Sublingual Immunotherapy: Guidance on a Game-Changer in Allergy Treatment

Gary J. Stadtmauer, MD


May 29, 2014

In This Article


Sublingual allergen immunotherapy (SLIT) is now FDA approved and commercially available in the United States for treatment of respiratory allergy to Timothy grass and ragweed. This is a milestone event in the management of allergic respiratory disease, presenting more options for treatment. But SLIT also poses challenges for the physicians who treat these allergies.

This article will address what SLIT means for patients, primary care physicians, and allergists.

For Patients

For patients, this is only good news. SLIT is ideal for those who would never agree to subcutaneous immunotherapy (SCIT; also known as allergy injections) because of travel schedules, needle phobia, or brevity of seasonal flares. Young children are obvious candidates but so are others who cannot tolerate even minimal symptoms, including singers/actors and outdoor athletes. At the same time, patients will need to keep up with the regimen not only for efficacy but also for safety, and also will need to know when to temporarily stop SLIT (such as during asthma flares).

SLIT Primary Care

SLIT has been around for a long time. It is not quite as effective as SCIT, and although it would seem easier than allergy shots, many patients still do not stick to the regimen. As with SCIT, SLIT is only effective if the appropriate allergens are administered. For example, while Grastek® may hyposensitize patients to Timothy grass and related grasses, it does not crossreact with Bermuda grass. Knowledge of patient sensitivities and exposures, then, is vital.

The therapy must be started a few months before allergy season, when patients are not yet symptomatic, and it also may cause discomfort (oral or gastrointestinal). It's very important to keep in mind that this is not a drug; it's an allergen and may induce anaphylaxis. While a patient might think of this as a regular prescription medication, you would never want to just "renew" the drug the way you might an antihistamine. As you read on, you will see that immunotherapy requires careful screening and monitoring.


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