Skip to main content
SpringerLink
Log in

Ragweed sublingual immunotherapy (SLIT) tablets in allergic rhinoconjunctivitis: a systematic review and meta-analysis

  • Review Article
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 08 April 2022

Abstract

Purpose

Ragweed allergen causes Allergic rhinoconjunctivitis and sublingual immunotherapy is one of the treatment modalities to desensitize allergic individuals. This systematic review assesses the effectiveness and safety of sublingual immunotherapy for allergic rhinoconjunctivitis caused due to Ragweed.

Methods

The databases search was done through December 2020. English-language randomized controlled trials were included if they compared sublingual immunotherapy with placebo, pharmacotherapy, or other sublingual immunotherapy regimens, and reported clinical outcomes. The strength of the evidence for each comparison and outcome was graded based on the risk of bias, consistency, magnitude of effect, and the directness of the evidence.

Results

The searches performed according to the protocol identified 134 abstracts of which 67 were duplicates. A total of 37 full papers were therefore reviewed of which 5 were included for the final study. Participants’ ages ranged from 4 to 58 years. The risk of bias was low in most studies. The review suggests that sublingual immunotherapy improves rhinoconjunctivitis symptoms, with 4 of 4 studies reporting efficacy showed improvement in the symptom score of SLIT groups compared to placebo. Local reactions were frequent, but anaphylaxis was not reported in any of the studies. Serious adverse events were very few in all the studies.

Conclusions

The overall evidence showed the effectiveness of sublingual immunotherapy for the treatment of allergic rhinoconjunctivitis with or without asthma, but high-quality studies are still needed to answer questions regarding optimal dosing strategies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

ARC:

Allergic rhinoconjunctivitis

AR/C:

Allergic rhinitis, with or without conjunctivitis

SLIT:

Sublingual immunotherapy

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

PROSPERO:

Prospective register of systematic review

RCT:

Randomized controlled trials

TCS:

Total combined symptom and medication score

DSS:

Daily symptom score

DMS:

Daily medication score

AE:

Adverse effects

References

  1. Roberts G, Pfaar O, Akdis C, Ansotegui I, Durham S, van GerthWijk R et al (2018) EAACI guidelines on allergen immunotherapy: allergic rhinoconjunctivitis. Allergy 73(4):765–798

    Article  CAS  Google Scholar 

  2. Greiner AN, Hellings PW, Rotiroti G, Scadding GK (2011) Allergic rhinitis. Lancet 378(9809):2112–2122

    Article  Google Scholar 

  3. Nurmatov U, Dhami S, Arasi S, Roberts G, Pfaar O, Muraro A et al (2017) Allergen immunotherapy for allergic rhinoconjunctivitis: a systematic overview of systematic reviews. Clin Transl Allergy 7(1):24

    Article  Google Scholar 

  4. Singh K, Axelrod S, Bielory L (2010) The epidemiology of ocular and nasal allergy in the United States, 1988–1994. J Allergy Clin Immunol 126(4):778–83.e6

    Article  Google Scholar 

  5. Dhami S, Nurmatov U, Arasi S, Khan T, Asaria M, Zaman H et al (2017) Allergen immunotherapy for allergic rhinoconjunctivitis: a systematic review and meta-analysis. Allergy 72(11):1597–1631

    Article  CAS  Google Scholar 

  6. Ariano R, Berra D, Chiodini E, Ortolani V, Cremonte LG, Mazzarello MG et al (2015) Ragweed allergy: pollen count and sensitization and allergy prevalence in two italian allergy centers. Allergy Rhinol 6(3):ar.2015.6.0141

    Article  Google Scholar 

  7. Tosi A, Bonini M, Wüthrich B, Pietragalla-Köhler B (2011) Time lag between Ambrosia sensitisation and Ambrosia allergy: a 20-year study (1989–2008) in Legnano, northern Italy. Swiss Med Wkly. https://doi.org/10.4414/smw.2011.13253

    Article  PubMed  Google Scholar 

  8. Dechamp C, Le Gal M, Deviller P (1995) Prevalence of ragweed hayfever in the south and east of the greater Lyon region in 1993. Allergie et Immunol 27(9):320

