Sublingual Immunotherapy for Aeroallergens: Optimal Patient Dosing, Regimen and Duration

Abstract

Sublingual immunotherapy (SLIT) is a proven effective treatment for allergic rhinitis and allergic asthma. It can be disease-modifying: preventing the development of new sensitivities in monosensitized patients, preventing progression from allergic rhinitis to asthma, and providing long-lasting benefit after discontinuation of a successful course of treatment. The efficacy of sublingual immunotherapy, like that of subcutaneous immunotherapy (SCIT), is dependent on proper administration. This includes appropriate dosing, frequency, and duration of therapy. The current evidence for SLIT tablets is that daily administration of a dose equivalent to the monthly SCIT maintenance dose is appropriate. The appropriate doses for SLIT drops have not been adequately defined and may be the same or more than SLIT tablets. The optimal frequency of administration of SLIT appears to be daily. The optimal duration of SLIT for insuring disease modification appears to be 3 or 4 years. The initiation of SLIT at the maintenance dose appears safe if performed under physician observation. Preliminary evidence supports administration of pollen extracts only before and during the season, but further long-term follow-up is needed to ensure adequate disease modification. There are no studies to support the simultaneous administration of more than two non-cross-reacting allergens by SLIT.