Sub-Lingual Allergy Desensitization SLIT

Another Major “I Told ‘Em.”

Actually, it’s not even mine. But I was one of the champion voices, first to demonstrate the method live on public television (BBC), and someone criticized openly by critical colleagues and called a fraud. So I certainly was telling ‘em!

We pioneers had learned to use sub-lingual anti-allergen therapy, using safe, low doses by mouth. It was highly effective. The late Joseph Miller MD was probably its greatest proponent and the testing and neutralization technique became known as Miller’s method.

To allergists and immunologists, the fact that we had a simple, safe method of controlling allergies was very bad news—it threatened their revenues and it is very dangerous to tread on the money hose in medicine! We came in for a lot of flack and accusations of fraud.

Yet people died of their allergy shots; a series of doses of their allergens, in steadily increasing doses.

In contrast, nobody, to my knowledge, has ever died or come to harm using the sublingual neutralization method. I must have tested over a hundred thousand substances and patients self-administered over a million doses in my care, with no ill effect.

Well, all that was almost 40 years ago.

Now a modern paper (there have been hundreds, incidentally) has shown yet again that we were right.

The authors mistakenly described the first use of oral immunization therapy as being 30 years ago. In fact it goes back to the 1950s at least.

Carlton Lee MD, from Missouri, had first noticed that if you gave patients more and more dilute doses of a specific allergen, there often came a moment when the symptoms would vanish! Strange.

But Lee was quick to develop the method; a classic case of the right person, in the right place, at the right time to exploit a valuable discovery.

The present paper confirmed everything I knew and Lee and Miller had discovered. Oral allergen-specific immunotherapy (OIT) as they call it (or SLIT – sublingual immunization therapy) is mainly applied as a treatment for adults and children with food allergies, including cow’s milk, egg, peanuts, tree nuts, wheat, soy, fish and shellfish allergies.

An excellent safety profile is recorded in SLIT studies, with more than 2 billion doses administered to either adults or children.

Nevertheless, some difficulties are faced in evaluating OIT efficacy since studies often rely upon small cohorts of patients and have to take into account spontaneous recovery rates. Overcoming such limitations, a recent study that included children with a severe and lifelong allergy to cow’s milk revealed a significant improvement in tolerated food allergen intake. Specifically, 36% of children became fully tolerant and 54% were able to drink limited amounts of cow’s milk.

Interestingly, the control group maintained on a cow’s milk-free diet failed the food challenge after 1 year.

These effects (fixed allergies and cyclical allergies have been well-described in all my allergy books, going back to 1985.

I am proposing to bring out a major volume soon, entitled OVERLOAD: The Lifetime Secrets Of The Number #1 Allergy Detective; that was the nickname given me by the media back in 1990.

In conclusion, the authors of the 2012 paper admit:

To date, the pertinence of SLIT for tolerance induction in humans has been confirmed by multiple DBPC studies conducted in large cohorts of patients allergic to grass pollen. Also, long-term clinical benefits of SLIT have been documented following a 3-year treatment with two different grass allergy immunotherapy tablets in adults with rhinitis, demonstrating clinical improvements sustained for at least 2 years after stopping the treatment (i.e., a ‘disease-modifying’ effect of SLIT).

[Immunotherapy. 2012;4(2):201-212]