Sublingual Immunotherapy May Be Safer Than Allergy Shots

Though SLIT doesn't have FDA approval, it IS and HAS BEEN available in the US for quite some time. It's simply an off-label treatment. Off-label treatment isn't uncommon.

There's plenty of research to validate SLIT's effectiveness, though much of it hasn't been done in the US (though much of it has been done by the same people who are recognized researchers for injection immunotherapy). Fortunately, that's finally changing, and studies are underway in the US.

Several of my family members, as well as friends, have benefitted from SLIT after getting no relief from other treatments. I would hope that the resistance to this treatment will begin to dissipate as more of the US studies are complete. With allergies and related asthma on the rise, as well as healthcare costs, it's time to look for options. It's unfortunate that so many people continue to suffer in the meantime.

The literature supporting allergy drops is very impressive. There are more than 400 citations in Pub Med including 100 double blind studies and four meta-analysis. That sublingual immunotherapy works and is safe and cost effective is undeniable. There are important benefits such as a four-fold decrease in asthma as reported by Novembre et al.  There is no medication that can do this. Sublingual immunotherapy has equivalent efficacy to injection therapy yet is safer, has better compliance and costs less. 

The limitation on the use of sublingual immunotherapy is a lack of expertise. Tucker et al reported that less than 6% of Allergists have any experience with this form of immunotherapy. There are more ENTs prescribing allergy drops than Allergists and this gap in expertise will continue to grow. The Allergist's approach of prescribing medications as first line treatment rather than prescribing a safe form of immunotherapy means that patients will go where they can get help.

Having citations on Pub Med doesn't necessarily validate this approach. Many banned and controversial treatments have citations on Pub Med. One famous example would be hormone replacement therapy in post menopausal women which is no longer endorsed due to its cardiovascular risks. Furthermore, research journals and publications vary in regards to its credibility. There are literrally hundreds of journals available and getting published is not a difficult task which is why only a select number of respected peer reviewed journals such as the New England Journal of Medicine and the Journal of the American Medical Association are the most strict in regards to accepting research for publication. Thus far, there have not been any good studies in these two journals advocating sublingual immunotherapy. In short, the two most respected medical journals have no well designed randomized double blind studies proving its efficacy which is why the FDA has yet to approve of this method.

In addition, the people advocating this therapy are primary care physicians, ENT etc. These physicians are not trained nor have experience managing FDA approved allergy shots and thus have incentive to provide this treatment as it is quick and can be an easy money maker for them. Unlike board certified Allergy/Immunology physicians, these doctors did not complete a fellowship in the field of Allergy Immunology nor did they pass a rigorous board examination to become licensed in this field. Patients are certainly free to choose to undergo sublingual immunotherapy however, they should be properly informed of all the facts.