The primary treatment of food allergy is avoidance, but it can become extremely difficult to do. Many of my patients have allergies to multiple common foods such as dairy, egg, yeast and peanuts. It is very challenging to avoid these foods if traveling or eating at restaurants or other’s homes. If these reactive foods are eaten inadvertently, a reoccurrence of heightened symptoms can occur which can be very bothersome. Luckily, there is another treatment for food allergy and sensitivity which can be very helpful. This treatment is SLIT, which stands for sublingual (under the tongue) immunotherapy.
SLIT – Sublingual Immunotherapy
Unlike most allergy drugs – which only treat symptoms – sublingual immunotherapy (SLIT) addresses the underlying causes of allergies. Allergy drops are administered in gradually increasing dosages until the patient develops a tolerance to the allergy-causing substance.
Allergy drop treatment does work similar to an allergy shot for treating inhalant or environmental allergies such as ragweed, pollen or animal dander. It works by delivering a slowly increasing dose of physician-prescribed antigen that over time builds the body’s tolerance. The difference is that the drops are placed under the tongue and affect the immune system through very specialized cells found under the tongue. Research shows these cells are a friendlier and effective route for long-term tolerance, making it an ideal option for patients who are not candidates for inhalant, or environmental allergy shots. Food allergies are not treated with allergy shots, and currently SLIT is the only treatment other than avoidance. Most patients take allergy drops each day for three to five years.
Drops tend to be more convenient, as frequent visits to the clinic are not necessary, and it’s a bit easier for children to handle. Children, beginning in infancy can be treated with allergy drops. Because sublingual therapies use carefully measured frequent doses to treat allergic conditions effectively, they are able to treat children early on, and this enables them to treat the root cause of the allergy before it develops into other related conditions.
For food allergies as well as mold and other environmental allergies, there has not been very much available to sufferers until now, and clinical evidence has shown that even the most sensitive patients can tolerate allergy drops, and more research is currently underway to validate more than 35 years of positive results with SLIT allergy drop treatment.
How Do We Begin Patients on SLIT?
The first step is to perform your IgG and IgE blood antibody tests to determine what you are allergic and reacting to. Dr. Cederquist formulates the prescription for SLIT is based on these results. The antigens (allergic foods) are placed into a dilution with glycerin and ‘allergy drops’ are created. Foods that cause a stronger antibody reaction are dosed at a low level and foods that cause a weaker antibody reaction are dosed at a stronger dilution. The drops are dispensed from a bottle with a pump that dispenses three drops per depression of the pump. The drops are dispensed sublingually, under the tongue. The drops have a pleasant sweet taste from the glycerin. After dispensing the drops under the tongue, hold them there for twenty seconds and then swallow. Ideally, the drops should be taken twenty minutes before eating and three times daily. For school children, it is easiest for the drops to be given before school, after school and before dinner or bed so that the bottle does not need to be transported to school.
The drops are usually very well-tolerated and most people have few or no adverse effects. To start, the drops should be dispensed as one drop a day for a few days, then increase to two drops per day and then proceed to three drops per day. If itching around the mouth develops, decrease the dosing back to twice or once daily and take a longer time to increase the dosage up to the three drops a day. Occasionally, a very allergic person will have an aggravation of their prior symptoms, like diarrhea, when they progress the drops to three doses per day. Decreasing to a less frequent dosing usually will stop these symptoms and after a period of several days, an attempt to increase the dosing frequency can be tried again.
After three months, the dose of the drop is increased and all the antigens are increased in the dilution until they are all at the highest dose. The more allergic foods will take several months to get to this maintenance point but the weaker antigens may move into this range in just three to six months. Once the antigens are all at the maintenance level, the treatment continues at that dosage. Ideally, the allergy drops are used for three to five years in order to build a tolerance to the allergic foods. The drops work by affecting the branch of the immune system that down regulates the hyper response of the body to an allergen. People who do not have allergies naturally down regulate some of their inflammatory cells when there are high antigen loads present. The allergic person does not down regulate the inflammatory immune system and reacts to many types of non-threatening substances such as foods and pollens. The SLIT works on this part of the immune system to bring it into a more normal, non-inflamed balance.
It is important to remember that the main treatment of all allergies is still to largely avoid the substance. If you use SLIT for food allergy, you should not eat large quantities of allergenic foods. It is best to get into a habit of rotating foods and eating a large variety of different foods to keep allergies at bay.
Importantly, Dr. Cederquist does not use antigens to wheat or other gluten containing foods in the immunotherapy for her patients. It is her theory that gluten is a unique food substance which is highly inflammatory to the immune system and may be the underlying cause of food allergy in some people.
To learn more about food allergy testing, please call our office at 239-288-2789.