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Sublingual immunotherapy and allergic rhinitis

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Abstract

This paper reviews the safety and efficacy of sublingual immunotherapy (SLIT) in the treatment of allergic rhinitis. The literature from 1986 through 2007 shows approximately a 6000-fold range in doses found to be effective with SLIT. However, recent studies in large patient populations have demonstrated a clear dose response with an effective dose range that appears to be equivalent to one to two times the monthly subcutaneous immunotherapy dose administered daily or weekly (ie, 15 to 30 μg of major allergen). Further study is needed to establish the optimal dose and dosing schedule for each formulation. Local reactions (eg, oral itchiness) are common, and serious adverse reactions, although rare, have been reported. Cost-effective analysis cannot be made until the effective dose is established. SLIT appears to be a promising treatment for allergic rhinitis, but it is currently considered investigational in the United States until a formulation approved by the US Food and Drug Administration is available.

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References and Recommended Reading

  1. Durham SR, Walker SM, Varga EM, et al.: Long-term clinical efficacy of grass-pollen immunotherapy. N Engl J Med 1999, 341:468–475.

    Article  PubMed  CAS  Google Scholar 

  2. Eng PA, Borer-Reinhold M, Heijnen IA, et al.: Twelve-year follow-up after discontinuation of preseasonal grass pollen immunotherapy in childhood. Allergy 2006, 61:198–201.

    Article  PubMed  CAS  Google Scholar 

  3. Purello-D’Ambrosio F, Gangemi S, Merendino RA, et al.: Prevention of new sensitizations in monosensitized subjects submitted to specific immunotherapy or not. A retrospective study. Clin Exp Allergy 2001, 31:1295–1302.

    Article  PubMed  CAS  Google Scholar 

  4. Polosa R, Al-Delaimy WK, Russo C, et al.: Greater risk of incident asthma cases in adults with allergic rhinitis and effect of allergen immunotherapy: a retrospective cohort study. Respir Res 2005, 6:153.

    Article  PubMed  Google Scholar 

  5. Des Roches A, Paradis L, Menardo JL, et al.: Immunotherapy with a standardized Dermatophagoides pteronyssinus extract. VI. Specific immunotherapy prevents the onset of new sensitizations in children. J Allergy Clin Immunol 1997, 99:450–453.

    Article  PubMed  Google Scholar 

  6. Jacobsen L, Niggemann B, Dreborg S, et al.: Specific immunotherapy has long-term preventive effect of seasonal and perennial asthma: 10-year follow-up on the PAT study. Allergy 2007, 62:943–948.

    Article  PubMed  CAS  Google Scholar 

  7. Bernstein JA: Pharmacoeconomic considerations for allergen immunotherapy. Clin Allergy Immunol 2004, 18:151–164.

    PubMed  Google Scholar 

  8. Ariano R, Berto P, Tracci D, et al.: Pharmacoeconomics of allergen immunotherapy compared with symptomatic drug treatment in patients with allergic rhinitis and asthma. Allergy Asthma Proc 2006, 27:159–163.

    PubMed  Google Scholar 

  9. Hankin CS, Cox L, Wang Z, et al.: Allergy immunotherapy practice patterns and associated outcomes of care. J Allergy Clin Immunol 2007, 199:S159.

    Article  Google Scholar 

  10. Long-term effects of budesonide or nedocromil in children with asthma. The Childhood Asthma Management Program Research Group [no authors listed]. N Engl J Med 2000, 343:1054–1063.

  11. Guilbert TW, Morgan WJ, Zeiger RS, et al.: Long-term inhaled corticosteroids in preschool children at high risk for asthma. N Engl J Med 2006, 354:1985–1997.

    Article  PubMed  CAS  Google Scholar 

  12. Joint Task Force on Practice Parameters; American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology: Allergen immunotherapy: a practice parameter second update. J Allergy Clin Immunol 2007, 120:S25–S85.

    Article  Google Scholar 

  13. Cox LS, Linnemann DL, Nolte H, et al.: Sublingual immunotherapy: a comprehensive review. J Allergy Clin Immunol 2006, 117:1021–1035.

    Article  PubMed  Google Scholar 

  14. Alvarez-Cuesta E, Berges-Gimeno P, Gonzalez-Mancebo E, et al.: Sublingual immunotherapy with a standardized cat dander extract: evaluation of efficacy in a double blind placebo controlled study. Allergy 2007, 62:810–817. [Published erratum appears in Allergy 2007, 62:1100.]

    Article  PubMed  CAS  Google Scholar 

  15. Nelson HS, Oppenheimer J, Vatsia GA, Buchmeier A: A double-blind, placebo-controlled evaluation of sublingual immunotherapy with standardized cat extract. J Allergy Clin Immunol 1993, 92:229–236.

