The Nuts and Bolts of SLIT for Food Allergy

You’ve heard the buzz about treating your severe food allergy with drops under your tongue, sublingual immunotherapy (SLIT), now it’s time to find out what is involved in the SLIT journey. The good news is, the process is simple, convenient, safe, and effective.

For starters, you need to make sure food desensitization is necessary for you. Strongly positive diagnostic testing and a history of reacting to the food are often enough, but sometimes an oral food challenge is worth doing to make sure you’re still highly allergic. While SLIT is typically the recommended form of desensitization, there are other options (see our blog on, “Is SLIT the Best Way to Treat My Food Allergy”).

Now that you are ready to start, here is what is going to happen: Day One – you come in to the office for a series of three increasing doses of a very weak solution containing your food allergen, 20 minutes apart. The largest dose is 0.3 ml, or 6% of a teaspoon, an amount easily placed under your tongue and held for 30-60 seconds. After that time, you can swallow or spit it out. We ask that you don’t eat or drink for five minutes after dosing. You will go home an hour after your last dose with a bottle of the food solution. You will take the top dose from Day One on a daily basis at home.

You can return in as soon as a week (longer if you like) to continue taking more and more of the food solution. This time it will be 10-times stronger with the same three dose increments. You’ll go home on the top dose and return for a similar 10-times stronger solution in visit three. Your last visit a week or more later, visit four, will advance to your top, or maintenance, dose of solution. You stay on that dose daily, indefinitely. We’ll invite you back in a year to update your food allergy testing and do a low dose food challenge to prove you are gaining tolerance to the food. 

Each year we’ll challenge you to larger amounts of the food to show how safe you are in the event of accidental exposure in your diet. In the case of staple foods, egg and milk, we’ll allow you to eat the safely tolerated amounts of the food you consume in the food challenge. Most kids don’t care about eating the other foods, in fact, they often dislike them. That has become our mantra, let’s take a feared food you were allergic to and make it a food you dislike. We all have foods we dislike, now you’re like everyone else. 

That was easy, but wait, there is more good news. SLIT is so safe that you can miss weeks of dosing for camp/trips/illness, and easily resume dosing. Also, there is no rest period after daily dosing, like there is in oral immunotherapy (OIT). For now, we are asking patients to strive for daily dosing, but like OIT, we expect over years you will be able to reduce dosing to a few days a week. To learn more, check out our website, www.WindomAllergy.com.