More research of SLIT and food allergies needs to be conducted, added Dr. Cox. Some research has shown that SLIT can desensitize patients to hazelnut allergies, and plans for a sublingual peanut study have begun. “That would be a useful tool to have,” she explained.
Explore This IssueAugust 2006
Organizations such as the AAAAI, ACAAI, and the American Academy of Otolaryngic Allergy (AAOA) need to craft some practice guidelines for SLIT once FDA approval occurs, said Dr. Cox. “SLIT is a home therapy, so allergists need to know what kind of instructions to provide the patient,” she said.
Despite these challenges, SLIT holds potential for several patient populations. “We have a vast number of allergic individuals who are not receiving treatment,” said Dr. Cox.
I think sublingual immunotherapy is going to fill an unmet need.” – —Linda Cox, MD
For example, physicians generally aren’t treating children younger than age five for allergies, said Dr. Cox, adding that the 2003 allergen immunotherapy practice parameters recommend careful consideration in this age group (Ann Allergy Asthma Immunol. 2003;90(1 Suppl 1):1–40). Young children may not be able to report they are having a shot reaction and may not have the pulmonary reserves necessary if they have an asthmatic reaction, explained Dr. Cox.
However, some evidence indicates that that allergists and immunologists need to be intervening early to prevent the march from allergic rhinitis to asthma. In Europe, three studies have found that treatment of children with SLIT is reasonable and does not result in anaphylaxis or respiratory reactions, although gastrointestinal side effects such as abdominal pain and diarrhea may occur, said Dr. Cox.
Patients who do not have time to undergo SCIT may also benefit from SLIT, said Dr. Cox. A large deterrent for many people who are candidates for subcutaneous immunotherapy is the amount of time required for treatment, said Dr. Cox. “It takes a good hour to hour and a half by the time patients drive to the doctor’s office and get their shots,” she said.
“I think that the acceptance by the public is likely to be great,” said Dr. Marple. This would drive the demand for this form of therapy in appropriately selected patients. How this will impact SCIT remains to be seen, he said. “One should perhaps assume that clear-cut indications for SLIT and SCIT may emerge based upon treatment outcome data.”
Injection therapy will continue to be used, said Dr. Cox, adding that monthly injections of SCIT are less costly than the daily dosing of SLIT.