Miễn
Dịch Trị Liệu Dị Ứng
Bác sĩ Nguyễn
Thanh Trà, Chuyên Khoa Bệnh Tai Mũi Họng
Allergy Immunotherapy: SLIT or SCIT
Tra T. Nguyen M.D., Otolaryngologist
SCIT (subcutaneous immunotherapy) injection of allergens
has been practiced for almost 100 years.
SLIT (sublingual immunotherapy) is a method of allergy
treatment using allergen solution as drops deposited under the tongue
and holding it there for a few minutes before swallowing.
Since 1969 SLIT was used for treating foods allergy and
since 1970 for treating inhalants allergens.
In 1998 the World Health Organization concluded that SLIT
was a viable alternative to the injections.
After numerous control trials SLIT is gaining support from
Allergists and Otolaryngologists
SLIT worked differently than SCIT: once the antigens
are placed under the tongue, dentritic cells take up the antigen, migrate
to cervical lymphatic nodes and have an effect on T-regulatory cells,
which then cause a Systemic response.
SLIT had a very good safety tract, is given at home to
adults and children:
-Allergic Food sensitivities and Asthma in young children.
-Allergic Rhinitis and Asthma in older children and Adults.
Patients can be treated with a large number of antigens
using drops (SLIT) compared to the shots (SCIT).
With (SLIT) there are so few reactions that up to 20 antigens
can be mixed in a single bottle.
ACAA: American College of Allergy, Asthma and Immunology
- SLIT may be beneficial for Adults with mild Allergic
Rhinitis caused by grass and trees.
- SCIT was better than SLIT for perennial Allergic Rhinitis
due to house dust and mites.
SLIT is administered at home with no direct supervision,
the physician will need to provide specific Instructions
to patients how to manage adverse reactions, unplanned treatment interruptions,
dosing adjustments.
SLIT desensitizes you to your own allergies, over time,
this shifts your immune system to tolerate instead of
react allergically to pollen, dander, dust, mites and molds.
Drops contain the same antigens as shots. Dosage will be
gradually increased as your treatment progresses.
SLIT can be given before a pollen season, during a pollen
season, both or year round.
SLIT doesn’t hurt. Allergy sufferers, especially children
are afraid of shots, they don’t like needles.
Patients visit the Dr. only 2-3 times per year for drop
strength adjustment vs. weekly or monthly for 3-5 years when using SCIT.
95-97% of patients stay on therapy for SLIT vs. 50 % of
patients on SCIT stop the therapy too soon.
_Unlike shots, dops are safe for children under 6yo, the
age when allergy immunotherapy can be most effective at preventing asthma
and new allergies. Allerdrops are safe, even for pregnant women.
SLIT is safer, no anaphylactic or life threatening side
effects have ever been reported.
Around 1986 injections for allergy immunotherapy were
practically banned in England because of some deaths were linked to the
therapy. The law requested the injections to be done in a hospital.
Shots caused serious reactions in about 5%: generalized
urticaria, severe pruritus, anaphylactic reaction
With airway edema.
_ Side Effects in SLIT are usually benign and very rare:1/12000
doses.
* itchy mouth
* lip, mouth, tongue, irritation
* nausea, vomiting, abdominal cramping and diarrhea
* sneezing, nasal congestion
* asthma symptoms
* urticaria, angioedema
At the present time SLIT is widely used in England, Europe
and South America.
In the USA, most Allergists and Otolaryngologists still
give allergy shots, U.S. may be several years away from a significant
acceptance of SLIT.
For a list of Drs who use SLIT visit: www.allergy
choices.com/find doct
References
-Morris D (1969) “Use of sublingual antigen in diagnosis
and treatment of food allergy” Ann Allergy 27.
-Reid M, Lockey R(1993) ”Survey of fatalities from skin
testing and immunotherapy 1985-1989”.
Allergy Clin immunology 92.
-Passalacqua G, Guerra L (2004) ”Efficacy and safety of
sublingual immunotherapy”.
Annals of Allergy, Asthma and immunology 93.
-American College of Allergy, Asthma and immunology, Jul-Aug,
1999.
-Issue of current opinion in Allergy and Clinical Immunology,
2004.
-Annals of Allergy, Asthma and Immunology, 2006
-ENT Today Vol 4. N2. February 2009
Nguyễn Thanh Trà, M.D., Otolaryngologist
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