Food SLIT –
Sublingual Drops

Children and adults with food allergies continue to avoid foods and carry Epinephrine autoinjectors for protection.

Sublingual Immunotherapy (SLIT) and Oral Immunotherapy (OIT) for food are becoming additional options to help with desensitization and tolerance.

Those who are not ready for food OIT, can begin with food-SLIT and switch over to OIT, when ready. They can choose to continue food-SLIT for an extended period of time. Current medical literature supports the role of food-SLIT for an extended period of time to reduce food-specific IgE.

We offer food-SLIT and food-OIT for peanuts, milk, eggs, wheat, soy, cashew, pistachio, walnuts, hazelnut, almonds, pecans, sesame, chickpeas, and many other foods.

We make an effort to be most efficient in treatment cycles by combining up to 4 foods. Safety remains our utmost priority.

PLEASE note: frequently asked question responses are NO substitute for in-office physician care and advice.

Q: Where do patients go for food SLIT and food OIT?

A: As of now, Dr. Shah and Dr. Mayer are among a very few, select board certified allergists who have knowledge, skills and resources to offer Food Immunotherapy - both SLIT and OIT. The number of practices offering it is growing, however, and may become mainstream in coming years. Dr. Shah and Dr. Mayer are in the forefront and leading the way by teaching other allergists at the national conferences. If you are considering Food SLIT and OIT, it is best to review the success rate and experience of the OIT team.

Q: What is Food-SLIT?

A: SLIT = Sublingual Immunotherapy.

When food allergen drops are put under the tongue for treatment benefits, it is known as Food-SLIT.

Q: Who and what age can you start food-SLIT?

A: Anyone who can hold a couple of drops of liquid under the tongue for 2 minutes can start SLIT. Usually, after 3 - 3 1/2 years of age, it is easy to follow these instructions. Some children can learn at a younger age.

Q: Should routine allergy medications be stopped during food-SLIT?

A: No, it is not necessary.

Q: What is the timeline for the months after the first day?

A: The first day takes 2-3 hours of starting and increasing the food SLIT drops under observation in our office. Once tolerated, the doses are continued and increased at home. We will schedule monthly up-dose visits for higher concentrations of food-SLIT for the first dose of the new set of bottles to be given under observation for safety reasons. By the end of 6 months, you will be on maintenance SLIT bottles and can continue it for an extended period of time. The majority of patients prefer to switch over to SLIT for a higher dose of food immunotherapy.

Q: What are the most common symptoms during build-up.?

A: Itchy tongue, mouth, and gums are the most common symptoms. Usually, they are self-limiting and improve with the continuation of treatment over days and weeks. Food-SLIT dose does not require exercise restrictions.

Q: How often can the dose be increased?

A: The office visit increase in concentration happens every month. At home increase in the number of drops is done weekly. The dose is given daily.

Q: How often and what time of day should home doses be given?

A: The Food-SLIT drops are given once a day and can be given anytime, preferably before 7 PM. Consistent timing helps with compliance.

Q: What precautions should be taken with SLIT dosing?

A: No specific preperation is needed for the food-SLIT dosing. The drops are put under the tongue and need to be held for 2 minutes. Avoid eating or drinking for 10 minutes to maximize the benefits of the food-SLIT drops.

Q: How many days can doses be skipped at home and resumed safely afterwards?

A: We recommend NOT missing any doses. When you start the food SLIT, we will provide written guidelines on how to adjust the dose, in case it is missed for one or the other reason.

Q: What is the goal of this process?

A: The goal of any immunotherapy therapy is to desensitize patients to an allergic food. This helps reduce the risk, frequency, and severity of anaphylaxis from accidental exposure. Food OIT helps increase the reactivity threshold so that a higher amount of allergenic food can be tolerated without allergic reactions. For those who can not or do not start OIT for any reason, the food-SLIT becomes an option. It is a desensitization process also but done with a much lower dose than OIT doses and with drops given under the tongue. Current medical literature suggests its benefits in lowering sIgE and increasing the threshold of reactivity. It is a better option than complete avoidance. The goal is to reduce or eliminate the risk of reaction with accidental exposure and cross-contamination with food allergens.

Q: What is the follow up schedule when a full portion of the food is being eaten?

A: When the full dose has been reached, we schedule follow ups after 1 month, 3 months, 6 months, and then once a year.

Q: What is the cost of the food-SLIT? Do you accept insurance?

A: Yes, we participate with most major health insurance plans and likely accept your insurance. The consultation, testing, and oral challenges are usually covered services by most health plans. The Food-SLIT is considered an elective process at this point, the cost of the Food-SLIT supply is not covered by insurance. Please check with our billing team and patient coordinator to get an estimate on the out-of-pocket costs related to SLIT.

Q. If a patient has multiple food allergies, how many foods can you treat at the same time with food-SLIT?

A: Each food SLIT process is food specific. We combine up to 4 foods based on the patient's history and lab results. The ability to tolerate multiple foods is a major consideration. Completing one program does not treat other food allergies. Some patients have shown benefits in cross-reactive food allergies.