Dr. Marple: The overarching questions are: Does SLIT replace SCIT, does SLIT augment traditional treatment, or does it provide another option? We don’t yet have enough data to really differentiate which patients would really benefit from SCIT and who would be best served with SLIT. With my own patients, I inform them about each method of delivery. Then, I let the patients make the choice. Given a choice that is completely independent of reimbursement, I find patients almost uniformly prefer to go with SLIT.
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February 2009How do you go about using SLIT?
Dr. Levine: In our practice, once the patient decides to use SLIT, we give the first dose in the office to make sure there’s no reaction. Then we give them enough solution for 12 weeks at a time. If they’re local, they stop in once every 12 weeks as we escalate the concentration of antigen and monitor their response. If they’re patients who are traveling long distances, we ship drops to them and have them stop in and see us when it’s convenient.
How does the off-label status affect the use of SLIT?
Dr. Marple: In reality, many treatments are used off-label. In otolaryngology, we’re forced on a very regular basis to treat diseases off -label. Consider chronic rhinosinusitis; there are no FDA-approved medical therapies available to physicians. Practitioners must resort to the off-label use of a variety of medications such as antibiotics, antifungals, and corticosteroids. It’s important to realize that all these medications have been approved for other uses by the FDA. Similarly, with SLIT, this is an off-label use of an already FDA-approved product.
Dr. Levine: Because it’s not being used in the way that was originally approved by the FDA, we call it off-label. But should that limit us from offering SLIT to our patients? Absolutely not. Twenty percent of the drugs that are prescribed in the United States today are off-label FDA drugs.
©2009 The Triological Society
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