Constant sneezing, red, itchy eyes, a runny nose... There's no end to these allergy problems, right? For some, it's caused by dust, for others, by pollen from certain trees. Even if you take medicine for this, sometimes it's not completely controlled. So today, we're talking about a slightly different, new treatment method in addition to vaccines, to get rid of these allergy problems.
What is sublingual therapy (SLIT)?
Sublingual Immunotherapy (SLIT) is a treatment for allergies. It involves placing a tablet or liquid under your tongue every day. Simply put, it delivers a very small , controlled amount of the allergen to your body every day. It's like "unpicking a thorn with a thorn."
Imagine, when this medicine dissolves under the tongue, the allergen in it passes through the mucous membranes in the mouth directly into the bloodstream. Then, a special type of cell in our immune system, T-cells, recognizes it. When treated in this way for a long time, these T-cells, instead of causing an allergic reaction, send signals to other immune cells saying, "Hey, this is not our enemy," and calm the system down. As you continue to do this, your allergy symptoms, such as sneezing, itchy eyes, and runny nose, gradually disappear.
Doctors most often use this treatment for allergic rhinitis (also known as "hay fever"), which is caused by pollen and other airborne particles. This includes allergies to things like grasses, weeds, and dust mites. It is also being tested for allergies to foods like peanuts.
How is this treatment done?
When you start SLIT treatment, your doctor (often an allergist) will give you the first dose in his office. This is to see if you have any reactions and to show you exactly how to do it at home. You will then be given a set of pills (or liquid) to use at home and instructions on how to use them.
Most importantly, your doctor will prescribe an injection of epinephrine, such as an EpiPen® , in case you have a severe allergic reaction. But don't worry, this is very rare with this treatment.
For some allergens, there may be a period of dose escalation. This means that the amount of allergen you are given is gradually increased over a period of weeks or months. You will need to see your doctor each time this dose is increased.
After that, you have to take this medicine at home every day. You need to follow the doctor's instructions exactly . The usual way to take the medicine might be like this:
- Place the tablet or the prescribed number of drops of liquid under your tongue.
- If it is a pill, let it dissolve completely.
- Wait a minute or two before swallowing.
- Wait 5-15 minutes (maybe more) before eating or drinking anything.
Who is this treatment suitable for and not suitable for?
This treatment is not suitable for everyone. Therefore, before starting this treatment, your doctor will perform the necessary allergy skin tests or blood tests.
| Compatible people | Incompatible people |
|---|---|
| Mainly for those who suffer from only one allergen (e.g. dust mites). | For those with severe asthma that is difficult to control. |
| For those who can commit to taking their medication at the same time every day. | For people with a condition called eosinophilic esophagitis (an inflammation of the esophagus). |
| For those who are reluctant or afraid to get vaccinated. | Those who are allergic to the inactive ingredients in the pill or liquid used for treatment. |
| - | For those who have had severe reactions to SLIT treatment before. |
Advantages and disadvantages of SLIT treatment
Like any treatment method, this one has both advantages and disadvantages.
| Advantages | Disadvantages |
|---|---|
| Effectiveness: May be more effective than antihistamines or nasal sprays. If taken correctly for several years, relief may last for several years after discontinuation. | Compared to vaccines: May not be as effective as allergy shots. |
| Comfort: This is a big relief for those who are afraid of vaccines. | Commitment: To get results, you need to take the medicine exactly every day , without missing a dose. |
| Convenience: You don't have to go to the doctor every day, you can do it at home. | Limitations: Currently approved for only a few allergens. The pills can only treat one allergy at a time. |
| Safety: There is a lower risk of severe reactions than with allergy shots. | Side effects: Minor side effects may occur. Rarely, they can be severe. |
| Benefit for asthma patients: It also helps reduce symptoms in some asthma patients. | - |
What are the possible side effects?
- Itching in the mouth, throat, or ears: This is the most common side effect. It usually goes away after a while after taking the medication.
- Swelling of the mouth or throat.
- Anaphylaxis: This is a very rare but serious allergic reaction that can be life-threatening, causing difficulty breathing, swelling, and loss of consciousness. If you experience any of these symptoms, you should immediately go to the nearest hospital's Emergency Department (ETU).
- Eosinophilic esophagitis: This is also a very rare complication. It is a swelling of the esophagus that can occur after prolonged treatment.
How long does it take to get results?
This is not a quick-acting treatment like taking Panadol. It can take several months to build up immunity to airborne allergens. To achieve full results, you will need to take this treatment daily for several years .
Things like dust mites need to be treated year-round. However, for seasonal allergies like grass pollen, it's best to start treatment about 12 weeks before the allergy season begins.
Studies have shown that if you take this treatment daily for three years or more without skipping a dose, your allergy symptoms will be controlled for at least two years after stopping treatment.
Take-Home Message
- Sublingual Immunotherapy (SLIT) is a good alternative to allergy shots.
- This involves giving your body a small, controlled dose of the exact thing you're allergic to, either as a pill or liquid under the tongue, every day.
- For best results, this treatment should be done daily for several years. It requires a lot of commitment.
- This treatment is not suitable for everyone, especially those with conditions like asthma that are difficult to control.
- Before deciding whether this treatment is right for you, be sure to talk to your doctor and seek his advice.
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