Sublingual Immunotherapy for Allergies: Could It Hurt Your Practice Financially?

Gary J. Stadtmauer, MD


May 29, 2014

In This Article

The Business of Allergy: Introduction

With the recent approvals of 2 therapies for Timothy grass allergy and 1 therapy for ragweed allergy, sublingual immunotherapy (SLIT) is now available as an alternative to subcutaneous immunotherapy (SCIT) in the United States.

Of course, this is good news for allergy sufferers. For the allergist, however, it is a more complicated issue. It is clearly a threat to the business of SCIT. But there may also be opportunity, and because we have no choice in the matter, I would encourage allergists to also see this option as a means of further educating patients about immunotherapy in general.

Remember that when omalizumab (Xolair®) was introduced to the market, there were concerns that it would supplant allergen immunotherapy.

This was not the case for many reasons (including cost and inadequate efficacy in allergic rhinitis). Nonetheless, omalizumab is useful; in fact, it has been reported to prevent anaphylaxis during venom immunotherapy and improve safety of rush immunotherapy in asthmatics.[1]

To put some perspective on this newly approved therapy, I've compiled lists of what's promising and what's problematic about SLIT. I've concluded with some other thoughts about SLIT as well as some advice on adding it to your practice.

What's Promising About SLIT?

1. It raises the profile of immunotherapy in general.

2. It may bring new patients into the office, and those patients might ultimately be better candidates for SCIT.

3. Patients who are candidates for oral immunotherapy will require an allergy evaluation. These may be patients who may otherwise not have seen an allergist (and relied on over-the-counter nasal steroids and antihistamines).

4. The patients who are candidates for allergy tablet immunotherapy may be scheduled before spring pollen season, a time when allergists will have more capacity to see patients in their schedules.

5. This gives allergists a legitimate tool to keep patients out of the hands of unscrupulous practitioners who might be offering unapproved, ineffective SLIT.


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