The Journal of Allergy and Clinical Immunology
Volume 125, Issue 1 , Page 277, January 2010

Do indications to sublingual immunotherapy need to be revised?

Article Outline

 

To the Editor:

The report by Cochard and Eigenmann1 highlights an important aspect of sublingual immunotherapy (SLIT): its safety in patients with previous reactions to subcutaneous immunotherapy. They describe 2 patients who withdrew from SLIT for repeated side effects with bronchial and nasal reactions, respectively.1 In both of them, previous subcutaneous immunotherapy treatment had to be discontinued for adverse reactions. This confirms a recent report on 2 patients with similar characteristics who had stopped subcutaneous immunotherapy because of adverse reactions and also had severe, anaphylactic reactions to SLIT.2 To complicate the issue, in all these patients, SLIT was not performed by conventional schedules: in the first case, an ultrarush schedule using the product Staloral 300 (Stallergenes, Antony, France) was used,1 whereas in the other report, the patients reacted at the very first dose of the product Grazax (ALK-Abelló, Horsholm, Denmark), which has no updosing phase.2

However, in studies conducted on patients without previous reactions to subcutaneous immunotherapy, both the ultrarush schedule with Staloral 3003 and the no-updosing schedule with Grazax4 were generally well tolerated. This indicates that patient-related more than schedule-related factors are likely to be linked to the development of systemic reactions to SLIT.

In official documents on allergen immunotherapy, indications to SLIT include “Patients with systemic reactions after subcutaneous immunotherapy.”5

The current observations on the development of systemic, and even anaphylactic, reactions to SLIT in such patients should encourage reconsideration of the issue.

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References 

  1. Cochard MM, Eigenmann PA. Sublingual immunotherapy is not always a safe alternative to subcutaneous immunotherapy. J Allergy Clin Immunol. 2009;124:378–379
  2. de Groot H, Bijl A. Anaphylactic reaction after the first dose of sublingual immunotherapy with grass pollen tablet. Allergy. 2009;64:963–964
  3. Ariano R, Incorvaia C, La Grutta S, Marcucci F, Pajno G, Sensi L, et al. Safety of sublingual immunotherapy started during the pollen season. Curr Med Res Opin. 2009;25:103–107
  4. Dahl R, Kapp A, Colombo G, de Monchy JG, Rak S, Emminger W, et al. Efficacy and safety of sublingual immunotherapy with grass allergen tablets for seasonal allergic rhinoconjunctivitis. J Allergy Clin Immunol. 2006;118:434–440
  5. Alvarez-Cuesta E, Bousquet J, Canonica GW, Durham SR, Malling HJ, Valovirta E. EAACI Immunotherapy Task Force. Standards for practical allergen-specific immunotherapy. Allergy. 2006;61(suppl 82):1–20

 Disclosure of potential conflict of interest: C. Incorvaia has received consulting fees from Stallergenes. M. Mauro has declared that she has no conflict of interest.

PII: S0091-6749(09)01581-4

doi:10.1016/j.jaci.2009.10.033

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    Marie M. Cochard, Philippe A. Eigenmann
    The Journal of Allergy and Clinical Immunology January 2010 (Vol. 125, Issue 1, Pages 277-278)

The Journal of Allergy and Clinical Immunology
Volume 125, Issue 1 , Page 277, January 2010

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