FAQ About Immunotherapy

 

What is Immunotherapy?

Allergen immunotherapy, also known as hypo-sensitization, desensitization, or allergy vaccination, is a long-term treatment that reduces hypersensitivity to allergens and related symptoms for many people with allergic conditions like food allergy. The science of food allergy is progressing in the direction of desensitization for food, and the food immunotherapy is now available as food SLIT (Sublingual) or food OIT (Oral Immunotherapy) for various foods for patients with IgE-mediated food allergies.

 

What is Food SLIT?

The conventional care for food allergy is avoidance and carrying emergency medications for accidental reactions. More and more patients are seeking treatment options for food allergies to reduce the risk of reactions from accidental exposure to food allergens. The currently available treatment options that are new but not widely accepted include food SLIT (Sublingual) or food OIT (Oral Immunotherapy) for various foods and biologic injections like Xolair. The Food SLIT involves administering patient-specific food allergen preparations under the tongue, holding it in your mouth, and then swallowing, once a day. We use a patient-specific schedule to follow, starting at a safe, low concentration and increasing gradually to achieve some level of desensitization for a particular food or foods. Doses of these allergen mixtures will be started in the office and increased over a short period of time until a maintenance dose is reached. Daily therapy is administered at home after some doses are done in the office.

 

What is the goal of this process?

The number one goal is safety. The first objective is to reduce the risk of a reaction from accidental cross-contamination of food. The long-term objective is to allow the patient to become less reactive to foods that contain allergenic food by desensitizing the immune cells so that these foods can be safely consumed.

 

What are the phases? - the SLIT has two phases;

Build-up phase: This involves receiving SLIT drops with increasing amounts of the allergens daily. The length of this phase depends upon how often the number of food allergens is administered and the patient’s ability to tolerate the doses. It can last from 4 weeks to six months.

Maintenance phase: This begins once the effective dose is reached. The effective maintenance dose depends on your level of allergen sensitivity and the patient’s response to the build-up phase. During the maintenance phase, the daily dose is kept the same and continued for an additional 1-3 years. We will continue or stop food SLIT based on ongoing monitoring and discussion with you. Many patients on food SLIT may transition to real food after oral food challenge or to food OIT before or during maintenance. The initial studies suggest that the patients on food SLIT have an easier transition to real food or to food OIT and may tolerate food OIT better with fewer side effects. Many patients may not require food OIT if the food sIgE drops significantly during the food SLIT.

 

What are the possible Risks?

The majority of patients do not experience any symptoms. In a small number of patients, a mild itchy mouth or tongue may occur. It is usually self-limiting and goes away without any treatment in a few minutes. Though very uncommon, in some instances, symptoms can include increased allergy symptoms such as sneezing, nasal congestion, or hives. Severe reactions to food SLIT are rare but include the possibility of anaphylaxis. The signs and symptoms of anaphylaxis include trouble breathing, wheezing or tightness in the chest, hives or swelling, tightness of the throat, hoarse voice, nausea, vomiting, abdominal pain, diarrhea, dizziness, fainting, low blood pressure, rapid heartbeat, a feeling of doom, and cardiac arrest.  It is necessary to have adult supervision for 30 minutes after administering the food SLIT dose. We advise you to have access to emergency medications, including an epinephrine auto-injector or epinephrine nose spray and antihistamines.

 

Where should the food SLIT be started?

This type of treatment should be supervised by a specialized medical provider in a facility trained with proper staff to manage adverse reactions, if any, should arise during the food SLIT. Ideally, the first dose of the new food SLIT bottle should be given in our office unless instructed otherwise.

 

How long will the entire process take?

The first-day procedure will take about 1-2  hours. If everything goes as per schedule, you will be at the desired SLIT maintenance dose (2+ mg food protein) in under 6 months.

 

Should routine allergy medications be stopped before the first-day procedure?

No. Patients should take all routine medications as they normally would and be allowed throughout the SLIT.

 

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

Exactly how it will go depends on each patient. Monthly office visits for up-dosing will be necessary until the desired SLIT maintenance dose is reached.

 

How often will the dose be increased?

Every 3-7 days at home, once a month in the office. (Please follow specific instructions designed for you)

 

What time of day should home doses be given?

The dose can be given anytime up to the early evening and should be given about 24 hours apart. Avoid giving after 7 pm. The dose will need to be kept under the tongue for 2 minutes hold and then swallowed. No eating or drinking for 5-10 minutes afterward is preferred. How long should my child stay awake after the evening dose? Children should be observed for at least one hour after the dose is given. They should not be allowed to sleep during this time. Please avoid giving the dose after 7 pm.

 

How do we dose at home on the day of the office appointment?

Please DO NOT give any dose at home on the day of the office appointment.

 

What if we are flying when the dose is due?

Do not administer the dose less than 4 hours before boarding, and do not administer the dose while flying. A letter explaining the procedure and need for food SLIT solutions for the Transportation Safety Authority is available upon request. If not sure, skip the dose on the day of travel or altogether while traveling.

 

If there is a reaction at home, what should I do?

Treat the reaction the same way you would any food reaction; the most common reaction is a mild itchy mouth or tongue, which is usually self-limiting and goes away without any treatment in a few minutes. Take an antihistamine if there is mild rash/hives. Use an Epinephrine Autoinjector or epinephrine nasal spray if there are any symptoms of anaphylaxis. If the reaction progresses, call 911 after the appropriate immediate intervention. Call our emergency phone after you have given appropriate initial treatment. We will give instructions on future dosing.