Environmental and Food Sublingual Immunotherapy (SLIT Allergy Drops)
A simple, safe, and effective form of allergy treatment
Immunotherapy is currently the only medical intervention that has the potential to change your natural course of allergic disease. There are a few types of immunotherapy currently available, and each has pros and cons. Dr. Schroeder has a special interest in working on the core of the immune system to attempt to enact changes in allergic conditions at the root cause level, and she has worked with and examined different available forms of immunotherapy. Based on her findings, Allergenuity Health has purposefully chosen to provide comprehensive liquid-antigen Sublingual Immunotherapy treatment (SLIT allergy drops) as our primary form of immunotherapy, because it is the safest and most adaptable type of immunotherapy currently available, both research and clinical evidence support its efficacy in making positive changes in the immune system and reducing chronic medication use, and it can be used to help anyone, of all ages (and even during pregnancy), with a wide variety of environmental or food sensitivity related issues.
Liquid antigen SLIT is provided by carefully choosing doses of appropriate allergens to present to your immune system via droplets placed in the sublingual (under the tongue) area of the mouth. The process uses special “messenger” immune cells in the mouth called oral Langerhans cells to capture the allergens in your treatment drops and provide tolerance-promoting signals to the “decision-making” part (T and B cells) of your immune system. These oral Langerhans cells are a key difference between SLIT and other types of immunotherapy, because they are uniquely primed to suggest tolerance of substances they encounter, rather than an attack, presumably because they are the primary initial immune-system contact for our body’s vital nourishment substances – food and water. If these oral Langerhans cells were generally primed to promote attack signals instead, we would not be able to survive. Therefore, the sublingual method of immunotherapy treatment harnesses the natural purpose of this very special type of tolerance-promoting cell in order to attempt to train or retrain your entire immune system regarding other harmless substances that it should tolerate – allergens.
Just as a meal at one restaurant may be nothing like a meal with the same name at another restaurant, not all SLIT treatment is created equally either. If you are considering SLIT treatment for yourself or your child from a provider or a company offering SLIT services, it is important to learn the details about the options you are considering including who is actually formulating your SLIT treatment plan and what type of experience and skill with SLIT this person has, so that you can evaluate for quality and make an informed choice about what to pursue.
At Allergenuity Health, we want to provide you with the highest quality SLIT treatment program we can imagine and create. Your SLIT treatment with us will be personalized to your specific health conditions and goals and will not be based solely off of test results (because they are inadequate to properly diagnose allergies alone). You will have the options of SLIT treatment for environmental allergens, food allergens, or both. Your SLIT treatment plan will be designed and personally managed by Dr. Schroeder, a board-certified allergist with extensive experience in multi-allergen SLIT and a personal interest in innovation and creative immunotherapy methods to best fit your goals. You will work directly with Dr. Schroeder for your overall allergy care and your SLIT treatment, and your SLIT treatment bottles will be prepared right here at Allergenuity Health (not sourced to an outside company). If you have any questions at any time, we are more than happy to answer them. We want you to understand the nuances of treatment as fully as you may desire.
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Having allergies or being prone to allergic disease is a chronic, life-long medical condition
Allergic disease can flare, can be out of control, can be well-controlled under active treatment, or can be in a state of “remission” where you’re not actively treating it and may feel as if you don’t even have it. As of yet, there is no 100% cure to make a person 100% incapable of ever having allergy symptoms again. However, there are some strategies such as immunotherapy that can be used to get your allergic conditions under good control or sometimes even into a state of remission such that you can enjoy your life without feeling like your allergic conditions significantly prohibit you or limit your activities and relationships. If allergies significantly impact your life, it is probably worth looking into which immunotherapy option may be right for you.
Sublingual immunotherapy (SLIT) is a safe treatment option by which you and your allergist can work together to train your immune system over time to be more tolerant of your allergens
SLIT treatment engages unique, tolerance-promoting immune cells underneath the tongue (the “sublingual” space) to influence and train the immune system to be tolerant of allergens and enter a generally calmer state of operation. SLIT treatment at Allergenuity Health is performed using liquid allergen drops that you place under your tongue typically 2-3 times per day. This type of SLIT treatment has been shown in both research and clinical studies to have less frequent severe allergic reactions from a treatment dose than allergy shots, oral immunotherapy (OIT), and SLIT tablets. It is not necessary to have epinephrine readily available to take your SLIT treatment dose given the great safety record, and typically there is no need for an extensive rest period required after each dose. After your initial evaluation, your personalized treatment plan will be designed, and Dr. Schroeder will review the specifics with you about your dosing schedule and treatment regimen.
