Skip to main content
SpringerLink
Log in

Pre-Coseasonal vs Perennial Sublingual Immunotherapy for Seasonal Allergens Dosing Regimen: Long-Term Benefits, Adherence, and Cost-Effectiveness—Is There a Difference?

  • Specific Immunotherapy (L Cox, Section Editor)
  • Published:
Current Treatment Options in Allergy Aims and scope Submit manuscript

Opinion statement

Allergen immunotherapy (AIT) is to date the only disease-modifying and etiological treatment for IgE-mediated respiratory allergies. In France and Italy, the main route of administration of AIT for respiratory allergies is currently constituted by sublingual allergen immunotherapy (SLIT). In other European countries, the marketing is growing. In the USA, SLIT is increasingly taking hold, too. Various SLIT regimens have been employed to date for respiratory allergies induced by pollen, which constitutes a major atopic sensitizer in Europe and North America: continuous (all year-round), pre-seasonal only, co-seasonal only, and pre-coseasonal. The best maintenance SLIT regimen is a pivotal issue to clinicians. In fact, a continuous regimen may pose problems of adherence, and patients could be reluctant to take a treatment when they are symptom-free, out of the pollen season. In addition, a continuous treatment carries on a relevant economic cost. Obviously, the economic aspect may not be primary on safety and efficacy. Data provided evidence of short-term, sustained, and post-treatment efficacy of pre-coseasonal regimen. However, further head-to-head studies are required to establish whether discontinuous SLIT regimens are associated with better safety and/or major very long-lasting and preventative benefits than perennial SLIT regimens.

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

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Canonica GW, Cox L, Pawankar R, et al. Sublingual immunotherapy: World Allergy Organization position paper 2013 update. World Allergy Organ J. 2014;7:6. The updated position paper of World Allergy Organization focused on sublingual immunotherapy.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Arasi S, Passalacqua G, Caminiti L, et al. Efficacy and safety of sublingual immunotherapy in children. Expert Rev Clin Immunol. 2016;12:49–56.

    Article  PubMed  Google Scholar 

  3. Arbes Jr SJ, Gergen PJ, Elliott L, Zeldin DC. 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;116:377–83.

    Article  PubMed  Google Scholar 

  4. Bousquet PJ, Castelli C, Daures JP, et al. Assessment of allergen sensitization in a general population-based survey (European Community Respiratory Health Survey I). Ann Epidemiol. 2010;20:797–803.

    Article  PubMed  Google Scholar 

  5. Demoly P, Calderon MA, Casale TB, Malling HJ, Wahn U. The value of pre- and co-seasonal sublingual immunotherapy in pollen-induced allergic rhinoconjunctivitis. Clin Transl Allergy. 2015;5:18. Critical recent overview on the topic.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Halken S, Agertoft L, Seidenberg J, et al. Five-grass pollen 300IR SLIT tablets: efficacy and safety in children and adolescents. Pediatr Allergy Immunol. 2010;21:970–6.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  8. Burks AW, Calderon MA, Casale T, Cox L, Demoly P, Jutel M, et al. Update on allergy immunotherapy: American Academy of Allergy, Asthma & Immunology/European Academy of Allergy and Clinical Immunology/PRACTALL consensus report. J Allergy Clin Immunol. 2013;131:1288–96.

    Article  PubMed  Google Scholar 

  9. Novembre E, Galli E, Landi F, et al. Coseasonal sublingual immunotherapy reduces the development of asthma in children with Allergic rhino-conjunctivitis. J Allergy Clin Immunol. 2004;114:851–7.

    Article  CAS  PubMed  Google Scholar 

  10. Walker SM, Pajno GB, Lima MT, et al. Grass pollen immunotherapy for seasonal rhinitis and asthma: a randomized controlled trial. J Allergy Clin Immunol. 2001;107:87–93.

    Article  CAS  PubMed  Google Scholar 

  11. Mosges R, Klimek L. Today’s allergic rhinitis patients are different: new factors that may play a role. Allergy. 2007;62:969–75.

