The use of grocery-sourced real food solutions in sublingual immunotherapy for food allergies.

Background: Sublingual immunotherapy (SLIT) is a safe, effective therapy for the treatment of food allergy. Studies demonstrating SLIT efficacy have primarily used pharmaceutical glycerinated food extracts for the administration of food allergens, which may limit accessibility due to extract cost and availability.

Objective: To develop novel sample protocols and resources for the preparation of grocery-sourced real food SLIT solutions, which could help more clinicians incorporate food SLIT into their practice and increase accessibility to this treatment. Secondly, to describe our site's experience with real food SLIT implementation.

Methods: Three- and five-dose build-up protocols were developed using powdered or liquid-based forms of food allergens, with a maintenance dose of 2-4 mg protein/day. Patient adherence and satisfaction data were collected via online surveys. After 1-2 years of daily real food SLIT maintenance dosing, patients were offered a low-dose oral food challenge (OFC) (cumulative dose, 330-340 mg protein).

Results: Sample protocols for real food SLIT were developed for 31 foods, including peanut, cow's milk, cashew, egg, and sesame. At our site, 305 patients have undergone or are currently undergoing real food SLIT. Of 162 satisfaction survey respondents, 99% (n=160) were satisfied or very satisfied with their care. Adherence surveys showed that 82% of respondents (n=105/128) reported consistently taking their SLIT dose. Among a subset of 33 patients, 57 low-dose OFCs were performed, of which 70.1% (n=40) were successful.

Conclusion: Grocery-sourced real food SLIT solutions present another food SLIT option that may expand the feasibility and accessibility of this safe and effective food allergy immunotherapy.