Is SLIT the Best Way to Treat My Food Allergy?

Before the 21^st century, there wasn’t any treatment for food allergy, but that wasn’t from a lack of trying. Studies in the early 1990’s showed some promising results from administering peanut allergy shots, similar to the environmental allergy shots that had been a staple of the allergy profession since the 1930’s. Unfortunately, the program was shut down after a dosing error led to a fatal anaphylactic reaction in one of the children in the study. This set back food allergy investigations for about a decade.

In 2006 the first case series in the US of administering peanut orally, oral immunotherapy (OIT), got the ball rolling again, giving hope to patients and families that prevention of food allergy reactions could be possible. This is referred to as desensitization. Over the next 15 years, OIT has been endorsed by countless research reports and tens of thousands patient experiences using many foods, in multi-food combinations, in patients as young as 6 months, and available all over the world. The mainstream recognition of the legitimacy of OIT came in early 2020 when the Food and Drug Administration approved a peanut flour capsule for use in OIT. This appeared to be the answer for people with food allergy, desperate for so long for a means to ameliorate their fear of a life-threatening food encounter, but over time the sheen over OIT has begun to fade.

For clinics like Windom Allergy who have treated hundreds of patients with OIT, there are wonderful memories of patients safely eating their previously dreaded food, some even losing their allergy altogether. Like a round of golf, the great shots keep you coming back for more. Unlike golf, where you can ignore the bad shots, we didn’t like seeing patients drop out of OIT because of abdominal pain, taste aversion, two-hour activity restrictions after dosing, and anaphylactic reactions. There had to be a better way.

At our Sarasota Clinical Research center, we participated in trials where peanut was administered to our patients through the skin, epicutaneous immunotherapy (EPIT). This sounded like a safer, less intrusive way to desensitize people with food allergy, but the results have been inconsistent. Work is still going on with EPIT, but no commercial product is on the near horizon. By 2021, we started thinking about putting the food under the tongue, sublingual immunotherapy (SLIT). There wasn’t an abundance of literature on the topic, but the papers that were out there, were consistently highly effective and universally safe (see our blog on, “How Well Does SLIT Work in the Treatment of Food Allergy?).

Since placing SLIT at the top of our treatment panel, we haven’t looked back. Patients and families are thrilled by the ease of dosing, the four-visit buildup schedule (vs. 12-15 for OIT), the flexibility of skipping doses for trips/camps, and, probably most appreciated, the miniscule fear of reacting to their daily dose. We have led the way with using real food in our SLIT dosing, rather than using food skin test solutions that were co-opted for the SLIT research trials. The skin test solutions were not made for oral use, so we carried on the tradition of OIT where real foods were used to desensitize patients to a real food allergy. We have an original article on this topic coming out in an upcoming issue of the prestigious Journal of Clinical Allergy & Immunology In Practice. 

While the majority of people with food allergy will make SLIT their treatment of choice, there is still a role for OIT in select populations. Very young children, under three, do amazingly well on OIT. Patients with less severe food allergy can take advantage of our Personalized OIT (P-OIT) protocol, wherein they start OIT the day after a failed oral food challenge, with a single updose a month later (see this and all of our treatment options on our website, www.WindomAllergy.com). With this shift to much safer desensitization, there is little, if any, role for omalizumab (Xolair) in the management of food allergy. It feels refreshing to know we can diminish food allergy, naturally, without the help of Big Pharm and all their TV commercials.