Sublingual Immunotherapy (SLIT) Allergy Treatment
It goes without saying that the food allergy community loves a good acronym—OFC (oral food challenge), IgE (immunoglobulin E), GF (gluten-free), and OIT (oral immunotherapy), to name a few! 😉
Today we’re digging into a relatively new acronym that’s quickly gaining popularity: SLIT (or sublingual immunotherapy). This one is of personal interest to me because my daughter recently started SLIT drops for her seasonal allergies after years of navigating the stress and pain of weekly allergy shots.
What is SLIT?
Sublingual immunotherapy is a fairly new way to treat allergies. The medication is delivered sublingually (under the tongue) with tablets or drops instead of subcutaneously (under the skin) via allergy shots, which has been the traditional delivery method. SLIT shares the same medical objective as other immunotherapy approaches: eventual tolerance and symptom reduction.
What does SLIT treatment entail?
After your allergist confirms your allergies or sensitivities with either a skin prick or blood test (or both), you’ll be prescribed a SLIT allergen extract that will come in the form of a pill or liquid drops. You’ll then be instructed to place the extract under your tongue for one to two minutes before swallowing. Bonus: this treatment can be done at home!
What is the cost?
SLIT tablets have been approved by the FDA and are covered by most insurance plans. SLIT drops are not, so prepare to pay a steeper price if you go with drops.
Tablets or drops—which is better?
There is no right or wrong answer. Currently, tablets can only be used for the following airborne allergens: house dust mites, grasses, and short ragweed pollen. Allergy drops, similar to allergy injections, offer a broader range of airborne allergens and are more customizable for each patient. For example, on top of the allergens mentioned above, drops can also treat for trees, cats and dogs, molds, and feathers. But again, drops are not currently covered by insurance! 💵
How often is SLIT treatment recommended?
Depending on your doctor’s preference and your body’s specific needs, SLIT may be performed daily or a few days each week. Sometimes treatment is specifically recommended before and/or during peak allergy season. Similar to allergy injections, the treatment plan can last multiple years to achieve peak and lasting immunity.
How safe is sublingual immunotherapy?
Most clinical trials and surveys published over the past several years show SLIT is relatively safe and effective for the treatment of a variety of airborne allergens. Evidence is also emerging that shows SLIT may be effective for treating hay fever, eczema, and food allergies. As with any medical treatment, it’s important to seek guidance from your physician on the treatment protocol and how to manage any adverse reactions in case they occur.
Are there any side effects or risks?
Reported side effects to SLIT tablets or drops are generally mild and usually occur right after administering the dose. Side effects may include swelling, itching, or stomach issues. They can usually be managed by adjusting the dosage. Severe allergic reactions are rare.
It’s important to keep in mind patient compliance is key with SLIT since it’s administered at home. Also, patience is key! The treatment may not work immediately, as it can take a few months to build a tolerance to airborne allergens and years to receive the full benefit.
How do I know if I’m a candidate for SLIT?
It’s always a good idea to start with a conversation with your provider. That said, there are a few scenarios where SLIT is not recommended, including if you have:
Eosinophilic esophagitis (EoE)
Acute asthma
A sensitivity/allergy to the inactive ingredients in the tablets or drops
A history of severe reactions to SLIT
In my experience, there are always benefits AND risks to weigh when considering any allergy-related treatment. Though I will say, SLIT has been very easy to work into my busy pre-teen’s schedule—no downtime after administering drops has been a plus!
Have you tried SLIT for managing allergies? What’s been your experience?
— Meg and the Amulet Team
These questions and their corresponding responses were written by the Amulet team and reviewed by Amulet advisors, Dr. Jordan Scott and Dr. John Lee.
Dr. Scott is an allergist/immunologist and operates several private allergy clinics throughout the Boston area. He is the past president of the Massachusetts Allergy and Asthma Society. Dr. Scott is an allergy/immunology instructor at the University of Massachusetts.
Dr. Lee is the clinical director of the food allergy program at Boston Children’s Hospital. Dr. Lee is widely recognized for his work in food allergy and his commitment to patient health.