. There is an activity restriction for 1 hour following administration.
The first doses/increased doses of the solution are administered under supervision in the office.
What kind of allergies can be treated with SLIT?
We treat many of the same kind of food allergies with SLIT that we treat with OIT, including peanut, tree nuts, milk, egg, sesame, soy, wheat, and other foods.
What are the side effects of SLIT?
The most common side effects are itching and mild swelling of the inside of the mouth, area under the tongue, lips and throat, which can last up to 60 minutes. These effects are usually the most noticeable with the first few doses and subside with time (persisting for less time with each day’s treatment and typically resolving within the first week or two weeks).
What can we expect from SLIT appointments?
The desensitization appointments where your doses are initiated/increased will take about 2-3 hours. The patient may not eat or drink during dosing time.
The patient should not take a dose at home on the day they are scheduled for a dose increase or a challenge.
Initial visits and follow-up visits will take about 30-60 minutes.