    CAS  Google Scholar 

  9. Im W, Schneider D (2005) Effect of weed pollen on children’s hospital admissions for asthma during the fall season. Arch Environ Occup Health 60(5):257–265

    Article  Google Scholar 

  10. Zhong W, Levin L, Reponen T, Hershey GK, Adhikari A, Shukla R et al (2006) Analysis of short-term influences of ambient aeroallergens on pediatric asthma hospital visits. Sci Total Environ 370(2–3):330–336

    Article  CAS  Google Scholar 

  11. Canonica GW, Cox L, Pawankar R, Baena-Cagnani CE, Blaiss M, Bonini S et al (2014) Sublingual immunotherapy: World Allergy Organization position paper 2013 update. World Allergy Organ J 7(1):6

    Article  Google Scholar 

  12. Creticos PS, Esch RE, Couroux P, Gentile D, D’Angelo P, Whitlow B et al (2014) Randomized, double-blind, placebo-controlled trial of standardized ragweed sublingual-liquid immunotherapy for allergic rhinoconjunctivitis. J Allergy Clin Immunol 133(3):751–758

    Article  CAS  Google Scholar 

  13. Nolte H, Bernstein DI, Nelson HS, Ellis AK, Kleine-Tebbe J, Lu S (2020) Efficacy and safety of ragweed SLIT-Tablet in children with allergic rhinoconjunctivitis in a randomized, placebo-controlled trial. J Allergy Clin Immunol Pract 8(7):2322–31.e5

    Article  Google Scholar 

  14. Lin SY, Erekosima N, Kim JM, Ramanathan M, Suarez-Cuervo C, Chelladurai Y et al (2013) Sublingual immunotherapy for the treatment of allergic rhinoconjunctivitis and asthma: a systematic review. JAMA 309(12):1278–1288

    Article  CAS  Google Scholar 

  15. Skoner D, Gentile D, Bush R, Fasano MB, McLaughlin A, Esch RE (2010) Sublingual immunotherapy in patients with allergic rhinoconjunctivitis caused by ragweed pollen. J Allergy Clin Immunol 125(3):660-6-6.e1-6.e4

    Article  Google Scholar 

  16. Nayak AS, Atiee GJ, Dige E, Maloney J, Nolte H (2012) Safety of ragweed sublingual allergy immunotherapy tablets in adults with allergic rhinoconjunctivitis. Allergy Asthma Proc 33(5):404–410

    Article  Google Scholar 

  17. Bowen T, Greenbaum J, Charbonneau Y, Hebert J, Filderman R, Sussman G et al (2004) Canadian trial of sublingual swallow immunotherapy for ragweed rhinoconjunctivitis. Ann Allergy Asthma Immunol 93(5):425–430

    Article  Google Scholar 

  18. Radulovic S, Wilson D, Calderon M, Durham S (2011) Systematic reviews of sublingual immunotherapy (SLIT). Allergy 66(6):740–752

    Article  CAS  Google Scholar 

  19. Wilson DR, Lima MT, Durham SR (2005) Sublingual immunotherapy for allergic rhinitis: systematic review and meta-analysis. Allergy 60(1):4–12

    Article  CAS  Google Scholar 

  20. Dretzke J, Meadows A, Novielli N, Huissoon A, Fry-Smith A, Meads C (2013) Subcutaneous and sublingual immunotherapy for seasonal allergic rhinitis: a systematic review and indirect comparison. J Allergy Clin Immunol 131(5):1361–1366

    Article  Google Scholar 

  21. Novembre E, Galli E, Landi F, Caffarelli C, Pifferi M, De Marco E et al (2004) Coseasonal sublingual immunotherapy reduces the development of asthma in children with allergic rhinoconjunctivitis. J Allergy Clin Immunol 114(4):851–857

    Article  CAS  Google Scholar 

  22. Jacobsen L, Niggemann B, Dreborg S, Ferdousi HA, Halken S, Høst A et al (2007) Specific immunotherapy has long-term preventive effect of seasonal and perennial asthma: 10-year follow-up on the PAT study. Allergy 62(8):943–948

