Sublingual immunotherapy has been performed for peanut allergy using liquid forms of allergen which are held under the tongue for a few minutes before being swallowed. This route tends to
result in fewer side effects, and systemic reactions are rare. The maintenance dose however is generally much smaller than oral immunotherapy making it less effective at desensitisation to high levels of inadvertent exposure.
Epicutaneous desensitization has also been studied in peanut allergy via the application of an adhesive patch delivering low doses of peanut allergen via the skin. It is generally applied to the back or upper arm and worn for 24 hours before being replaced. Like oral and sublingual immunotherapy the dose is administered daily however the dose is standard and much lower (generally 250 micrograms). Epicutaneous desensitisation appears to have a more favourable safety profile than oral or sublingual immunotherapy but local reactions at the site of the patch are common. Systemic reactions have not been reported and it is generally well tolerated.