Sublingual Immunotherapy (SLIT)


What is SLIT?

biological treatment for environmental allergies

Sublingual immunotherapy (SLIT) is a biological treatment for environmental allergies. It is the awesome way to get rid of symptoms without medication. It also is long-lasting treatment working for years after the treatment course.

Allergen immunotherapy allows for the body to become desensitized by exposing the body to small amounts of the allergen and increasing its tolerance to them. SLIT is also an alternative immunotherapy option for people who could not tolerate allergy shots or could not maintain the schedule.

SLIT is placed under the tongue as a liquid drop form daily. This way it trains immune system to become “tolerant” to the proteins (cat, dog, cochroach etc.) that caused the allergy in the first place. Symptoms start going away almost immediately after the person advances to the top dose (usually a month). SLIT is commonly referred to as “allergy drops.”   

How is SLIT made?

SLIT is prepared individually to treat your specific allergies. SLIT treatment serum is an individual prescription with 1-4 allergens mixed in one bottle. There can be up to 4 different bottles made for each person based on their allergens. For example, an Indoor treatment bottle can contain cat, dog and dust mite allergens, An Outdoor Spring bottle may contain grasses mix, birch and juniper extracts, an Outdoor Fall bottle can have ragweed, Russian thistle, sage and Mugwort mix.

We are able to make SLIT for a variety of allergens, including molds and small house pets. There is a homeopathic treatment for patients with severe allergies and asthma who cannot tolerate conventional allergy shots.

Is SLIT a medicine?

not a pharmaceutical treatment

Yes and NO. It is definitely not a pharmaceutical treatment and does not have any chemicals in it. It is not a naturopathic treatment, as it is acknowledged as a conventional allergy treatment in Europe. But it is an absolutely natural treatment that does not have any systemic side effects.

SLIT consists of allergen extracts diluted in glycerin. Glycerin acts as a natural preservative preventing mold and bacteria contamination, and also keeps the serum stable at room temperature.

Can I use SLIT at home?

Yes – it is so safe that this treatment is for a home use. When you receive your first prescription you need to come into the office to be trained how to use it, and to receive the first dose. A physician or medical staff will observe you for 30 min for any reactions. You will get the schedule of doses and explained what the color-coding is. After that – you take off. So, you don’t neet to cancel your vacation to get treatment. Take SLIT with you.

What are the allergy serums?

Allergy serum is a commercial extract made by the immunotherapy companies. We buy only the finest serums that are standardized and FDA approved. There are many serums we keep in stock as common allergens, but we also can order custom serums of uncommon allergies, such as mosquito allergy.

Which of my allergies can be treated with SLIT?

SLIT is known for outstanding result for any environmental allergens. Some people use it to treat food allergies, but there is no good research yet that would prove that such method works. It is interesting, that people who are on SLIT for environment report having much less problems with food allergy and food intolerances. It makes sense, as there is only one immune system that works in the body, so if SLIT improves immune function it will work for all allergic problems.

SLIT can treat all of the following:

  • Outdoor allergies; including grasses, trees and weeds.
  • Molds
  • Indoor allergies; including cat, dog, cockroach and dust mites.
  • Allergic asthma
  • Allergic nose problems (rhinitis or hay fever, sinusitis)
  • Allergic eye problems (conjunctivitis, blepharitis)
  • Allergic skin rashes (eczema, atopic dermatitis)

What are my immunotherapy options?

An old-fashion therapy for allergy is Allergy shots, or subcutaneous immunotherapy (SCIT), is also a common and effective option for people. Allergy shots can help prevent further allergies and reduce inflammation that is caused by allergies. Unfortunately, allergy shots have a rare but severe side effect – anaphylaxis (a systemic allergic reaction that may cause death if not timely treated with epinephrine). That is why Allergy shots require office visits and a patient needs to stay for at least 30 min each time.

Shots need to maintain the action, so they need to be administered once or twice weekly, for quite some time. People must be consistent with treatment dosing and will require “catch up” doses if there is a lapse in treatment. these requirements are harsh in our modern life when each minute is valued. Most of our families cannot afford losing so much time out of their already packed routine, so they opt out of shots and prefer SLIT.

SLIT is based on the same formula as shots treatment, so only the administration is different. It has the same benefits as shots, but allows for dosing flexibility and more individual approach. This treatment is allowing for more independence and flexibility in that you can administer them yourself at home. SLIT also does not need to be refrigerated, so it will not mess up your travel plans. Just take one bottle in your travel bag and continue the treatment without interruptions.

What are the allergen tablets?

The tablets are equivalent to the SLIT drops

The FDA has also approved sublingual tablets for ragweed, grass pollen and dust mites. The tablets are equivalent to the SLIT drops. This administration directly targets the specific allergen and will not prevent the development of new allergies.

