Sublingual immunotherapy highly effective for chronic allergy and asthma sufferers

Published on October 5, 2012 at 1:48 AM · 3 Comments

Could it be that those with allergic rhinitis (hay fever) and childhood nasal allergies can finally get a break from their allergies and their allergy shots? Chicago's leading allergy, asthma, and immunology expert, Dr. Brian Rotskoff, who treats a large number of Chicago pediatric allergy patients, is happy to say, "Yes!"

Sublingual immunotherapy (SLIT) is a highly effective, easy-to-administer option for chronic allergy and asthma sufferers. Dr. Rotskoff of Clarity Allergy Center, is one of very few Chicago allergists to offer children and adults the allergy drops/allergy shots option.

What Are Allergy Drops?

Sublingual immunotherapy is simply a less invasive way of administering the very same antigen formulas used in allergy shots (subcutaneous immunotherapy) for nearly a century. "Allergy shots work well but let's face it, no one enjoys getting a shot every week, especially not children. And the weekly schedule commitment can be a challenge for parents and busy professionals," says Dr. Rotskoff.

How Does Sublingual Immunotherapy Work?

After comprehensive allergy skin testing, Dr. Rotskoff prepares a custom antigen blend for each patient. The allergy solution is then administered daily, in the comfort of the patient's home, in the form of drops placed under the tongue. No more shots, no more weekly trips to the doctor.

Just like with allergy shots, SLIT works by exposing the patient to gradually increasing quantities of their allergens to build tolerance and desensitize the immune system. Dosage increases during the escalation phase and then stabilizes for a maintenance phase of about three to five years.

Why Allergy Drops?

While relatively new in the U.S., allergy drops are widely used in Europe and are proven to achieve lasting results in the majority of patients. Further, they can significantly reduce the development of childhood asthma up to 7 years after treatment.

Beyond the obvious appeal of pain-free allergy treatment, allergy drops help patients in a number of ways:

  • Convenient, at-home application
  • Significantly more child-friendly and safe for young children
  • More cost-effective maintenance regimen
  • Reduces need for oral allergy medication
  • Successfully treats broader range of allergies and prevents new allergies
  • Achieves long-term alteration of the body's immune response to allergens
  • Improves asthma control and can prevent asthma from developing
  • Proven effective in reducing childhood asthma, chronic ear infections, and eczema

"Allergy drops significantly improve quality of life for my patients," adds Dr. Rotskoff, "their allergies are controlled just as effectively as with allergy shots, in a much more convenient and comfortable way." Dr. Rotskoff checks in with his SLIT patients every six months to monitor progress, more frequently during the escalation phase.

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Comments
  1. Susan Raschal Susan Raschal United States says:

    The Journal of Allergy 2006 reveals a 50% chance of asthma prevention in severely allergic patients who are treated with subcutaneous immunotherapy, but am not aware of any studies that reveal prevention of asthma with SLIT as your recent post stated.  Please share those references. Thank you.
    Susan Raschal DO sssociate professor and  board certified allergist practicing allergy and immunology in Chattanooga,TN.

  2. Phil Phil United States says:

    Here is a study that compares rates of sensitization to new environmental allergens in the control group vs. the SLIT group.   All control group subjects had at least one new sensitization vs.  an approximate sensitization rate of about 15% in the SLIT group.  Methacholine sensitivity also decreased in the SLIT group.  It did not mention the prevention of asthma in this study.  But to be fair- one small study for SCIT does not really prove anything either.  Yet everyone quotes that study.   So it does appear there is significant immunologic benefit.  

    www.mdconsult.com/.../1.html

    Here is another study that looks at long term remission rates in those on long term SLIT.  There did appear to be successful long term remission after discontinuing SLIT- again supporting long term immune modulation.  It did not comment on preventing asthma.  Unfortunately the studies will take a long time to conduct.  It is not a promise I would make to patients but more of a possibility.  And I think it is a reasonable possibility given the long term impact on new environmental sensitivities and long term remission.  

    I think there is a bias in the information that is reported on SCIT vs. SLIT.  As an example- i don't think there are any real great studies looking at SCIT and polysensitization.  Yet almost every allergist uses large numbers of allergens in their immunotherapy vials.  But not once will you read about academic allergists mentioning that short coming in the SCIT literature.  Yet they are very quick to point that out about SLIT.  So I think we all need to be fair and balanced.  So if you are telling your SCIT patients that IT with multiple allergens has been shown to be clinically effective, that is not really true.  Yet we all know that there is significant clinical benefit when selecting the right patients and using the right dose of IT.  
      Durham SR, Emminger W, Kapp A, et al. SQ-standardized sublingual grass & immunotherapy: confirmation of disease modification 2 years after 3 years of treatment in a randomized trial. J Allergy Clin Immunol 2012; 129:717–
    725.

  3. Brian Brian United States says:

    Susan,

    Thanks for your interest in the article on sublingual immunotherapy.  

    The preventative effect of sublingual immunotherapy (SLIT) on the onset of asthma in children with allergic rhinitis  was shown in a study by Novembre et al- they followed 153 children with allergic rhinitis due grass pollen for 3 years.  After 3 years, 45 children in the active group and 44 children in the control group were evaluated for the presence of asthma.  8/45 children in the SLIT group had developed asthma compared with 18/44 in the control group (P < 0.01).   (Novembre E et al. JACI 2004; 114: 851-859).  

    Another study looking at the long-lasting benefit of SLIT was an open, controlled study involving more than 500 adult and adolescent patients.  The onset of new sensitization after 3 years was 5.9% in the active group and 38% in the control group (P > 0.01).  (Marogna M, Allergy 2004; 59: 1205-1210).  

    A third study by the same author (Marogna) showed that new sensitizations were found in 100% of the control subjects but in the different  SLIT groups, new sensitization rates ranged from 11.7% - 21.4%.  (Marogna, JACI 2010; 126 (5): 969- 975).

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News-Medical.Net.
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