A Q&A With an Expert on SCIT and SLIT
I looked for some more answers via email correspondence with Désirée E.S. Larenas Linnemann, MD, who has lectured and published widely on the topic of immunotherapy (both SCIT and SLIT). Here are her responses:
How do you adjust SLIT (or do you withhold it) if a patient has an asthma exacerbation?
Dr. Larenas Linnemann: Just as with SCIT, we withhold, but for a shorter time: We withhold for 3-4 days in case of exacerbation of allergic symptoms [including] marked AR [allergic rhinitis] activation after exposure to allergen or after viral disease, asthma exacerbation, and febrile disease. We then continue with half the dose for 3 days and [then it's] back to normal again. Also, [use] care after [dental visits and] erosions of the oral mucosa. We suspend treatment until [the dental work is] healed to avoid direct absorption [of the therapy] into the circulation.
How do you move a patient from SLIT to SCIT? Do you have a protocol? I imagine a few scenarios, one in which the response to SLIT is partial. In that case, I would imagine that one might be able to fast-track SCIT.
Dr. Larenas Linnemann: For safety reasons, in my clinic, I [start] from square one when switching SLIT to SCIT, [although updosing would] allow me to reach maintenance in the planned 3 months without delay. I do not fast-track.
Is a nonresponder to SLIT also likely to be a nonresponder to SCIT?
Dr. Larenas Linnemann: If a patient does not experience the desired improvement after 12-18 months of SLIT, we suggest changing to SCIT. For the full effect of SLIT to kick in, it does take quite some time in some cases.
Do you ever see exercise-induced anaphylaxis in SLIT patients that you suspect to be related to the immunotherapy?
Dr. Larenas Linnemann: Never had a case, but we do instruct [patients] to avoid strenuous exercise, preferably [for] 1-2 hours after SLIT. So if the [patient goes regularly] to the gym, it's better [to administer] SLIT after [going to] the gym.
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Cite this: Gary Stadtmauer. Sublingual Immunotherapy: Guidance on a Game-Changer in Allergy Treatment - Medscape - May 29, 2014.