Journal of Allergy & Therapy

Abstract

Sublingual Immunotherapy in Real-Life: When and Why

Maurizio Marogna*

Sublingual immunotherapy (SLIT) has gained wide acceptance in many European countries and has raised the level of interest in immunotherapy among practicing allergists and primary care physicians. SLIT was firstly accepted as a viable alternative to subcutaneous immunotherapy (SCIT) in the World Health Organization (WHO) Position Paper, published in 1998, and then included in ARIA guidelines. Since 1986, 60 DBPC-RCT trials have been published. There seem to be 2 distinct and perhaps sequential immunologic responses to SLIT; generation of regulatory T- cells (Tregs) secreting interleukin (IL)-10 and transforming growth factor (TGF)-β and immune deviation from Th2 to Th1 responses. The available meta-analyses are in favor of SLIT (rhinitis and asthma in adults and children).SLIT appears to be better tolerated than SCIT: a few case of SLIT-related anaphylaxis have been reported but no fatalities. SLIT may alter the natural history of respiratory allergy by preventing the onset of new skin sensitizations and/or reducing the risk of asthma onset. The clinical effects of SLIT are not immediate, such those of traditional drugs (ie, bronchodilatators or anti-histamines), but the immune modulation is profound and long-lasting (for 5-8 years after discontinuation). Special SLIT indications exist in everyday clinical practice in the following patients: uncontrolled with optimal pharmacotherapy, in whom drugs induces undesirable side effects, affected by moderate to severe rhinitis with moderate to severe nasal eosinophilia, associated with non specific bronchial hyper responsiveness (BHR) and/or bronchial asthma.