Managing Food Allergies: What Parents Should Know About Sublingual Immunotherapy

For families managing food allergies, even simple moments—like snack time or birthday parties—can bring stress. A parent checks every label on lunches and grocery lists, hoping nothing gets missed. That worry adds up day after day.

Avoiding allergens remains the first line of defense. But more families are now exploring medical options for added protection and peace of mind. One of these options is sublingual immunotherapy. It offers a gentle, at-home approach that may help reduce allergic reactions over time.

So what exactly is sublingual immunotherapy, and how might it help families managing food allergies? Here’s an overview to help you decide if it’s right for your family. 

What Are Food Allergies?

Food allergies happen when the immune system mistakenly identifies a certain food protein as harmful, even if it isn’t. The body responds by releasing chemicals that cause symptoms ranging from mild (like hives or itching) to life-threatening (such as anaphylaxis). 

About 1 in 13 children in the United States has a food allergy, with common triggers including:

• Peanuts
• Tree nuts
• Milk
• Eggs
• Wheat
• Soy
• Fish and shellfish

Because accidents can happen anytime, especially in public settings where control is nearly impossible, families often live with constant anxiety. 

What is Sublingual Immunotherapy (SLIT)?

Sublingual immunotherapy, or SLIT, helps reduce sensitivity to allergens. It works by introducing small, controlled doses of an allergen into the body. These doses come in liquid or tablet form and go under the tongue.

Instead of avoiding allergens completely, SLIT gently exposes the immune system to them. Over time, this exposure helps the body react less aggressively. In the U.S., the FDA has approved SLIT for treating environmental allergies like grass pollen, dust mites, and ragweed.

Is SLIT Used for Food Allergies?

Some allergists in the U.S. offer SLIT off-label for food allergies such as peanuts, milk, and hazelnuts. The FDA has not approved it for this purpose, but off-label use is common in healthcare. In fact, about one in five prescriptions written today is for off-label use.

Clinical trials show early promise. Some patients develop increased tolerance and experience less severe reactions over time. Studies funded by the National Institutes of Health suggest that SLIT may lower the risk of severe reactions from accidental exposure to certain foods.

SLIT is not a cure. However, it may offer an option for families who aren't ready for oral immunotherapy (OIT) or want a less intensive approach.

How SLIT Works

Take SLIT at home once a day by placing a small amount of allergen extract or tablet under your tongue and holding it for 1–2 minutes before swallowing. Most people follow this treatment for 3–5 years under the ongoing supervision of an allergist.

While most common in treating seasonal allergies, the process of building immune tolerance is the same regardless of the allergen:

1. Initial dose: Determined by your allergist after allergy testing.
2. Daily dosing: Administered at home with check-ins to monitor progress.
3. Long-term goal: Reduce symptoms or risk of serious reaction over time.

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Side effects are usually mild, such as mouth or throat itching. Serious reactions are rare. Still, families should have an emergency plan, especially when treating food allergies in a clinical trial setting.

Benefits of SLIT for Families

Even though SLIT is not yet widely available for food allergy treatment, it’s worth understanding why it’s gaining interest:

• Needle-free: No injections, which is great for kids who are nervous about needles.
• Home-based: After the first dose, most doses can be taken at home, reducing clinic visits.
• Potential peace of mind: SLIT can offer a layer of protection against accidental food exposures, although results vary, and it may not be the right fit for everyone. 
• Good safety profile: In early trials, SLIT showed fewer severe reactions compared to oral immunotherapy.

For many types of allergies, SLIT is already helping kids and families experience fewer symptoms, improved sleep, and greater freedom in everyday life. As food allergy research evolves, SLIT may soon offer similar benefits in that space.

What to Consider Before Starting SLIT

If your child has a food allergy and you’re exploring emerging treatments, here are a few things to keep in mind:

• SLIT for food allergies isn’t FDA-approved in the U.S., but it is available for off-label use. 
• Always consult with an allergist to evaluate whether your child is a good candidate for any immunotherapy.
• SLIT for environmental allergies is widely available, and in some cases, treating environmental allergies can improve overall immune regulation in children with multiple sensitivities.

A Growing Option for Families Managing Food Allergies

While sublingual immunotherapy (SLIT) isn’t FDA-approved for food allergies just yet, it is available off-label for families looking to expand their options.

For certain children with diagnosed food allergies, SLIT may help build tolerance over time and reduce the risk of severe reactions, especially when daily life is full of uncertainties around meals, snacks, and social events.

For families navigating food allergies every day, having more options can make all the difference. SLIT may not be the right fit for everyone, but for some, it offers a safe, at-home step toward a more flexible and confident life.

If you’re curious about whether it could work for your child, a conversation with your allergist is a good place to start.