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Food Allergies

What is the difference between sublingual and oral immunotherapy?

Typically, the amount of antigen given under the tongue (sublingual) is significantly less than the amount used in powder form (oral), mixed with food or drink and swallowed. Perhaps because the area under the tongue is a privileged immunologic site, the safety/side effect profile is better with SLIT. (FAAN newsletter February/March 2010, page 5). www.foodallergy.org

Results are not yet available comparing oral vs. sublingual immunotherapy for peanut. However, February 2010, results were presented at the AAAAI meeting on the first sublingual liquid vs. oral powder immunotherapy trial for milk allergy. All 30 children were started with sublingual immunotherapy. Once minimum tolerance was achieved, they were then divided into two groups. One continued with allergy drops under the tongue, the other group switched to milk powder that was eaten and swallowed. The rate of significant side effects such as hives or asthma that required medication was 13% in the oral immunotherapy group. Less than 1% of the patients in the sublingual immunotherapy group had side effects significant enough to use medication. All 20 children in the oral immunotherapy group were, on average, able to drink seven times more milk without an allergic reaction compared to baseline. Nine out of 10 children treated with sublingual immunotherapy were able to do so.

Studies exploring oral and sublingual immunotherapy for foods are ongoing with additional sites now added, including Johns Hopkins, National Jewish in Denver, Mount Sinai in New York and the University of Arkansas. (NCT00580606). Learn more about sublingual immunotherapy for food allergy clinical trials.

peanut allergyThe most common food allergies are quite common in our diet: eggs, milk, wheat, peanut, soy and corn. Serious allergic reactions are not only seen with these common foods, but also with seafood, fish and tree nuts (almonds, cashews, hazelnuts, pistachios, walnuts, etc.). Often times there is an underlying inhalant allergy, such as dust mite, which primes the immune system to react.

Diagnosing food allergy begins with identifying a history of sensitivity to certain foods. Many people with food allergies will have chronic symptoms such as eczema, stomach upset, congestion and skin itching.

Once diagnosed with food allergies, treatment options range from avoiding the allergens, managing symptoms, to treating the root cause through immunotherapy. The only way to change underlying allergic disease is immunotherapy. Treating food allergies with sublingual immunotherapy begins at a much lower dosing level than the amount that triggers reactions at the microgram level. This small amount, placed under the tongue, is enough for the immune system to build allergic tolerance over time, yet is below the level that triggers a reaction. The effectiveness of sublingual immunotherapy depends on how often the drops are taken. When using the La Crosse Method™ Protocol for food allergies, we recommend one pump dose, three times a day — morning, afternoon, and night.

The goal of sublingual immunotherapy treatment for food allergy varies between patients. For those with mild to moderate allergies, it is possible to reintroduce allergic foods into the diet; while with those whose allergies are severe and life-threatening, the goal is to reduce the likelihood of an allergic reaction to an accidental exposure. When study results using more aggressive dose escalation are available, we may be able to set our sights higher. A cure for peanut and other severe food allergies is now within the realm of possibility in the next few years.