    Article  PubMed  CAS  Google Scholar 

  16. Didier A, Malling HJ, Worm M, et al.: Optimal dose, efficacy, and safety of once-daily sublingual immunotherapy with a 5-grass pollen tablet for seasonal allergic rhinitis. J Allergy Clin Immunol 2007, 120:1338–1345.

    Article  PubMed  CAS  Google Scholar 

  17. Durham S, Yang W, Pedersen M, et al.: Sublingual immunotherapy with once-daily grass allergen tablets: a randomized controlled trial in seasonal allergic rhinoconjunctivitis. J Allergy Clin Immunol 2006, 117:802–809.

    Article  PubMed  CAS  Google Scholar 

  18. Dahl R, Kapp A, Colombo G, et al.: Efficacy and safety of sublingual immunotherapy with grass allergen tablets for seasonal allergic rhinoconjunctivitis. J Allergy Clin Immunol 2006, 118:434–440.

    Article  PubMed  CAS  Google Scholar 

  19. Dahl, R, Stender A, Rak S: Specific immunotherapy with SQ standardized grass allergen tablets in asthmatics with rhinoconjunctivitis. Allergy 2006, 61:185–190.

    Article  PubMed  CAS  Google Scholar 

  20. Durham SR, Riis B: Grass allergen tablet immunotherapy relieves individual seasonal eye and nasal symptoms, including nasal blockage. Allergy 2007, 62:954–957.

    Article  PubMed  CAS  Google Scholar 

  21. Dahl R, Kapp A, Colombo G, et al.: Sublingual grass allergen tablet immunotherapy provides sustained clinical benefit with progressive immunologic changes over 2 years. J Allergy Clin Immunol 2007, Epub ahead of print.

  22. Frew AJ, Powell RJ, Corrigan CJ, et al.: Efficacy and safety of specific immunotherapy with SQ allergen extract in treatment-resistant seasonal allergic rhinoconjunctivitis. J Allergy Clin Immunol 2006, 117:319–325.

    Article  PubMed  CAS  Google Scholar 

  23. Valovirta E, Jacobsen L, Ljorring C, et al.: Clinical efficacy and safety of sublingual immunotherapy with tree pollen extract in children. Allergy 2006, 61:1177–1183.

    Article  PubMed  CAS  Google Scholar 

  24. Savolainen J, Jacobsen L, Valovirta E: Sublingual immunotherapy in children modulates allergen-induced in vitro expression of cytokine mRNA in PBMC. Allergy 2006, 61:1184–1190.

    Article  PubMed  CAS  Google Scholar 

  25. Arbes SJ, Jr, Gergen PJ, Elliott L, et al.: Prevalences of positive skin test responses to 10 common allergens in the US population: results from the third National Health and Nutrition Examination Survey. J Allergy Clin Immunol 2005, 116:377–383.

    Article  PubMed  Google Scholar 

  26. Marogna M, Spadolini I, Massolo A, et al.: Effects of sublingual immunotherapy for multiple or single allergens in polysensitized patients. Ann Allergy Asthma Immunol 2007, 98:274–280.

    PubMed  CAS  Google Scholar 

  27. Khinchi MS, Poulsen LK, Carat F, et al.: Clinical efficacy of sublingual and subcutaneous birch pollen allergen-specific immunotherapy: a randomized, placebo-controlled, double-blind, double-dummy study. Allergy 2004, 59:45–53.

    Article  PubMed  CAS  Google Scholar 

  28. Wilson DR, Torres LI, Durham SR: Sublingual immunotherapy for allergic rhinitis. Cochrane Database Syst Rev 2003, 2:CD002893.

  29. Calderon MA, Alves B, Jacobson M, et al.: Allergen injection immunotherapy for seasonal allergic rhinitis. Cochrane Database Syst Rev 2007, 1:CD001936.

  30. Polosa R, Li Gotti F, Mangano G, et al.: Effect of immunotherapy on asthma progression, BHR and sputum eosinophils in allergic rhinitis. Allergy 2004, 59:1224–1228.

    Article  PubMed  CAS  Google Scholar 

  31. Di Rienzo V, Marcucci F, Puccinelli P, et al.: Long-lasting effect of sublingual immunotherapy in children with asthma due to house dust mite: a 10-year prospective study. Clin Exp Allergy 2003, 33:206–210.

    Article  PubMed  Google Scholar 

  32. Novembre E, Galli E, Landi F, et al.: Coseasonal sublingual immunotherapy reduces the development of asthma in children with allergic rhinoconjunctivitis. J Allergy Clin Immunol 2004, 114:851–857.

    Article  PubMed  CAS  Google Scholar 

  33. Des Roches A, Paradis L, Knani J, et al.: Immunotherapy with a standardized Dermatophagoides pteronyssinus extract. V. Duration of the efficacy of immunotherapy after its cessation. Allergy 1996, 51:430–433.

    Article  PubMed  Google Scholar 

  34. Cox L, Cohn JR: Duration of allergen immunotherapy in respiratory allergy: when is enough, enough? Ann Allergy Asthma Immunol 2007, 98:416–426.

