Ask The Expert
September 30, 2021
Food Desensitization and SLIT
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?
From the Editors: While food desensitization has great potential it is (as we say in the USA) "not ready for prime time"
By Dr. Liz Veramendi-Espinoza:
At present, there is no Food and Drug Administration (FDA)-approved Sublingual Immunotherapy (SLIT) to treat food allergies. In January 2020, FDA approved Oral Immunotherapy (OIT) Palforzia [Peanut (Arachis hypogaea) Allergen Powder-dnfp] to mitigate allergic reactions that may occur with accidental exposure to peanuts. The effectiveness of Palforzia was supported by a randomized, double-blind, placebo-controlled study which showed that 67.2% of Palforzia recipients tolerated a 600 mg dose of peanut protein in the challenge, compared to 4.0% of placebo recipients. The most commonly reported adverse events (AEs) were abdominal pain, vomiting, nausea, itching (including in the mouth and ears), cough, runny nose, hives, shortness of breath, and anaphylaxis (1).
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.
By Dr. Wesley Burks:
SLIT as a treatment for food allergy has been associated with successes for kiwi, hazelnut, peach, milk, and peanut allergies. The best trial to date has evaluated SLIT in children with peanut allergy in a randomized, placebo-controlled trial. Subjects receiving peanut SLIT safely ingested more peanut during OFC than control subjects (1710 vs. 85 mg, respectively). Side effects were predominantly oropharyngeal, and epinephrine was not administered during the trial. Immunologic changes at 12 months included decreased skin prick test response size, basophil activation, and IL-5 levels with an increase in peanut-specific IgG4 levels.
By Dr Hugh Sampson:
SLIT for food allergy is still considered experimental and is not ready for use in clinical practice.
Hugh Sampson, MD
Dean for Translational Biomedical Research
Professor Pediatrics, Allergy and Immunology
Mount Sinai School of Medicine
New York, New York, USA
By Prof Ulrich Wahn:
"Desensitization" or "specific tolerance induction" to food in cases of an established food allergy has become an interesting area of research during the last few years. Groups from the US, different European countries, Australia as well as Japan have initiated randomized controlled studies in peanut, hen’s egg as well as cow’s milk allergy, which have included primarily children. First published results are encouraging, since the concept of systematic application of minute and increasing dose of food protein via the oral or sublingual route seems to work in increasing threshold doses in comparison to placebo intervention. Obviously these protocols involve the risk of anaphylactic reactions. In addition, the documented effects need more data on long-term follow up. Therefore, oral desensitization studies should be considered as an important part of clinical research and not as routine in allergological practice.
Ulrich Wahn, PhD
Director, Berlin Charité,
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