New research suggests that sublingual immunotherapy (SLIT) holds promise as a safe and effective treatment option for older children and adolescents with multiple food allergies, mirroring the success of oral immunotherapy (OIT) in younger age groups. Preliminary findings from a study involving over 180 pediatric patients revealed encouraging outcomes, with SLIT demonstrating a high level of safety and efficacy in this population.
Published in the Journal of Allergy and Clinical Immunology: In Practice, the study evaluated the use of SLIT in older children aged 4 to 18 years who were at high risk due to multiple food allergies. The majority of participants had multiple food allergies, with a significant proportion also presenting with other allergic conditions such as atopic dermatitis, asthma, and allergic rhinitis.
Led by senior author Dr. Edmond Chan, clinical professor of allergy at the University of British Columbia and pediatric allergist at BC Children’s Hospital in Vancouver, British Columbia, Canada, the study aimed to address the need for alternative therapeutic options for older children with food allergies. While OIT has shown efficacy in infants and toddlers, older age groups are often considered at higher risk for severe allergic reactions during treatment.
The study enrolled 188 high-risk pediatric patients for multifood SLIT, with most participants completing the SLIT buildup phase under nurse supervision. Notably, the virtual nature of the study, necessitated by COVID-19 pandemic restrictions, required patients and their caregivers to administer SLIT doses at home using specially developed recipes provided by the research team.
Over the course of 1 to 2 years of daily SLIT maintenance, patients underwent low-dose oral food challenges (OFCs) to assess treatment effectiveness. The majority of patients experienced mild reactions during SLIT buildup, with only a small percentage requiring epinephrine administration and emergency department visits.
Encouragingly, nearly three-quarters of patients who underwent low-dose OFCs demonstrated successful tolerance to their allergen, enabling them to transition to daily OIT maintenance without the need for additional buildup. This hybrid approach, combining the safety of SLIT with the efficacy of OIT, represents a promising treatment strategy for older children with food allergies.
Commenting on the study, Dr. Julia Upton, associate professor of pediatrics at the University of Toronto, highlighted the importance of low-dose exposure and time in driving meaningful desensitization. She emphasized the study’s contribution to the growing body of evidence supporting alternative therapeutic approaches for food allergies, underscoring the potential benefits of personalized treatment regimens tailored to patient preferences and goals.
The study was supported by BC Children’s Hospital Foundation and involved disclosures from both Dr. Chan and Dr. Upton related to research support, advisory roles, and professional affiliations within the field of allergy and clinical immunology. As research in this area continues to evolve, the findings offer hope for improved outcomes and quality of life for children and adolescents living with food allergies.