SLIT has been shown to reduce the development of new allergies over time and to prevent or reduce the further progression of allergic diseases in all ages
Immunotherapy is currently the only medical intervention that can potentially change your natural course of allergic disease. In young children, a common progression of allergic disease is called the “atopic march” – typically beginning with the development of eczema, then food allergies, then “hayfever” or allergic rhinitis, and then asthma. SLIT treatment offers the earliest and safest mode of intervention to attempt to train a young child’s immune system to follow a different course with potentially dramatically better long-term outcomes.
SLIT treatment helps reduce medication use
Allergy medications can help provide much needed allergy symptom relief. However, most allergy medications work on superficially stopping allergy symptoms, not changing core immune system factors to help minimize your ability to have allergic reactions in the first place. This is sort of like simply putting a bandage on an injury instead of also figuring out how and why it happened and trying to prevent it from happening again in the future. Sometimes, medications are all that is needed to provide allergy relief, but other times, even maximum medication treatment cannot provide adequate control.
SLIT works within the core immune mechanisms that set up the infrastructure and pathways that cause your allergic reactions and chronic allergic disease. As the SLIT treatment begins to influence change deep within your immune system, better symptom relief and symptom control is achieved, and you will often find that you need less medication to achieve or maintain control of your allergic conditions than you did before.
Good candidates for SLIT treatment include people with known allergies or sensitivities, chronic allergic and inflammatory conditions, or known risk factors for developing allergies (such as a child with strong family history of allergies)
SLIT can be an extremely helpful part of the treatment for many chronic allergic and inflammatory conditions including eczema (atopic dermatitis), asthma, allergic rhinitis (hayfever), chronic sinusitis, recurrent sinus infections, allergic conjunctivitis (swollen, itchy eyes), hives (urticarial), food allergy reactions, a history of anaphylaxis, stomach aches, fatigue, headaches, joint inflammation, and more.
Children with known risk factors for potentially developing allergies (such as a strong family history of allergies) could also theoretically benefit from early training and guidance of their immune system towards choosing tolerance of allergens before it gets too far off track.
Whether or not to pursue a SLIT treatment option depends on a combination of personal factors involving the details of your allergic history, your risk factors, and your specific goals. SLIT is a fantastic treatment tool for a very large number of allergic people. At Allergenuity Health, one of our goals is to match you with the right type of treatment for your specific health situations and goals, so we will discuss all your options and help you determine whether or not SLIT treatment is the best choice for you.
Taking your SLIT allergy drops from Allergenuity Health is easy
No frequent need to be at the doctor’s office (though we would love to say hi anytime you want to drop by)!
Taking your SLIT allergy drops is easy and you can do the majority of your treatment at home.
To take your SLIT treatment, open your mouth and lift up your tongue, and then fully depress the pump on your bottle to dispense your liquid allergens into your sublingual (under the tongue) space. If done correctly, you will notice a slightly sweet taste. Keep your tongue slightly up and let the liquid allergens rest in that spot for 2 minutes without swallowing in order to allow the immune cells in the sublingual area to notice and pick up the allergens from your treatment. (A decent amount of the allergens may be picked up within the first 30 seconds, so consider that the minimum but 2 minutes the goal.) When you’re done, swallow your saliva whatever is remaining of the allergen unless advised by Dr. Schroeder otherwise, and go about with your day until your next dose.
Infants or young children may not be able to achieve this technique perfectly, but that is no reason to worry or hold off on treatment if appropriate. Dr. Schroeder will discuss alternate ways in which the allergy drops can be administered to little ones and still be effective at your appointment.
Our SLIT treatment is a specialized, off-label use of FDA-approved and regulated commercial antigens
The antigens we purchase for use in testing and treatment are regulated for quality and safety. The antigens are prepared by the supplier companies by the strategic collection of the individual source material (specific pollen, food, animal allergen, venom, etc), a purification process, and then suspension in a liquid solution containing components to stabilize the antigenic proteins and prevent microbial growth.
For more detailed information on the FDA and SLIT, please see our FAQ: “What is the current situation with FDA approval and Sublingual Immunotherapy?”
SLIT allergy drops treatment is effective for many patient goals and is safer than allergy shots, oral immunotherapy (OIT), and SLIT tablets
One of the many benefits of using liquid allergen for dosing is that our SLIT treatment doses can be adjusted to the right dose for each individual patient, making this an extremely safe form of controlled allergen exposure treatment. SLIT allergy drops have been shown in studies to result in less frequent severe reactions with up-dosing than all other forms of immunotherapy. Most importantly, epinephrine has not typically been required for adverse effects upon SLIT allergy drops dosing.
