What is Sublingual Immunotherapy?

Sublingual immunotherapy, or SLIT, is a form of immunotherapy that involves putting drops of allergen extracts under the tongue. Many people refer to this process as “allergy drops,” and it is an alternative treatment for allergy shots. This form of immunotherapy has been used for years in Europe, and recently has had increased interest in the United States. However, it is not approved by the Food and Drug Administration (FDA) in the United States.

SLIT is usually delivered one of two ways: drops (or tablets) of allergen extract are placed under the tongue, then either swallowed or spat out. Most studies have looked at swallowing the extract, which seems to work better. Immunotherapy by the oral route (swallowed and not kept under the tongue for any period of time), causes too many gastrointestinal side effects (nausea, vomiting, diarrhea), and therefore is not used.

Generally, SLIT is administered daily, or multiple times per week, over a period of years. Most patients are able to self-administer SLIT at home. Studies have looked at giving SLIT before a pollen season, during a pollen season, both, or year-round. It is not yet known what the best dosing regimen is for SLIT.

How Does SLIT Work?

The immune system of the gastrointestinal tract tends to “tolerate” foreign substances, meaning that it does not respond in an over-active way to swallowed material. This makes sense; otherwise the body would over-react to anything swallowed, including food. When SLIT is administered into the gastrointestinal tract, the immune system tolerates the allergen, instead of the over-reactivity of the immune system, as with allergic disease. This results in less allergy symptoms when the body is exposed to the allergy source, such as airborne pollen or pet dander.

How Well Does SLIT Work?

SLIT appears to be effective in the treatment of allergic rhinitis, allergic conjunctivitis and, to a lesser degree, allergic asthma. While most studies on SLIT do show benefit in the treatment of allergic disease, the results are somewhat inconsistent, with up to one-third of studies showing no benefit over placebo treatment.

What is the Safety of SLIT?

Over the past 10 years, the safety of SLIT has been well documented. Serious and fatal reactions to SLIT have not been reported to date. Mild side effects, such as an itchy mouth, occur in the majority of people, and moderate side effects have been documented (1 in about every 12,000 doses), including:

lip, mouth and tongue irritation
eye itching, redness and swelling
nausea, vomiting, abdominal cramping and diarrhea
sneezing, nasal itching and congestion
asthma symptoms
urticaria and angioedema

Because of the safety of SLIT, people generally treat themselves at home, and are followed in the clinic at close intervals to monitor response to treatment.

Who Could (or Should) Receive SLIT?

People with documented allergic disease (allergic rhinitis, allergic conjunctivitis and/or allergic asthma) by allergy testing may be considered for SLIT. Young children have been shown to tolerate and benefit from SLIT, as have older adults. Pregnant women, as is considered the general rule of thumb for allergy shots, can continue SLIT during pregnancy, but should not start the therapy while pregnant. People with severe asthma may need to be monitored more closely on SLIT, since asthma symptoms can worsen with SLIT.

Most studies on SLIT have focused on people with one type of allergy, such as grass or dust mite allergy. People with multiple allergies, such as to molds, pollens, pet dander and dust mite may not be good candidates for SLIT, given the large volume of different allergen extracts that would need to be taken.

The Advantages of Sublingual Immunotherapy

Excellent safety Profile: The safety profile for SLIT is superior to injection based on research studies and patient treatment experience. Systemic reactions occur 3 times less, and there has never been an anaphylactic reaction (life threatening) recorded over the last 30+ years of sublingual treatment. Studies indicate that sublingual immunotherapy is very effective. The most common side effect you may experience from this procedure is a few minutes of slight tingling or itching in your mouth.

Compliance has not been studied extensively. However, one large managed-care organization did find 50% of patients receiving allergy shots dropped out of therapy during the first year. In looking at sublingual compliance among patients in many of the studies identified previously, approximately 90% of patients complete their treatment.

More convenient, fewer medications: You can take allergy drops anywhere, making it much easier to stick with treatment. Many patients find they need less medication to control their symptoms after beginning allergy drops.

A better quality of life, less school and work absenteeism, better asthma control, less nasal stuffiness, sneezing, itchy eyes, fatigue, and sinus infections.