    Article  CAS  PubMed  Google Scholar 

  12. Pajno GB, Passalacqua G, Vita D, et al. Sublingual immunotherapy abrogates seasonal bronchial hyperresponsiveness in children with Parietaria-induced respiratory allergy: a randomized controlled trial. Allergy. 2004;59:883–7.

    Article  CAS  PubMed  Google Scholar 

  13. Pajno GB, Barberio G, De Luca F, et al. Prevention of new sensitization in asthmatic children monosensitized to house dust mite by specific immunotherapy: a six-year follow-up study. Clin Exp Allergy. 2001;31:1392–7.

    Article  CAS  PubMed  Google Scholar 

  14. Calderon M, Mösges R, Hellmich M, Demoly P. Towards evidence-based medicine in specific grass pollen immunotherapy. Allergy. 2010;65:420–34.

    Article  CAS  PubMed  Google Scholar 

  15. Calderon MA, Casale TB, Nelson HS, Demoly P. An evidence-based analysis of house dust mite allergen immunotherapy: a call for more rigorous clinical studies. J Allergy Clin Immunol. 2013;132:1322–36.

    Article  CAS  PubMed  Google Scholar 

  16. Horak F, Zieglmayer P, Zieglmayer R, Lemell P, Devillier P, Montagut A, et al. Early onset of action of a 5-grass-pollen 300IRsublingual immunotherapy tablet evaluated in an allergen challenge chamber. J Allergy Clin Immunol. 2009;124:471–7.

    Article  CAS  PubMed  Google Scholar 

  17. Lombardi C, Incorvaia C, Braga M, Senna G, Canonica GW, Passalacqua G. Administration regimens for sublingual mmunotherapy: what do we know. Allergy. 2009;64:849–54.

    Article  CAS  PubMed  Google Scholar 

  18. Creticos PS, Esch RE, Couroux P, Gentile D, D’Angelo P, Whitlow B, et al. Randomized, double-blind, placebo-controlled trial of standardized ragweed sublingual-liquid immunotherapy for allergic rhinoconjunctivitis. J Allergy Clin Immunol. 2014;133:751–8.

    Article  CAS  PubMed  Google Scholar 

  19. Sieber J, Köberlein J, Mösges R. Sublingual immunotherapy in daily medical practice: effectiveness of different treatment schedules - IPD meta-analysis. Curr Med Res Opin. 2010;26:925–32.

    Article  CAS  PubMed  Google Scholar 

  20. Quercia O, Bruno ME, Compalati E, Falagiani P, Mistrello G, Stefanini GF. Efficacy and safety of sublingual immunotherapy with grass monomeric allergoid: comparison between two different treatment regimens. Eur Ann Allergy Clin Immunol. 2011;43:176–83.

    CAS  PubMed  Google Scholar 

  21. Pajno GB, Caminiti L, Crisafulli G, et al. Direct comparison between continuous and coseasonal regimen for sublingual immunotherapy in children with grass allergy: a randomized controlled study. Pediatr Allergy Immunol. 2011;22:803–7.

    Article  PubMed  Google Scholar 

  22. Calderon MA, Birk AO, Andersen JS, Durham SR. Prolonged preseasonal treatment phase with Grazax sublingual immunotherapy increases clinical efficacy. Allergy. 2007;62:958–61.

    Article  CAS  PubMed  Google Scholar 

  23. Didier A, Worm M, Horak F, Sussman G, de Beaumont O, Le Gall M, et al. 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. 2011;128:559–66.

    Article  CAS  PubMed  Google Scholar 

  24. Didier A, Malling HJ, Worm M, Horak F, Sussman G, Melac M, et al. Post-treatment efficacy of discontinuous treatment with 300IR 5-grass pollen sublingual tablet in adults with grass pollen-induced allergic rhinoconjunctivitis. Clin Exp Allergy. 2013;43:568–77.

