Sublingual Immunotherapy and Oral Immunotherapy: Are WE There Yet?

Dear JAT,

Thank you for your comments. Allergens in Europe are not identical to allergens in the United States. I think there is enough experience with SLIT here (though not FDA approved) to expect similar benefits once many other details (discussed in the article) are worked out. The allergens that are unique to Europe would not be used in SLIT or SCIT in this country.

Many people would choose sublingual treatment over allergy shots if they offered the same benefits. If future clinical trials more consistently show as good or better results from SLIT compared to SCIT, the choice will be clear. We are far away from such a comparison as it stands. The fact that SLIT is not FDA approved is a major issue.

I hope your mom and sister are  in the 80% that respond well to allergy shots.

Again thank you for your comments and questions.

J. Thompson MD

Dr. Daniels,

Thank you for comments. Please visit and share more with us in the future.

J. Thompson, MD

Katie,

Your comments and questions are appreciated. SLIT offers an alternative to allergy shots but has several shortcomings as discussed in the posting. SLIT has been done with both cat and dog allergen in Europe and in the United States (not FDA approved here). Published reports reflect better outcomes with cat desensitization. When SLIT becomes available pet extracts will likely be an option.

Few studies have shown effective desensitization to more than one unrelated allergen (for example grasses and trees, or ragweed, cat and dust mite). One problem is the increased volume of extract required to be placed under the tongue as more allergens are included. A second problem is the escalation of the cost when multiple allergens are involved. There are clinical trials being conducted to address these issues. As you mentioned, allergy shots (SCIT) offer multiple allergen desensitization.

Thanks again for sharing your thoughts,

J. Thompson, MD

Hi Sara,

Sorry I missed your comment months ago. I wonder How you are coming along with your SLIT. I am glad you have responded well. When SLIT becomes FDA approved and more information is available on appropriate and safe doses, I will probably begin treating some of my patients with it as an alternative to shots.

Experts in allergy have estimated SLIT to be about 50% as effective as allergy shots given by a board certified allergist.

Good Luck!

J. Thompson, MD

Hi,

You appear to be another satisfied customer on SLIT. That's good. Those three drops under your tongue sure seem to cover an awful lot of trigger factors. Most well controlled studies on SLIT contain one or only a few allergens because amounts needed are much greater in volume than the quantity typically used in allergy shots.

No good clinical trials have shown favorable results in as high a number of allergens you are getting (I don't think such studies are available).

The important thing is it is working for you. SLIT will likely be approved in the U.S. in the near future. I plan on using it in some patients once approval has been achieved and dose schedules have been published.

Thanks for sharing,

J. Thompson, MD

at what age can kids start the therapy? i have a 4 year old allergic to cats, dogs & mold (peanuts & tree nuts too). how soon is "in the near future" for the FDA approval? we are especially watching the progress of slit study on peanut at duke univ!! can't wait for that one to approve!

Hi Lori,

I probably should have left "near" out of the sentence regarding when SLIT will be approved by the FDA. There are several issues that need to be worked out before approval. I don't know when this will be but support for this method of immunotherapy has markedly grown. The starting age is one of the factors that await establishment.

Stay Tuned,

J. Thompson, MD

I am considering taking SLIT for dust, mites, mold trees and grasses. Are you still having good results?

Dear Kathy

I made it through one of the worst Oak pollen seasons that Florida has had with improvement in my overall sinisuitis and allergies.  I did not realize how bad the season was until I went to my allergist for a regular checkup and she said the only people who were not overly bothered were those on SLIT.  Everyone else has had severe problems.  I also am not at maintenance level, so that says a lot for it.

Hi Suzie,

I appreciate you sharing your experience. I suspect your allergist meant to also include patients on allergy shots (doing better with the season in addition to those on SLIT). People on allergy shots actually do better than those on SLIT (sublingual therapy) according to clinical studies I have reviewed.

SLIT and SCIT (allergy shots) help a lot of people all around the U.S. but SCIT is the only one FDA approved. There are lots more people on SCIT (in America) than SLIT but that may change once a lot of issues have been addressed (discussed in my posting).

I am glad it has worked out for you. SLIT is easier to do and tends to be relatively safe. Of course, when it works, life is better.