    Article  CAS  Google Scholar 

  23. Rienzo VD, Minelli M, Musarra A, Sambugaro R, Pecora S, Canonica W et al (2005) Post-marketing survey on the safety of sublingual immunotherapy in children below the age of 5 years. Clin Exp Allergy 35(5):560–564

    Article  Google Scholar 

  24. Passalacqua G, Nowak-Węgrzyn A, Canonica GW (2017) Local side effects of sublingual and oral immunotherapy. J Allergy Clin Immunol Pract 5(1):13–21

    Article  Google Scholar 

  25. Agostinis F, Tellarini L, Canonica GW, Falagiani P, Passalacqua G (2005) Safety of sublingual immunotherapy with a monomeric allergoid in very young children. Allergy 60(1):133

    Article  CAS  Google Scholar 

  26. Shah-Hosseini K, Krudewig EM, Hadler M, Karagiannis E, Mösges R (2017) Management of grass pollen allergy with 5-grass pollen tablet: results of a 2-year real-life study. Adv Ther 34(6):1382–1397

    Article  CAS  Google Scholar 

  27. Didier A, Worm M, Horak F, Sussman G, de Beaumont O, Le Gall M et al (2011) Sustained 3-year efficacy of pre- and coseasonal 5-grass-pollen sublingual immunotherapy tablets in patients with grass pollen-induced rhinoconjunctivitis. J Allergy Clin Immunol 128(3):559–566

    Article  CAS  Google Scholar 

  28. Rodríguez Del Río P, Vidal C, Just J, Tabar AI, Sanchez-Machin I, Eberle P et al (2017) The European Survey on Adverse Systemic Reactions in Allergen Immunotherapy (EASSI): a paediatric assessment. Pediatr Allergy Immunol 28(1):60–70

    Article  Google Scholar 

  29. Passalacqua G, Guerra L, Pasquali M, Lombardi C, Canonica GW (2004) Efficacy and safety of sublingual immunotherapy. Ann Allergy Asthma Immunol 93(1):3–12 (quiz -3, 103)

    Article  Google Scholar 

  30. Tsabouri S, Mavroudi A, Feketea G, Guibas GV (2017) Subcutaneous and sublingual immunotherapy in allergic asthma in children. Front Pediatr 5:82

    Article  Google Scholar 

  31. Campo P, Rondón C, Gould HJ, Barrionuevo E, Gevaert P, Blanca M (2015) Local IgE in non-allergic rhinitis. Clin Exp Allergy 45(5):872–881

    Article  CAS  Google Scholar 

  32. Pitsios C, Demoly P, Bilò MB, van GerthWijk R, Pfaar O, Sturm GJ et al (2015) Clinical contraindications to allergen immunotherapy: an EAACI position paper. Allergy 70(8):897–909

    Article  CAS  Google Scholar 

  33. Lockey RF, Nicoara-Kasti GL, Theodoropoulos DS, Bukantz SC (2001) Systemic reactions and fatalities associated with allergen immunotherapy. Ann Allergy Asthma Immunol 87(1 Suppl 1):47–55

    Article  CAS  Google Scholar 

  34. Bernstein DI, Wanner M, Borish L, Liss GM (2004) Twelve-year survey of fatal reactions to allergen injections and skin testing: 1990–2001. J Allergy Clin Immunol 113(6):1129–1136

    Article  Google Scholar 

Download references

Acknowledgements

We acknowledge the technical support in data entry, analysis, and manuscript editing by “Evidencian Research Associates.”

Funding

The project was self-funded. No external agency had funded the project.

Author information

Authors and Affiliations

  1. Department of ENT, Katuri Medical College and Hospital, Flat no-003, Mayuri Palace Appts, Beside Bommidala Kalyanamandapam, Ring Road, Guntur, Andhra Pradesh, 522006, India

    Sharmila Dhulipalla

Authors
  1. Sharmila Dhulipalla
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sharmila Dhulipalla.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dhulipalla, S. Ragweed sublingual immunotherapy (SLIT) tablets in allergic rhinoconjunctivitis: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 279, 2765–2775 (2022). https://doi.org/10.1007/s00405-022-07270-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-022-07270-5

Keywords

Search

Navigation