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June 5, 2014

Food Desensitization and SLIT

Question

Food desensitization by SLIT is supposed to reduce the degree of sensitivity. Can we introduce SLIT for food in our routine practice? If permitted what is the suggested dose of MD/M?

Answer

By Dr Corinne Keet:

Although small studies have shown some desensitization to foods with both sublingual immunotherapy (SLIT) and oral immunotherapy (OIT), there remain many important questions about these approaches that need to be answered before they can be introduced into routine practice. The studies performed so far have been on very small groups of carefully selected patients treated in research settings, and most have not been randomized, much less blinded.

Even within these parameters, important questions about safety, efficacy and long-term outcomes have already been raised. Less data is available for SLIT specifically, and the few studies performed thus far have generally shown poorer outcomes than with OIT.(1) Whether the partially desensitized state reported in most studies of SLIT for food allergy justifies the risk of treatment has not been definitively answered; to answer this question we will need larger and longer studies that are carefully controlled and that meticulously measure adverse events.

As originally stated by Sheikh et al, and recently quoted by Sampson in a review of immunotherapy for peanut allergy: "It is important that our excitement about (the early success of OIT), which has the potential to transform the lives of millions of people worldwide, does not get the better of us, and that we wait for the science to lead the way."(2, 3)

References:

  1. Narisety S. D., Keet C. A. Sublingual vs oral immunotherapy for food allergy: identifying the right approach. Drugs. 2012 Oct 22;72(15):1977-89.
  2. Sampson H. A. Peanut Oral Immunotherapy: Is It Ready for Clinical Practice? The Journal of Allergy and Clinical Immunology: In Practice. 2013 January;1(1):15-21.
  3. Sheikh A., Venderbosch I., Nurmatov U. Oral immunotherapy for peanut allergy. BMJ. 2010;340:c2938.

Corinne Keet, MD, MS
Assistant Professor of Pediatrics
Department of Pediatrics
Johns Hopkins School of Medicine
Baltimore, Maryland, USA
 


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