Sublingual Immunotherapy for Japanese Cedar Pollinosis: Current Clinical and Research Status

Abstract

The incidence of Japanese cedar pollinosis is increasing significantly in Japan, and a recent survey suggested that about 40% of the population will develop this disease. However, spontaneous remission is rare. The increased incident rate of Japanese cedar pollinosis is a huge issue in Japan. Allergen immunotherapy is the only fundamental treatment that modifies the natural course of allergic rhinitis and provides long-term remission that cannot be induced by general drug therapy. Sublingual immunotherapy for Japanese cedar pollinosis has been developed and has been covered by health insurance since 2014 in Japan. The indication for children was expanded in 2018. Clinical trials of sublingual immunotherapy for Japanese cedar pollinosis have demonstrated its long-term efficacy and safety. It is recommended for patients who wish to undergo fundamental treatment regardless of the severity of the practical guidelines for the management of allergic rhinitis in Japan. For sublingual immunotherapy, a long-term treatment period of 3 years or longer is recommended to obtain stable therapeutic effects. In recent years, evidence based on basic research and clinical trials has demonstrated sublingual immunotherapy-induced immunological changes and efficacy in patients; however, biomarkers that objectively predict and judge these therapeutic effects need to be established.

The Combined Effects of Sublingual Immunotherapy and Lactobacillus acidophilus-Producing Extract on Cedar Pollinosis Symptoms

“…Sublingual immunotherapy (SLIT) is a promising curative therapy, which induces regulatory T cells to induce Th1-type immune responses and alleviate Th2-type immune responses. It is also thought to have a mechanism of action such as inducing allergen-specific IgG4 antibodies, which are antibodies that block cedar pollen antigens, in the body [ 3 ]. The use of various food-derived ingredients has been investigated for the purpose of improving QOL and treatment of cedar pollinosis.…”

“…There are reports [ 3 ] that the usefulness of SLIT and the intake of lactic acid bacteria and components such as probiotics and postbiotics are effective against cedar pollinosis by bringing about improvement of the intestinal environment. However, there are no studies within the scope of the author's search that evaluated the combination therapy of SLIT and LEX or the usefulness of LEX as a salvage therapy for SLIT ineffective cases.…”

Safety of Sublingual Immunotherapy: A Secondary Analysis of Post-marketing Adverse Events Reports Using a Japanese Public Database

“…In Japan, sublingual immunotherapy (SLIT) has received increasing attention recently. This treatment involves the daily administration of small quantities of allergenic substances throughout three to five years, gradually acclimating the body to these allergens [4]. SLIT is considered safer than injecting allergenic substances, and the possibility of self-administration at home enhances patient convenience.…”