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Dr Nikhila Deo Schroeder MD, an American Board-certified allergist and immunologist as well as a qualified engineer, co-founded Allergenuity Health clinic with her husband James Schroeder – a veteran U.S. Marine turned IT specialist and office executive – in 2018. Their clinic in North Carolina has become one of the leading U.S. providers for delivering SLIT for food and environmental allergies based on a personalised approach and Dr Schroeder’s own method.

The Schroeders share their journey and discuss why individuals from Australia and New Zealand have sought their clinic’s services across the Pacific during an interview with Dr Nina Markovic Khaze (PhD), co-founder of Immunity Group Australia.

What is SLIT? 

SLIT stands for sublingual immunotherapy and is becoming increasingly popular, including among Australians who opt for overseas allergy treatments that are not routinely available in Australia. The American College of Allergies, Asthma and Immunology (ACAAI) states that SLIT is “an alternative way to treat allergies without injections.” In Australia, TGA-approved SLIT tablets have been used for patients as young as five to treat dust mite allergies, and grass pollen allergies. In cases such as tree, mold and animal allergies there are “special exemptions” for non-TGA-related products. There have been issues with the availability of SLIT products in Australia and New Zealand, prompting some Australians and New Zealanders to travel overseas to access SLIT treatments faster, even using them for food allergies—an approach which does not formally exist in Australia. Allergy drops are off-the-label in the US, and are privately billed.

According to ACAAI, SLIT “might prove an effective therapy for children with mild eczema and is currently being studied for its potential in treating food allergies.”

SLIT in practice: Dr Schroeder’s experience

Allergenuity Health is well-positioned to lead the way in studying such potential benefits. According to its co-founder, Dr Nikhila Schroeder:

“Liquid antigen SLIT treatment is done by literally just holding a sweet-tasting liquid droplet – a very specially formulated one – in your mouth a few times each day. Like any form of allergen immunotherapy, achieving substantial, true immunologic change does take time and a commitment.”

“Being able to navigate, think, create, and adjust solutions to the individual person can help patients in ways that following a predetermined or standard solution simply can’t, so I’ve kept that idea central to my practice of medicine.”

“SLIT has a unique ability of exposing the immune system to its allergens via special highly tolerogenic (tolerance-promoting) immune messenger cells found only in the mouth – oral Langerhans cells. They are very efficient at capturing substances present in the mouth and then sending calming signals to the rest of the immune system via specific tolerance-promoting natural chemicals, and important T and B cell influences. In fact, this appears to be a main part of their job – to help the immune system learn to tolerate the exposures seen regularly and non-threateningly in the mouth. These cells help teach the rest of our immune system what to tolerate. We can use them to help teach our immune system that “allergens” are harmless too.”

Many roads lead to Rome

“Problems often have more than one solution, and that is a beautiful and extremely useful concept to remember in health. One solution may be the best overall for one person and a different solution may be best overall for another person with the same underlying issue.”

“Choosing a treatment option is a very personal decision and there is no right or wrong. No single type of treatment is going to be the right choice for everyone, and thankfully there are several effective options available for patients and families to choose from – though some may require travel. SLIT offers significant benefits to the majority of allergic patients in a safe, easy and convenient way. In our typical dosage range, I can fit up to 20 allergens in the same bottle. This allows me to treat up to 20 environmental allergens and up to 20 food allergens with my most common method. But I also completely respect all the other treatments available and discuss them with patients regularly, including the option of avoidance, as each option has specific merits that may be a better fit for certain families.”

Dr Schroeder serves as an outstanding advocate for SLIT and is a valuable source of expertise on all aspects of SLIT, catering not only to Australian and global specialists but also to members of the public keenly interested in this field.

Parts of this article were originally published as ‘An Inside Look at Sub-lingual Immunotherapy’ (no website), reproduced with permission from Allergenuity Health.