Challenges in SLIT vs SCIT and initial results of a food allergen oral immunotherapy study

September 17, 2018

Fall is coming to the Northern hemisphere. School has started everywhere, and the football season is firing up in North America. Along with these societal events is the inevitable fall allergen season. Many pollen allergic individuals seriously contemplate (and some actually begin) allergen immunotherapy. This month’s issue of the Annals of Allergy, Asthma and Immunology has an outstanding lineup of articles and other features that emphasize new developments in allergen immunotherapy. An ongoing discussion/debate is the utility of sublingual (SLIT) vs. subcutaneous (SCIT) immunotherapy for treating aeroallergen sensitivities. Several articles address this topic and provide important new information within the context of what we currently know.

The first is an excellent perspective article by Harold Nelson, MD, FACAAI, from Denver, that discusses the continuing challenges for both therapies which limit their wider-spread utility. Such challenges for SCIT include safety, duration of therapy and the inconvenience of regular appointments and waiting after injection. For SCIT, challenges include dosing for liquid extracts, duration, proper use in multi allergen sensitive patients and level of evidence necessary to validate this type of immunotherapy.

Another important contribution in this month’s issue is a perspective by Richard Wasserman, MD, FACAAI, and colleagues, who report initial results from a group of allergists who provide oral immunotherapy for food-allergic individuals in the U.S. These allergists have banded together to form a 501c3 organization called the Food Allergy Support Team (FAST). Two of the authors are current officers in the College, and they describe the collective experience of FAST members in the practice of food oral allergen immunotherapy (FOIT). The authors are careful to express their clinical experiences as just that – and do not claim these to be equivalent to data-driven therapies. But they do provide their rationale and experience with FOIT. This is a topic that is upon us in North America and opinions regarding utility as well as need for further research deserve to be heard in a respectful, information-seeking forum. As you read and ponder this article, I am hopeful that many of you may be moved to submit a commentary (pro or con) to Annals. This will continually refine the discussion as we, the allergy/immunology specialists, determine what we are going to do with FOIT in our own practices. Remember, you can send your commentary (500 words and five references maximum) directly to our editorial office, and we will assist you in getting the manuscript uploaded for editorial review.

I do hope you will spend some time, pre- (or post) football, with this month’s Annals and that you will be aided in better caring for your patients because of these and other articles. As always, feel free to reach out to me with comments about how to make the journal more useful to you.

Gailen Marshall, Jr., MD, PhD, FACAAI