Sublingual Immunotherapy

Sublingual immunotherapy (SLIT) is a non-injectable method for treating allergies. The FDA has approved only tablet forms of SLIT for ragweed, grass pollen from northern pasture grasses like timothy, and dust mites. To use, the tablet is held under the tongue for a few minutes before swallowing as it dissolves. The frequency of use ranges from three times a week to daily. Over time, the tablets can build your tolerance to the allergens and reduce symptoms. However, long-term treatment for up to three years or more may be necessary for sustained effectiveness. At present, SLIT tablet forms are only available for ragweed and grass pollen.

How Does It Work?

Sublingual immunotherapy (SLIT) induces tolerance to the offending allergens by the same mechanism as SCIT, but the allergens are given orally in a dissolvable tablet.  At this time, there is no known benefit in modifying asthma.  These tablets are available for grass and ragweed pollen and are approved for adults up to 65 years of age and in some cases in children as young as 5 years of age.  The grass tablets do not treat two of our major southern grasses, Bermuda and Bahia.  These tablets are also not helpful for patients with allergies to tree pollen, pet dander, or dust mites. It is not known whether multiple tablets can be taken at the same time.

When Can Immunotherapy Be Helpful?

SLIT is an addition to currently available treatment options for allergic rhinitis and is not a replacement for SCIT.  Allergic rhinitis is a complex disease, and not all patients will benefit from SLIT.  Discuss with your doctor to find out if this therapy is right for you.  Insurance may cover SLIT to some degree.

Risks

The major side effects of SLIT are oral itching, throat irritation, mouth swelling, and ear itching.  Severe life threatening reactions are rare.  The tablets must be taken daily and work best if started 12 weeks before the allergy season.  The first dose must be given in a clinic followed by at least 30 minutes of observation.  An EpiPen must be kept available at all times in the rare case of an allergic reaction.  If several doses of SLIT are missed, the patient must return to clinic to restart the therapy.

Practical Tips For SLIT

  • Tablet should be taken once daily

  • Tablet should be placed under the tongue, NOT chewed or swallowed whole

  • Do not swallow for at least one minute after use

  • Do not brush teeth or eat/drink for 5 minutes after use

  • Have injectable epinephrine (EpiPen, Auvi-Q) available at all times

  • Hold the dose if asthma is unstable/ actively wheezing

  • Contact your doctor if several doses are missed