    Article  CAS  PubMed  Google Scholar 

  25. Di Bona D, Plaia A, Scafidi V, Leto-Barone MS, Di Lorenzo G. Efficacy of sublingual immunotherapy with grass allergens for seasonal allergic rhinitis: a systematic review and meta-analysis. J Allergy Clin Immunol. 2010;126:558–66.

    Article  PubMed  Google Scholar 

  26. Stelmach I, Kaluzi_nska-Parzyszek I, Jerzynska J, et al. Comparative effect of pre-coseasonal and continuous grass sublingual immunotherapy in children. Allergy. 2012;67:312e320.

    Article  Google Scholar 

  27. Di Bona D, Plaia A, Leto-Barone MS, La Piana S, Di Lorenzo G. Efficacy of grass pollen allergen sublingual immunotherapy tablets for seasonal allergic rhinoconjunctivitis: a systematic review and meta-analysis [published online June 29, 2015]. JAMA Intern Med.

  28. Committee for Medicinal Products for Human Use at the European Medicines Agency. Guideline on the clinical development of products for specific immunotherapy for the treatment of allergic diseases, Draft CHMP/EWP/18504/2006. London: 2008.

  29. de Groot H, Bijl A. Anaphylactic reaction after the first dose of sublingual immunotherapy with grass pollen tablet. Allergy. 2009;64:963–4.

    Article  PubMed  Google Scholar 

  30. Eifan AO, Keles S, Bahceciler NN, Barlan IB. Anaphylaxis to multiple pollen allergen sublingual immunotherapy. Allergy. 2007;62:567–8.

    Article  CAS  PubMed  Google Scholar 

  31. Antico A, Fante R. Esophageal hypereosinophilia induced by grass sublingual immunotherapy. J Allergy Clin Immunol. 2014;133(5):1482–4.

    Article  PubMed  Google Scholar 

  32. Sabate E: Adherence to long-term therapies: evidence for action. Available from: http://www.who.int/chp/knowledge/publications/adherence_report/en/.

  33. Christensen AJ. Patient adherence to medical treatment regimens: bridging the gap between behavioral science and biomedicine. Current Perspectives In Psychology. New Haven: Yale University Press; 2004.

    Google Scholar 

  34. Westerhout KY, Verheggen BG, Schreder CH, Augustin M. Cost effectiveness analysis of immunotherapy in patients with grass pollen allergic rhinoconjunctivitis in Germany. J Med Econ. 2012;15:906–17.

    Article  CAS  PubMed  Google Scholar 

  35. Dranitsaris G, Ellis AK. Sublingual or subcutaneous immunotherapy for seasonal allergic rhinitis: an indirect analysis of efficacy, safety and cost. J Eval Clin Pract. 2014;20:225–38.

    Article  PubMed  Google Scholar 

  36. Cox L, Nelson H, Lockey R, et al. Allergen immunotherapy: a practice parameter third update. J Allergy Clin Immunol. 2011;127:S1–S55.

    Article  PubMed  Google Scholar 

  37. Fiocchi A, Pajno G, La Grutta S, et al. Safety of sublingual-swallow immunotherapy in children aged 3- to 7 years. Ann Allergy Asthma Immunol. 2005;95:254–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics- Allergy Unit, University of Messina, Via Consolare Valeria- Gazzi, Messina, Italy

    Stefania Arasi MD & Giovanni B. Pajno MD

Authors
  1. Stefania Arasi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giovanni B. Pajno MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giovanni B. Pajno MD.

Ethics declarations

Conflict of Interest

Dr. Stefania Arasi declares that she has no conflict of interest.

Dr. Giovanni B. Pajno declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Specific Immunotherapy

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Arasi, S., Pajno, G.B. Pre-Coseasonal vs Perennial Sublingual Immunotherapy for Seasonal Allergens Dosing Regimen: Long-Term Benefits, Adherence, and Cost-Effectiveness—Is There a Difference?. Curr Treat Options Allergy 3, 93–101 (2016). https://doi.org/10.1007/s40521-016-0070-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40521-016-0070-8

Keywords

Search

Navigation