How Well Does SLIT Work in the Treatment of Food Allergy?

The short answer is, very well. The longer answer involves reviewing published research studies of patients treated with food sublingual immunotherapy (SLIT). There had been a few case reports of treating severe food allergy with drops under the tongue, i.e. SLIT, prior to 2011, but it was in that year the first study of a group of patients with peanut allergy came out in our major US allergy journal.¹ This report from Dr. Windom’s alma mater, Duke University, treated 1-11 years old children for one year with daily SLIT drops and found that 50% were able to tolerate 7 peanuts or more. The kids on placebo still reacted at ~1/3 of a peanut.

 The next year a study of milk SLIT was published, this one from Duke and Johns Hopkins, both places where Dr. Windom trained.² They found in 6-16 years old milk allergic patients that in just over a year of milk SLIT the average tolerance of milk increased 40-fold, to 120 ml or 4 ounces of milk. In 2015 another study out of Baltimore looked at 7-13 years old peanut allergic children, finding a median 22-fold increase in sensitivity (up to 2 peanuts) after one year of SLIT.³ SLIT is intended to be a long-term treatment, so did the kids do even better as time went on?

Indeed, they did. An additional 30 patients were added to the 2011 study group by Dr. Kim (now at UNC, boo!) and followed for 3-5 years on peanut SLIT.⁴ After this longer course of treatment, 1/3 of the kids tolerated 20 peanuts ½ tolerated more than 7 peanuts, and 86% at least 3 peanuts. Only 5% failed to tolerate one peanut. It was at this point that our eyes were opened to the wonders of SLIT. Here at Windom Allergy we are now recommending SLIT as our preferred method of food allergy desensitization.

A few studies have come out since, including one in 1-4 years old children, confirming the success of SLIT.⁵   These young kids went from reacting to a median amount of ½ a peanut to ~17 peanuts in 3 years of SLIT. We presented our data from Sarasota, FL on treating 50 food allergy patients with SLIT at the 2024 annual meeting of the American Academy of Allergy Asthma and Immunology.⁶ We look forward to sharing more of our SLIT experiences with the global allergy community to help patients discover the best way of treating their food allergy. In the meantime, we are treating our patients with food SLIT every day and welcome new patients to join us. See what your journey will be like by reading our blog, “The Nuts and Bolts of SLIT for Food Allergy.”

References

1. Dr. EH Kim and others. Journal of Allergy & Clinical Immunology 2011;volume 127: pages 640-6.

2. Dr. CA Keet and others. Journal of Allergy & Clinical Immunology 2012;volume 129: pages 448-55.

3. Dr. SD Narisety and others. Journal of Allergy & Clinical Immunology 2015;volume 135: pages 1275-82.

4. Dr. EH Kim and others. Journal of Allergy & Clinical Immunology 2019;volume 144: pages 1320-6.

5. Dr. EH Kim and others. Journal of Allergy & Clinical Immunology 2024;volume 153: pages 173-81.

6. S Seitz, R Windom, Dr. J Ly, Dr. N Dunn, Dr. J Fergeson, and Dr. H Windom. Food SLIT: Safety and simplicity of using real food. Journal of Allergy and Clinical Immunology 2024; volume 153, Issue 2:AB124.