Placing a tablet with an allergen under someone's tongue to help ameliorate allergic responses has been around for a bit and is known as 'sublingual immunotherapy', but now, as Rick and I discuss on PodMed this week, the strategy was tried in people with moderate to severe asthma who were allergic to dust mites to try to reduce asthma attacks or exacerbations when corticosteroids were tapered. Wow, that's a mouthful in describing the study population, but the upshot is it is desirable both to reduce corticosteroid use in these folks but also to avoid hospitalizations relative to asthma attacks. The study was published in JAMA, and the news is good. The two groups who received the allergen under their tongues did see a reduction in their exacerbations even when the steroids were reduced and discontinued.
Rick says the benefits to the treatment, abbreviated 'SLIT,' are multiple, and include ease of administration (no one likes shots!) and a reduced dosing schedule over months rather than continuously, as is seen with allergy shots. Potential downsides include slightly less efficacy relative to injections and some oral itching and associated mouth symptoms in about 20% of the higher dose SLIT group. Do these results warrant expanded investigation into other groups of allergic folks, and perhaps tablets with more than one allergen? Stay tuned, as we agree that the likelihood seems high.
Other topics this week include 'antibiotic stewardship' and risks of smoking cessation drugs in the Lancet, and methods to reduce Clostridium difficile infection in the hospital in JAMA Internal Medicine. Until next week, y'all live well.