At the Allergy & Immunology Clinic of the East Bay, we currently offer allergy shots (SCIT), and allergy drops (SLIT) for allergy treatment.  

Why choose SLIT?

Many people prefer the convenience of SLIT treatment

Many people prefer the convenience of SLIT treatment, with the ability to use the drops at home. This method also requires less office visits with the doctor. SLIT is portable, meaning you can take the drops with you if you are traveling or away from home, without interfering with your dosing schedule. In addition, if treating seasonal allergies the drops are only used for a few months versus allergy shots which are administered year-round.

SLIT is also an incredibly safe option for allergy treatment. SLIT has very few adverse reactions, which are typically localized to the mouth. It is very rare to have a systemic allergic reaction to SLIT, rarer that it is for allergy shots. There is no evidence of life-threatening anaphylactic reactions to SLIT, making it safe to use at home. Side effects, if any, are generally very tolerable leading to better compliance with treatment. In other words, when there are fewer side effects people throughout the research are more likely to use SLIT efficiently versus other immunotherapy options.    

What are the most common side effects when using SLIT?

Dogs as a cause of allergies

When using SLIT there are no side effects at all, and it does not interact with other treatments of conditions. However, mild allergic reactions may happen at high doses of allergen. These are eliminated by mouth washing or eating a piece of a cracker.  Most commonly people report a mild local itching in the mouth. Additional side effects, although extremely rare, may include:

  • Mouth, tongue and lip itching
  • Eye itching and redness
  • Sneezing and nasal itching
  • Hives
  • Stomach ache

These side effects are similar to allergy symptoms and can be easily managed by adjusting your dose in the drops.

Who is a good candidate for SLIT?

children and adults with known allergies symptoms

SLIT can be given to children (ages 2 and up) and adults with known allergies symptoms that affect quality of life, or become systemic (like asthma). You are a good candidate for SLIT when standard treatments such as over the counter antihistamine use had failed to manage your symptoms. There have been good results documented through the research on SLIT uses for children and adults.

If you have difficulty getting to the doctor’s office frequently, if you travel often for leisure or work, or if you have a busy lifestyle and do not want to be bothered with frequent doctors’ appointments, SLIT is a good option for you.

How often do I need to see a doctor when using SLIT?

How often see a doctor

Once you have decided to treat your allergies with SLIT, there will be an initial appointment to pick up your individualized drops. At the initial visit, we will demonstrate how to use the drops and have you demonstrate its proper usage. There will be a follow-up visit 3-6 months later to check in and assess how the SLIT treatment is going. You may return once every 3-6 months from after the dose is established and if the treatment is going well. SLIT can be picked up in the office, and there is an option to have it mailed directly to you with overnight service.

How long do I need to use SLIT until my allergies have improved?

allergy symptom relief

SLIT is used daily for about 3 years in kids and at least for 5 years in adults. There is a wide range of completion time, as this is dependent on the individual and proper use of treatment. The goal of SLIT treatment is free you of your bothersome allergy symptoms and allow your immune system to normalize function as your natural defense system. We are here to support you on your journey to an allergy-free life every step of the way. We can address any questions you many have before, during and after treatment. In addition, we can retest you for specific allergens over time to see the improvement of your treatment. Often people are pleasantly surprised to see their “less reactive” immune system and allergy symptom relief.

References

Use of Sublingual Immunotherapy for Aeroallergens in Children with Asthma J Clin Med. 2020 Oct; 9(10): 3381. Published online 2020 Oct 21. doi: 10.3390/jcm9103381 PMCID: PMC7589061 PMID: 33096894 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7589061/

Li, Yi et al. “Sublingual Immunotherapy Tablets Relieve Symptoms in Adults with Allergic Rhinitis: A Meta-analysis of Randomized Clinical Trials.” Chinese medical journal vol. 131,21 (2018): 2583-2588. doi:10.4103/0366-6999.244108 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213837/

Blanco, Carlos et al. “Sublingual allergen immunotherapy for respiratory allergy: a systematic review.” Drugs in context vol. 7 212552. 5 Nov. 2018, doi:10.7573/dic.212552 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6220898/

Aissa, S et al. “Critical appraisal of the clinical utility of sublingual immunotherapy in allergy.” Contemporary clinical trials communications vol. 4 1-8. 18 Jun. 2016, doi:10.1016/j.conctc.2016.06.002 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5935903/

James, Christine, and David I Bernstein. “Allergen immunotherapy: an updated review of safety.” Current opinion in allergy and clinical immunology vol. 17,1 (2017): 55-59. doi:10.1097/ACI.0000000000000335 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644500/

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