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Facts About SLIT Administration

TASTE: SWEET!

The usual diluent or vehicle used in oral vaccines is Glycerin and Glycerin has a sweet taste. This fact explains why SLIT administration is usually acceptable even for very young children.

Glycerin is a very potent stabilizer. While proteins with biological activity (like allergy vaccines) tend to deteriorate over time – which is why the injectable vaccines need to be kept refrigerated – proteins dissolved in Glycerin (like with SLIT) will maintain their biological activity for a very long time. Therefore SLIT does not require refrigeration in order to maintain potency. This is a very significant advantage as the bottle of SLIT can travel with the patient in case of long trips as the drops are going to be used way before potency can be affected.

HOW ARE THE ALLERGY DROPS APPLIED?

The protocol or administration schedule has been published in the ENT Journal 1 and it is summarized below:

  1. Drops are placed under the tongue (i.e.: sublingually)
  2. Drops are held under the tongue for 20-30seconds and then swallowed
  3. Drops are taken once a day every day
  4. Number of drops applied under the tongue every day oscillates between 1 and 5 according to following schedule:
    1. First dose is 1 drop: 1 drop is applied under the tongue once a day every day for a week
    2. Dose is advanced by 1 drop once a week as follows:
      1. Week 1: 1 drop per day every day
      2. Week 2: 2 drops per day every day
      3. Week 3: 3 drops per day every day
      4. Week 4: 4 drops per day every day
      5. Week 5: 5 drops per day every day
    3. When the dose of 5 drops per day is reached, it does not increase, but rather continues at 5 drops per day once a day until the bottle is finished
    4. When a bottle is finished, the next bottle will start at 1 drop per day every day. Once a week the dose will increase by 1 drop as above, repeating the cycle just described. Because each bottle will be of increasing strength (higher concentration) it will require starting at a smaller volume (less number of drops)

SLIT bottles do not need to be kept in the refrigerator. Patient can therefore keep the bottle in a convenient place where it will be seen or have easy access. This fact helps in attaining compliance. For optimal administration the drops should be applied using a mirror so that drops can be counted and placed accurately. Our protocol requires that the drops are held under the tongue for 20 to 30 seconds only. This is in agreement with the latest scientific research, that proves that even a relatively brief contact (of the allergens in the drops) with the sublingual mucosa is enough to elicit the desired effect.15  

When we mix our treatment bottles we use the allergenic extracts in such a way that the maximum number of drops taken at any time will not be higher than 5 drops. This also contributes to the easy administration of our SLIT drops, as the volume will always be small and the time of administration brief (it is much easier to keep 5 drops under the tongue for 20-30 seconds, than for example 10 or 20 drops for 1 or 2 minutes).

Bibliography

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