In a perfect world, we could remove all of the allergy triggers that plague asthmatics, including dust mites, tree and grass pollen, and animal dander. But as one of my asthmatic patients put it, “I can’t stop living.” For many, necessary treatment may include uncomfortable allergy desensitization injections for prolonged periods, sometimes years. For young children with asthma and allergy problems, this may be not just inconvenient, but emotionally traumatic.

One potential alternative that may become available to more individuals, particularly children, is sublingual immunotherapy (SLIT). Already widely in use in Europe, further studies are now taking place in the United States. Usually given in a tablet form under the tongue, the tablet is allowed to dissolve for one to two minutes, and is then swallowed.

A recent meta-analysis, published in the journal Chest (2008; 133: 599-609), several research studies were examined that included children between the ages of three and eighteen years of age. They found that using standardized sublingual dosages, these children had lower symptom scores and decreased rescue medication use. The safety profile appears to be good compared to allergy injections. Side effects included mild nausea, as well as oral, nasal, and eye itching, but no serious systemic reactions were noted. Since side effects are minimal, parents can easily and safely manage giving the treatments at home.

SLIT therapy may also be of value in other potentially severe allergic reactions. In other studies involving peanut and honeybee allergies, SLIT treatments are also showing promise in decreasing severe allergic reactions(American Academy of Allergy, Asthma & Immunology 2008 Annual Meeting: Abstract LB11. Presented March 18, 2008; poster 529).

It appears that sublingual immunotherapy may also alter the natural history of allergic disease, potentially preventing the worsening of allergic asthma. One potential disadvantage of sublingual immunotherapy is the cost, estimated to be approximately three times greater than the injectable form. Research is continuing to evaluate the most effective dosages as well as the long-term efficacy of SLIT treatment.