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Researchers Find Sublingual Immunotherapy Effective for High-Risk Food Allergy Patients

A recent study conducted by researchers at the University of British Columbia (UBC) has unveiled a promising approach to address food allergies in older children and individuals unable to tolerate oral allergen exposure. Known as sublingual immunotherapy (SLIT), this novel method involves administering small amounts of food allergens under the tongue, offering a safe pathway to desensitization. 

Led by UBC clinical professor and pediatric allergist Dr. Edmond Chan, the study found SLIT to be both safe and effective for high-risk older children and adolescents with multiple food allergies, a population often deemed ineligible for traditional oral immunotherapy due to safety concerns. Dr. Chan emphasizes that SLIT could be the optimal approach for this patient cohort, presenting a viable alternative to conventional methods. 

Previously, Dr. Chan’s team demonstrated the safety and efficacy of oral immunotherapy in preschoolers. However, the build-up phase of oral immunotherapy poses significant risks for older children and individuals with a history of severe reactions. In search of a safer alternative, the team investigated SLIT to safely transition this at-risk group to the maintenance phase of therapy. 

The study enrolled approximately 180 patients aged four to 18, most of whom had multiple food allergies. The SLIT protocol, initiated during the COVID-19 pandemic, involved virtually supervised appointments over several months, during which patients gradually built up tolerance to allergens by administering small doses under the tongue. Unlike traditional oral immunotherapy, SLIT allows allergens to be absorbed through the oral mucosa rather than ingested. 

Patients and their caregivers were trained to administer SLIT doses at home using recipes developed by the research team’s dietitian. Various allergens, including peanuts, tree nuts, eggs, milk, fish, and wheat, were included in the treatment regimen. Despite the longer duration required for SLIT compared to oral immunotherapy, the enhanced safety profile of SLIT made it preferable for older children and high-risk individuals. 

Throughout the study, patients experienced mild symptoms during the build-up phase, with no severe reactions reported during either build-up or maintenance. Remarkably, 70% of patients tested at the end of the protocol demonstrated tolerance to higher doses of their allergen, approaching the success rate of oral immunotherapy. 

The results underscore the potential of SLIT as a home-based therapy guided by healthcare professionals. Dr. Chan highlights the benefits of SLIT, including its superior safety profile and reduced burden on allergists, who often face capacity constraints when administering traditional oral immunotherapy. By offering a viable alternative, SLIT not only ensures patient safety but also optimizes clinic resources for those most in need. 

Moving forward, the study advocates for the integration of SLIT into clinical practice as a viable option for patients unable to undergo traditional oral immunotherapy. The longer timeline associated with SLIT is outweighed by its safety benefits, offering a practical solution for managing food allergies in high-risk populations. 

In conclusion, the UBC study demonstrates the feasibility and effectiveness of SLIT in desensitizing older children and individuals with food allergies. With its potential to improve patient outcomes and alleviate clinic burdens, SLIT represents a significant advancement in allergy management and underscores the importance of personalized approaches in healthcare. 

Journal Information  

Lianne Soller et al, Safety and Effectiveness of bypassing oral immunotherapy buildup with an initial phase of sublingual immunotherapy for higher-risk food allergy, The Journal of Allergy and Clinical Immunology: In Practice (2024). DOI: 10.1016/j.jaip.2024.02.024 

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