Sublingual Immunotherapy for the Treatment of Allergic Rhinoconjunctivitis and Asthma

Abstract

LLERGIC RHINITIS AFFECTS approximately 20% to 40% of the US population. 1 Currently, 2 forms of specific immunotherapy (subcutaneous immunotherapy and sublingual immunotherapy) are used clinically in the United States. Considerable interest has emerged in sublingual immunotherapy, which involves placement of the allergen under the tongue for local absorption to desensitize the allergic individual over an extended treatment period to diminish allergic symptoms. Compared with subcutaneous immunotherapy, sublingual immunotherapy is easy to administer, does not involve administration of injections, and may be administered at home, avoiding the inconvenience of office visits. The opportunity for home-based therapy makes it potentially suitable for use in medically underserved areas. In 1996, a World Health Organization Task Force on Immunotherapy cited the For editorial comment see p 1297. CME available online at www.jamanetworkcme.com and questions on p 1299.

Five-grass-pollen sublingual immunotherapy tablet for the treatment of grass-pollen-induced allergic rhinoconjunctivitis: 5 years of experience

“…Until only recently, SCIT was the sole on-label option for AIT management of grass-pollen allergy in the USA, although some physicians use subcutaneous aqueous allergen preparations off-label for sublingual desensitization in allergic patients [33]. In April 2014, Oralair Ò (OA) (Stallergenes, Antony, France) became the first SLIT to be licensed in the USA for the treatment of grass-pollen-induced AR with or without conjunctivitis.…”

“…Factors that have been shown to be important for adherence to AIT include cost; inconvenience; feelings of inefficacy; adverse events (AEs); patient, parent and physician education and number of followup visits [21,32]. Lack of adherence to SLIT may also be caused by the incorrect perception that upon improvement in allergic symptoms, there is no further need to continue therapy [19].AEs with SLIT are generally minor and local (such as oral irritation or ear pruritus), resolving spontaneously, and anaphylaxis is extremely rare (one study reported 11 non-fatal cases from an estimated 1 billion SLIT doses administered since 2000 [26]), as are serious systemic side effects (a comprehensive review of 104 publications on SLIT found 169 of 314,959 administered doses [0.056%] were classified as producing systemic reactions) [21,33,34]. According to recent guidance from the World Allergy Organization, SLIT may be considered as first-line therapy for AR and ARC, and failure of prior pharmacological treatment is not a requirement for its use [21].…”

“…AEs with SLIT are generally minor and local (such as oral irritation or ear pruritus), resolving spontaneously, and anaphylaxis is extremely rare (one study reported 11 non-fatal cases from an estimated 1 billion SLIT doses administered since 2000 [26]), as are serious systemic side effects (a comprehensive review of 104 publications on SLIT found 169 of 314,959 administered doses [0.056%] were classified as producing systemic reactions) [21,33,34]. According to recent guidance from the World Allergy Organization, SLIT may be considered as first-line therapy for AR and ARC, and failure of prior pharmacological treatment is not a requirement for its use [21].…”

Allergen immunotherapy for the treatment of allergic rhinitis and/or asthma: an umbrella review

“…Allergic rhinitis: Anaphylaxis or epinephrine use was reported in the SCIT group of 5 reviews 6,27,29,30,34 (Table 4). One review reported the occurrence of anaphylaxis in a participant receiving placebo.…”

“…30 No deaths were reported in 2 of 3 reviews that assessed SLIT. 27,34 One review reported that 3 deaths occurred in 3 trials, all in the SLIT group; 22 however, none were considered by the manufacturer to be related to treatment.…”