Sublingual immunotherapy: A comprehensive review

Sublingual immunotherapy (SLIT) has been used with increasing frequency in Europe and is viewed with increasing interest by allergists in the United States. To address this interest, a Joint Task Force of the American College of Allergy, Asthma and Immunology and the American Academy of Allergy, Asthma and Immunology's Immunotherapy and Allergy Diagnostic Committees reviewed the available literature on SLIT and prepared this report. The task force concluded that despite clear evidence that SLIT is an effective treatment, many questions remained unanswered, including effective dose, treatment schedules, and overall duration of treatment. Until these have been determined, an assessment of the cost/benefit ratio of the treatment cannot be made. SLIT does appear to be associated with few serious side effects, but it has not been administered in high-risk asthmatic patients, nor in the studies reviewed has it been administered as a mixture of non–cross-reacting allergens. Furthermore, there is currently no allergy extract approved for this use in the United States, nor is there a Current Procedural Terminology code for billing purposes. All of these factors should be given careful consideration by anyone contemplating initiating SLIT treatment for their allergic patients.

Key words: Sublingual-swallow immunotherapy, sublingual-spit immunotherapy, allergen immunotherapy, allergic asthma, allergic rhinitis

Abbreviations used: AAAAI, American Academy of Allergy, Asthma and Immunology, AE, Adverse event, CMD, Cumulative monthly dose, CPT, Current Procedural Terminology, DBPC, Double blind, placebo controlled, ECP, Eosinophil cationic protein, FDA, US Food and Drug Administration, HDM, House dust mite, ICAM, Intercellular adhesion molecule, NFR, Near-fatal immunotherapy reaction, RC, Randomized controlled, SCIT, Subcutaneous immunotherapy, SLIT, Sublingual immunotherapy, SPT, Skin prick test, SR, Systemic reaction