Like with any form of immunotherapy, there are still risks to be aware of since an integral part of the treatment is exposures to your allergens. A discussion of the risks and benefits of this treatment and how they may relate specifically to your personal situation should always be had with before starting.
The most common overall side effects of SLIT allergy drops are mild local reactions in the mouth such as tingling, a sensation of warmth, or itching
Most patients’ experience with sublingual immunotherapy (SLIT) drops is that they are easy to take and without side effects. However, like any treatment, there is a potential for adverse effects in certain circumstances, and it is important to be able to recognize them and know what to do. The mild oral side effect symptoms (tingling, warmth, itching, etc) occur more often during the beginning of your treatment program or just after a dose increase, and they tend to resolve within a couple minutes of a dose and stop occurring altogether within a few days or a week. For these symptoms, no medical intervention or dose adjustment is typically needed.
Other adverse effects can occur but are more rare, and these can in theory be any type of allergic reaction since with immunotherapy treatment comes exposure to your allergens (albeit in a highly controlled way). Sneezing, increased mucus production in the nose and mouth, asthma symptoms, hives, or a stomach ache have occasionally been reported in studies. Anaphylaxis is not a typical adverse effect concern with SLIT allergy drops, especially when the treatment plan is designed by an allergist with expertise in SLIT specifically and when using a long-term treatment plan rather than a rush treatment plan.
Improvement in chronic, allergen-related symptoms is typically seen within the first year
For some individuals, signs of some improvement in symptoms from SLIT treatment can be apparent as quickly as within the first few months. However, it may take several months or closer to a year in others – so it is important to not be discouraged if quick changes are not seen and to hang in there to allow the process to have enough time to get started. The immune system needs time to make changes to its intricate, allergen-attacking infrastructure, and this amount of time varies based on many factors that differ among individuals so it is hard to exactly predict. Continued gradual improvement will occur over the next several months to years until you are feeling overall quite well compared to your starting point.
Your results on SLIT treatment will depend on several factors, some controllable, others not
The main factors that will influence your results include your personal allergic history, your specific allergens and their unique properties, the complexity of your entire immunologic load, your overall health, lifestyle and dietary exposures, the design of your immunotherapy program, your compliance with your treatment program doses and recommendations, the length of time you spend on treatment, and some factors internal to your immune system that we cannot test for or evaluate ahead of time.
Some of these factors are under our control and your control, and others are not. At Allergenuity Health, you can be assured that your SLIT program is designed and managed directly by Dr. Schroeder, a board-certified allergist with experience in utilizing SLIT to enact immunologic change, not an outside company that generically formulates your treatment or an inexperienced provider. With your active participation in the treatment regimen designed specifically for you, you are sure to see some form of positive results. In the rare case that your immune system is resistant to this form of retraining (which can happen), we will be able to tell within the first 12-18 months that something is not working right and can discuss the appropriate next options for you to try, either with us or available elsewhere.
Research and clinical data has shown that long-term immunotherapy treatment (including SLIT) tends to provide a better opportunity for sustained benefit off of the treatment for some time
Studies have shown that after 3-5 years of treatment with environmental allergen immunotherapy (either allergy shots or sublingual immunotherapy), a decent percentage of people are able to stop their immunotherapy treatment (if desired) and maintain their results of improved symptom relief and allergen tolerance while off treatment for some time – possibly years. This sustained allergen tolerance suggests that the immune system has been deeply modified and re-trained by the immunotherapy treatment. Some good quality studies looking into this deeper suggest that immunotherapy treatment for 4-5+ years can lead to longer persistent results off of treatment than immunotherapy for 3 or less years.
Restarting another course of treatment if needed down the road, due to a change in environment or return of symptoms, can often even more quickly bring your immune system and allergy symptoms back under good control than the first treatment course. Many who tolerated being off the treatment before for several years can often cycle on and off the treatment again after another course, enjoying more years of sustained benefit. For those who notice benefit while actively on their SLIT treatment but do not have a sustained tolerance after stopping the treatment (often due to other immune-related or environmental factors that cannot be changed), there is always the option of safely remaining on the treatment longer and then trying off again, or remaining on the treatment indefinitely to continue to maintain this degree of control.
