Depending on your degree of allergies, allergen avoidance steps and medications by themselves may not be entirely effective in managing your symptoms. It is possible, therefore, to identify and treat the underlying condition instead of simply treating the symptoms with medications.
Sublingual immunotherapy (SLIT) is an alternative approach in which the allergen preparation is administered orally beneath the tongue in a dissolvable tablet. This is repeated daily beginning prior to the onset of the allergy season and continued throughout the season or year-round. Since SLIT is given orally, it is easily administered at home, and the incidence of severe allergic reactions is rare. The convenience of this self-administered treatment and its low potential for severe side effects have helped SLIT gain popularity.
The FDA has approved four allergy tablets for sublingual immunotherapy. There are two directed at grass pollen, one for short ragweed, and one for house dust mites. The two for grass pollen allergies are Oralair®, which contains five kinds of grass pollen, and Grastek®, which contains Timothy grass pollen. The tablet for short ragweed is called Ragwitek®. The tablet for house dust mite is called Odactra®. The tablets are only effective for the specific allergen they contain.
Differences Between Sublingual (SLIT) and Subcutaneous (SCIT) Immunotherapy
Subcutaneous immunotherapy (SCIT) — also commonly referred to as allergy shots or allergy injections — has been adopted by allergy specialists in the U.S. with millions of doses administered annually. SCIT is approved by the FDA for subcutaneous injections of approved allergy extracts. Allergy serum is formulated into one or more vials specific to each patient and covers multiple allergen sensitivities. SLIT, by contrast, covers single allergens — dust mites, ragweed, or grass pollen.
Both SCIT and SLIT have proven to be effective and long-lasting in inducing tolerance to allergens, even well beyond the term of treatment for allergic rhinitis and allergic asthma. However, SCIT has the potential for serious side effects including anaphylaxis, and therefore requires administration in a medical office under a supervising provider prepared to treat potential reactions.
SLIT has a very low risk of severe allergic reactions and can be administered at home. All patients are given an epinephrine autoinjector in case of a severe or potentially life-threatening allergic reaction. The first dose must be administered in a doctor's office. SCIT has a 50–80% reduction in allergy symptoms, whereas SLIT has approximately a 40% reduction.
SLIT Side Effects
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Very Common
Itching of the mouth or tongue, swelling of the mucosa or tongue, sneezing, itching of the ears, throat irritation, and soreness.
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Common (affecting 1 in 10 to 1 in 100 people)
Itchy eyes, runny or congested nose, swelling in the mouth or throat, throat tightness, cough, asthma, tingling or numb sensation in the mouth, blistering in the mouth, swollen or painful tongue, headaches, indigestion, nausea, general itching, and fatigue.
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Uncommon (affecting 1 in 100 to 1 in 1,000 people)
Dizziness, eye swelling, upper airway infection, mouth ulcers or sores, dry mouth and throat, vomiting, diarrhea, abdominal pain, swollen glands, shortness of breath, voice changes or hoarseness, difficulty swallowing, rash, fever or feeling hot, face swelling, or chest tightness.
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