Best Wishes!

J. Thompson, MD

My allergist only uses SLIT.  She will not even administer allergy shots to people like my husband who brings along his own syrum  from PA.  So that means that she was comparing SLIT to only antihistimines and regular asthma treatments.  However, my husband on shots had a horrible allergy season and developed a sinus infection.  I on the other hand constantly improved with my cronic sinusitis to the point that there was no visible sinus infection at the end of the season.  I'm sold. The convenience of three drops per day to a drive of twenty miles one way every two weeks for a shot for him is wonderful.  And as far as cost is concerned, we both pay about the same amount for his syrum and my drops.

suzie

Hi again Suzie,

If I had the success with my allergies you have had I would be sold on SLIT too. That is the beauty of medicine. Despite what clinical studies may show in terms of comparisons and outcomes, every individual has their individual experience to bank on.

I will probably offer SLIT to my patients in the future, once it gets FDA approved and more is learned about dose limits and other guidelines. Currently I have a success rate of about 80% with allergy shots (which mirrors clinical reports). This means of course, 20% of my patients won't be helped. But neither SCIT nor SLIT works for everyone.

I suspect your husband's allergies are more severe than yours. I doubt SLIT would do any better for him, but who knows. Maybe one day he may follow your lead.

To Your Health,

J. Thompson, MD

Hi Kathy,

I don't use SLIT in my office. I only utilize SCIT (allergy shots) for ages five and above. There is a much longer history of allergy shot therapy and it is FDA approved. I choose to only practice FDA approved treatments but I know many other doctors, including some allergist have gone to SLIT.

Therefore I cannot comment on effectiveness of SLIT from my own experience (have not done it). But I am closely following the research, and reports on clinical experiences in other practices.

Currently, SLIT is not FDA approved. Yet more people are being treated with it every year in the U.S.

The issues I commented on in my posting remain unsolved.

But as you can see by Suzie's testimonial it can be effective.

If you have an interest in SLIT try to find a board certified allergist that does it.

Good Luck,

J. Thompson, MD

I am considering taking SLIT for dust, mites, mold trees and grasses. Are you still having good results?

Dear Lisa,

Thank you for your question. Your daughter may in fact be going through the "allergic march" based on her eczema and food allergies. I am glad she has been evaluated by an allergy specialist. You did not mention skin testing. Most board certified allergists do skin testing to further confirm allergy triggers. I assume her allergy test to grass was negative. If so, SLIT would not be helpful for her skin problem. Neither SLIT nor allergy shots are indicated for food allergy or eczema.

I think you should have her see a skin specialist (dermatologist). Follow up with your allergist for guidelines on food avoidances (egg etc.). She should be under the care of a board eligible or board certified allergist.

Learn more about the "allergic or atopic march": (click here)

Click here to learn more about eczema: (Eczema)

Good Luck!

J. Thompson, MD

Dr Thompson,

 Thank you for your reply. The confusing part of the eczema is she really only develops it when she is in the grass. She had a skin test done at age 3 and tested positive to grass cats and eggs. She develops a rash with contact to grass and big hives sometimes. She also has allergic shinners,itchy nose and itchy eyes. She also had wheezing problems up to the age of 3. For one summer she had no eczema at all. She was on singular. She just had very terrible sleeping problems and aggressive behavior. So they took her off of it. Our allergist first told me that we needed to re-test her with the skin test because it is more sensitive to aero allergens. Then he said that the rast test would have picked up a grass allergy. The information is just confusing. I made another appointment this week and requested that she be re skin tested. I just am wondering if the grass could cause the eczema? In the winter she does not have a problem. 

Thanks,

Lisa

Hi Lisa,

Hope things are going well for your daughter. Grass allergy may be identified by allergy skin testing or by Rast-IgE blood test. The skin test is considered a little more sensitive than the blood test. Someone very allergic to grass would likely show a positive finding on either test.

Summer eczema may be triggered by grass if there is contact with it. Eczema triggered by the grass pollen in the air (with no direct contact) is less likely.

The good news is, summer is three seasons away now (which is also the bad news).

Best Wishes,

J. Thompson, MD