Sublingual immunotherapy and other updates on adolescent and adult Asthma
What is SLIT?
Sublingual immunotherapy or ‘SLIT’ is a course of treatment given to reduce allergy symptoms of allergic rhinitis or asthma caused by a specific allergen. SLIT is prescribed to patients where their allergy symptoms persist despite usual treatments (i.e. antihistamines, nasal sprays and inhalers), and where the symptoms are affecting normal daily life.
This course of treatment lasts for a period of about 3 years. Treatment is given as a tablet. SLIT for symptoms due to grass or tree pollens is started a few months before the pollen season. SLIT for perennial (year round) allergens (e.g. house dust mites) can be started at any time of year.
The first dose of SLIT is administered with access to medical supervision in the Clinic. After this visit you will administer the treatment yourself at home but will be required to attend the Clinic for review to monitor progress.
What types of allergies can be treated?
SLIT is available for allergic symptoms caused by grass (Grazax, Oralair), tree pollen (Itulazax) or house dust mites (Acarizax).
Is SLIT advised for all allergy sufferers?
SLIT is not advised for all patients with allergic symptoms. It works best for those who have persistent symptoms despite regular conventional therapy or who require higher than desirable doses of standard therapy to control their symptoms. Treatable allergies must be confirmed by skin prick tests or blood antibody levels (IgE) for each antigen.
How do I take SLIT?
A dissolvable SLIT tablet is placed under the tongue for 1-2 minutes (depending on treatment type), before swallowing. You must not eat or drink anything for the next 5 minutes. The medication is taken in the morning before breakfast.
It is very important to take the medication daily as prescribed for the whole treatment period. This will help symptom improvement during treatment and the long-term benefits after treatment. If you miss a dose do not give a double dose the next day, just continue as normal. If you miss several days of treatment, you may need to return to the Clinic to restart your treatment under supervision.
Are there times when I should not take SLIT?
SLIT works on the immune system. There are therefore are certain situations when treatment should not be taken. These are:
Any inter-current illness, eg coughs, colds, flu or if you feel unwell or have a temperature. If in doubt, please contact the Clinic.
Any mouth ulcers or after dental surgery. Wait 1 week for the mouth to heal before re-starting treatment.
Any serious illness or surgeries - in this situation, please discuss with your treating doctor whether treatment should be continued.
What are the possible risks of SLIT?
The most commonly reported side-effects of SLIT are swelling or bumps under the tongue, tingling or itching sensation under the tongue, in the mouth or in the ears and mild tummy pain. These usually happen immediately after taking the medication. These symptoms are only temporary and usually does not last more than 5–10 minutes. These symptoms gradually improve after about a week or two and can disappear altogether. However if they continue and are troublesome please discuss this with the Clinic. These symptoms can be treated with an antihistamine or antacid.
If you experience any of the following less common side-effects, you must stop the treatment immediately, seek medical attention via your GP or local accident and emergency department and report to the Clinic as soon as possible:
Swelling of the face, mouth or throat
Difficulty swallowing
Difficulty breathing
Worsening of existing asthma
Nettle rash
Voice changes
More severe tummy pain, nausea and/or vomiting
What are the benefits of SLIT?
Clinical trials have shown that SLIT is beneficial and safe in patients with grass, tree pollen and house dust mite allergy. The benefits persist for many years (up to 10 years in one study) after the 3-year treatment programme has been completed. However, benefit cannot be guaranteed in everyone. SLIT is a convenient treatment option as hospital visits are minimised.
What about other medication?
You should take your other medication as prescribed. SLIT does not replace these medications, so they should be continued as normal. It is likely that your need for rescue medication and the dose of maintenance medication will reduce over time with the same or better control of your symptoms. This will present the opportunity to reduce these medications whilst monitoring symptoms.
If you develop a new illness that needs long-term medications, please report this to the Clinic so we can advise you about continuation of SLIT. Most short courses of medicines like antibiotics will not interfere with immunotherapy, but the illness itself may be an indication to stop the SLIT temporarily.
Can I take SLIT if I am pregnant?
You should not start immunotherapy if you are already pregnant. However, if you become pregnant whilst you are established on treatment, this can be continued.