Less has been formally studied about food allergy SLIT in terms of sustained tolerance off of treatment, but it makes sense that there would be some similarities to the results of environmental allergy SLIT in terms of the possibility of persistent allergen tolerance off of SLIT treatment. It also makes sense that there could be potential key differences, especially depending on the molecular properties of a your specific food allergens, as well as based on other factors like your ingestion patterns. At Allergenuity Health, Dr. Schroeder will discuss with you the likely realistic treatment length scenarios for you specifically, based on your personal allergy history, allergen details, and how your immune system appears to be handling your food SLIT treatment along the way.
Based on these fundamental principles, your SLIT treatment course at Allergenuity Health will likely be designed for 4-5 years (unless you have been on immunotherapy before)
Allergenuity Health long-term SLIT protocols include a build-up phase of 1-3 years and an initial maintenance phase of 1-2 years. Those with less allergens, less severe allergens, less risk factors, less chronic illness, or who have been on some form of immunotherapy before starting on SLIT may be able to tolerate a higher starting dose, quicker buildup phase, and/or shorter maintenance phase. Those with more complex issues may require a more gradual start, slower buildup, and/or longer maintenance phase.
Dr. Schroeder will evaluate your individual factors and your goals and then design a SLIT treatment plan specifically suited to your unique situation. She will actively manage and adjust your treatment course while you are on it should circumstances change or your symptom control and test results suggest adjustments should be made in either direction. Therefore, your course on immunotherapy could be shorter or longer in the end than initially structured, but you will always be informed about why it is being structured a particular way and will have direct input and communication with your allergist on the entire process.
Some people will be able to retain prolonged benefit off of SLIT, while others will need to continue on SLIT in order retain its benefits
Once the immune system is in a more calm and more tolerant state and the infrastructure to easily attack an allergen (or multiple allergens) has been broken down, the choice becomes whether or not to remain on the SLIT treatment that helped get you to this more tolerant state. Unfortunately, there is no “test” that can easily predict if your immune system will be able to hold itself in this state on its own, or if it will need the signals it was getting from your SLIT treatment to maintain this state.
For some people, if enough changes have settled in and if their outside influences (environment, diet, etc) do not seem like they would provide a stimulus that would push the immune system back into attack-mode, a trial off SLIT would be appropriate in order to see how you feel off of treatment. Many people find that they retain some or all of the benefit they were able to build while on their long-term SLIT treatment for a prolonged period of time off of the treatment, especially those treated for environmental allergies. Some may need or desire to do another course on SLIT at some point in the future, whereas others never will.
For other people, their immune system may require the persistent calming influence of the oral Langerhans cells’ signals in order to keep their attack-mode immune infrastructure in check, otherwise it will start to rebuild and reactivate. This can sometimes be the case with certain stubborn food allergens, if certain environmental or dietary aspects cannot be controlled appropriately, or based on other factors unique to the genetics of how your immune system functions. A longer or indefinite course on SLIT may be most beneficial to these individuals and a plan to make this sustainable and affordable can be discussed.
The entire load of stressors on your immune system can affect your allergies, so at Allergenuity Health we aim to reduce this total load via both SLIT and other Integrative Health strategies
You may have noticed that often when you’re sick with a cold, your eczema also flares up. Or you can have milk in your cereal but don’t feel well after drinking a big glass of it. Or in the spring when tree pollen is high, you also seem more allergic to your friend’s cat and need your asthma inhaler when you go visit.
The way your immune system functions at any given time is influenced by numerous factors that are all placing a load on it. These factors include allergen exposures, illnesses, injuries, physical activity, temperature, physical stress, mental stress, lack of sleep, dietary components, and so on. No two moments are exactly the same for your immune system, and your symptoms will reflect the cumulative load on your system at that time as well as the overall state your immune system has been in chronically (activated, overwhelmed, calm, etc).
Attempting to minimize the stressful loads on your immune system as much as possible and keep your immune system in a calm and not overwhelmed state can be very helpful in both allergy symptom relief as well as building allergen tolerance. SLIT treatment can help reduce the load on the immune system over time by building tolerance to your allergens so that your immune system is not as stressed upon future encounters with them. SLIT treatment also helps calm down an immune system by signaling your immune cells to release general immune-calming natural chemicals. At Allergenuity Health, we will help you understand which allergens you should (and can) be treated for in order to best reduce the load on your immune system, as well as what other measures you can take to control both your allergen load and any other stressors on your immune system. Many individuals that show signs of both environmental and food allergies will benefit greatly from treating both types of allergens rather than focusing solely on one or the other for this total-load reason, and the patients who also make the changes needed to control their other immune system stressors will notice even quicker and better results from their SLIT treatment.