Dr Nagendra Prasad Pharmacy

Sublingual Immunotherapy (SLIT)

Allergens are well tolerated and stable in room temperature in solid form. Bengaluru Allergy Centr (BAC) initiated SLIT drops with unique diluent formulations for better absorption and adherence of allergens through mucous membrane. Subsequently formulated to solid dosage form of SLIT STRIPE to begin with, which is well tolerated by patients. Recently SLIT TABLET dosage form is introduced to make the delivery much more effectively in a palatable dosage form. It took more than three years and finally successful in formulation to present STRIPE and TABLET dosage forms. Stripe process takes several hours and involves crucial and hectic technical efforts to monitor and to prepare SLIT stripes and skilled labour oriented. So we adopted the SLIT tablet formulation for House Dust Mite, made successful to prepare under GMP standards and with monitoring parameters like disintegration time, dissolution and maintaining the desired potency levels of the purified and standard allergen extract. SLIT TABLETS are having selective excipients for better absorption, release and to retain the stable allergens at mucosal level. SLIT tablet is a custom made, personalized medicine and Dr Nagendra Prasad Pharmacy received approval from the statutory body of KDSC for dispensing SLIT.

SLIT tablet dosage form, straight you can initiate Maintenance dose from day one with no systemic side effects without Build up phase which is very much necessary in SCIT. SLIT showed and noticed only 4 to 5 % local side effects at the sublingual mucous membrane, which disappears in few days.

Advantage over SLIT drops, SLIT tablets is more allergen stable when stored at room temperature at dry and dark place. The sublingual tablet dosage form is convenient to operate, to hold below the tongue and without over or under shooting doses as it happens with SLIT drops.

How to administer SLIT

SLIT is a unique immunotherapy treatment modality: it combines extreme safety with efficacy and it has some advantages over the traditional injectable method:

1). It is much easy to administer so it becomes the ideal home-based immunotherapy: As patient self-administers the treatment at home, the need of transportation to and from the office, and the safety-requirement of waiting at the doctor’s office for 30 minutes after each shot are avoided.

2). Because of the easy administration SLIT is useful for the treatment of young children. Its sweet taste facilitates administration. Weekly co-pays (required usually for each weekly injection) do not exist.

As SLIT eliminates the need for needles, people that cannot tolerate injections can now become candidates for immunotherapy.

Lastly SLIT is useful in special situations like.

  • The patient with asthma. (We strongly suggest that SLIT should be considered the treatment of choice for these patients).
  • The patient on beta blockers (BB’s). Betablockers are a group of medications used mainly for the treatment of Hypertension, Arrhythmias and Migraines. They can facilitate a severe reaction to allergy shots.
  • The patient with physical or logistical difficulties in coming to the doctor’s office on a weekly basis.

Important information on Sublingual Immunotherapy (SLIT) Administration

Sl.No Procedure Rational
1 Check patients’ name and DOB to confirm that SLIT is being administered to the correct patient To ensure the patient receives the correct treatment
2 Obtain baseline observations prior to commencingSLIT, including lung function testing and/or peak flow levels for patients with asthma and assessment of skin condition in those with eczema. To reduce the risk of a severe or systemic reaction.
Complete a visual inspection of the mouth, observing for oral lesions or loose teeth. If oral lesions are present, do not proceed with SLIT until the lesions have healed. To ensure patient is able to safely commenceon administration of SLIT.
Ensure patient is not unwell.
3 Confirm that the patient is not pregnant. SLIT should not be initiated in patients who are pregnant, due to the risk of anaphylaxis.
4 The patient should refrain from eating and drinking for five minutes prior to and following administration of SLIT. Food or drink in the oral cavity could affect the absorption of the SLIT.
5 Administer SLIT by placing the treatment in the sublingual pocket under the base of the tongue. Please see individual SPC for product specific advice. SLIT is absorbed via the sublingual route.
6 SLIT should remain under the tongue for between 1–2 minutes before swallowing To ensure SLIT is absorbed by the sublingual glands
7 Monitor patient for any sign of an allergic reaction for 30–60 minutes following administration of SLIT. An allergic reaction could occur following administration of SLIT.
8 Reassure patient if they experience symptoms such as oral tingling, pruritus, mild tongue swelling, itchy throat or ears that these are common side effects in the early phase of treatment. These are common side effects and should resolve 1 – 2 weeks after beginning SLIT.
9 Promptly treat any allergic reaction or side effects of SLIT. To ease discomfort and prevent the development of moderate symptoms.
10 Advise patient that if side effects are unpleasant that they can take an oral non-sedating antihistamine 30-60 minutes prior to taking their SLIT medication. Pre-dosing with an oral antihistamine in the first 1-2 weeks may help reduce unpleasant side effects in the early stage of treatment.
11 Advise the patient to stop taking SLIT in the following situations:
• For 7 days following oral surgery, including dental extraction
• For 7 days after shedding a deciduous tooth
• If patient has an oral ulcer or open wound in the mouth or oral mucosa – to temporarily discontinue SLIT until area has healed.
To reduce the risk of SLIT being absorbed systemically through an open lesion rather than through the sublingual mucosa.
Patients with concomitant asthma and experiencing an acute upper respiratory tract infection – to temporarily discontinue until infection has resolved. To reduce the risk of patient experiencing exacerbation of asthma and/or respiratory symptoms.
12 Document administration of SLIT, any side effects and treatment given To record administration and treatments for governance.
13 Reassess the patient prior to discharge. To ensure the patient has not had an allergic reaction and is fit for discharge.
14 Ensure the patient and/or family have the following information on discharge;
• How to recognise and manage an allergic reaction
• Advise the patient to ensure they have immediate access to a non-sedating antihistamine.
• Revision and reinforcement of the importance of compliance with medication
• Have a supply of initial treatment and are aware of how to collect ongoing supply
• Written information relating to the product they are using
• Contact details should they require ongoing support
To ensure the patient and family are supported and aware of how to overcome any problems with their treatment.
To treat side effects of SLIT.
15 Advise patient to continue taking SLIT daily as prescribed (typically for the next 3 years). In order to gain maximum benefit from SLIT treatment.