    PubMed  Google Scholar 

  35. Marogna M, Bruno M, Massolo A, et al.: Long-lasting effects of sublingual immunotherapy for house dust mites in allergic rhinitis with bronchial hyperreactivity: a long-term (13-year) retrospective study in real life. Int Arch Allergy Immunol 2007, 142:70–78.

    Article  PubMed  CAS  Google Scholar 

  36. Tari MG, Mancino M, Monti G: Efficacy of sublingual immunotherapy in patients with rhinitis and asthma due to house dust mite. A double-blind study. Allergol Immunopathol (Madr) 1990, 18:277–284.

    CAS  Google Scholar 

  37. Rolinck-Werninghaus C, Wolf H, Liebke C, et al.: A prospective, randomized, double-blind, placebo-controlled multi-centre study on the efficacy and safety of sublingual immunotherapy (SLIT) in children with seasonal allergic rhinoconjunctivitis to grass pollen. Allergy 2004, 59:1285–1293.

    Article  PubMed  CAS  Google Scholar 

  38. Stewart GE 2nd, Lockey RF: Systemic reactions from allergen immunotherapy. J Allergy Clin Immunol 1992, 90(4 Pt 1):567–578.

    Article  PubMed  Google Scholar 

  39. Van Metre TE, Adkinson NF, Amodio FJ, et al.: A comparison of immunotherapy schedules for injection treatment of ragweed pollen hay fever. J Allergy Clin Immunol 1982, 69:181–193.

    Article  PubMed  Google Scholar 

  40. Amin HS, Liss GM, Bernstein DI: Evaluation of near-fatal reactions to allergen immunotherapy injections. J Allergy Clin Immunol 2006, 117:169–175.

    Article  PubMed  Google Scholar 

  41. Bernstein DI, Wanner M, Borish L, et al.: Twelve-year survey of fatal reactions to allergen injections and skin testing: 1990–2001. J Allergy Clin Immunol 2004, 113:1129–1136.

    Article  PubMed  Google Scholar 

  42. Reid MJ, Lockey RF, Turkeltaub PC, et al.: Survey of fatalities from skin testing and immunotherapy 1985–1989. J Allergy Clin Immunol 1993, 92(1 Pt 1):6–15.

    Article  PubMed  CAS  Google Scholar 

  43. Lockey RF, Benedict LM, Turkeltaub PC, Bukantz SC: Fatalities from immunotherapy (IT) and skin testing (ST). J Allergy Clin Immunol 1987, 79:660–677.

    Article  PubMed  CAS  Google Scholar 

  44. Antico A, Pagani M, Crema A: Anaphylaxis by latex sublingual immunotherapy. Allergy 2006, 61:1236–1237.

    Article  PubMed  CAS  Google Scholar 

  45. Eifan AO, Keles S, Bahceciler NN, et al.: Anaphylaxis to multiple pollen allergen sublingual immunotherapy. Allergy 2007, 62:567–568.

    Article  PubMed  CAS  Google Scholar 

  46. Dunsky EH, Goldstein MF, Dvorin DJ, Belecanech GA: Anaphylaxis to sublingual immunotherapy. Allergy 2006, 61:1235.

    Article  PubMed  CAS  Google Scholar 

  47. Bachert C, Vestenbaek U, Christensen J, et al.: Cost-effectiveness of grass allergen tablet (GRAZAX(R)) for the prevention of seasonal grass pollen induced rhinoconjunctivitis: a Northern European perspective. Clin Exp Allergy 2007, 37:772–779.

    Article  PubMed  CAS  Google Scholar 

  48. Andre C, Perrin-Fayolle M, Grosclaude M, et al.: A double-blind placebo-controlled evaluation of sublingual immunotherapy with a standardized ragweed extract in patients with seasonal rhinitis. Evidence for a dose-response relationship. Int Arch Allergy Immunol 2003, 131:111–118.

    Article  PubMed  CAS  Google Scholar 

  49. Marcucci F, Sensi L, Di Cara G, et al.: Dose dependence of immunological response to sublingual immunotherapy. Allergy 2005, 60:952–956.

    Article  PubMed  CAS  Google Scholar 

  50. Bordignon V, Burastero SE: Multiple daily administrations of low-dose sublingual immunotherapy in allergic rhinoconjunctivitis. Ann Allergy Asthma Immunol 2006, 97:158–163.

    Article  PubMed  Google Scholar 

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  1. Nova Southeastern University Osteopathic College of Medicine, 5333 North Dixie Highway, Suite 210, Fort Lauderdale, FL, 33334, USA

    Linda Cox

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Correspondence to Linda Cox.

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Cox, L. Sublingual immunotherapy and allergic rhinitis. Curr Allergy Asthma Rep 8, 102–110 (2008). https://doi.org/10.1007/s11882-008-0019-5

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