Sublingual immunotherapy (SLIT) – indications, mechanism, and efficacy
Position paper prepared by the Section of Immunotherapy, Polish Society of Allergy
Marek Jutel 1, Małgorzata Bartkowiak-Emeryk 2, Anna Bręborowicz 3, Ewa Cichocka-Jarosz 4, Andrzej Emeryk 5, Radosław Gawlik 6, Paweł Gonerko 7, Barbara Rogala 8, Anna Nowak-Węgrzyn 9, Bolesław Samoliński 10, and other members of IT Section PTA 11 1 - Wroclaw Medical University, Wrocław, Poland 2 - Chair of Clinical Immunology, Department of Clinical Immunology, University of Medicine, Lublin, Poland 3 - Department of Pneumonology, Allergology and Clinical Immunology, Poznan University of Medical Sciences, Poland 4 - Chair of Pediatrics, Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland 5 - Department of Lung Diseases and Rheumatology, University of Medicine, Lublin, Poland 6 - Chair and Department of Internal Medicine, Allergy, Clinical Immunology, Medical University of Silesia, Katowice, Poland 7 - I Department of Pediatrics, Allergy and Pulmonology, Szczecin, Poland 8 - Chair and Department of Internal Medicine, Allergy, Clinical Immunology, Medical University of Silesia, Katowice, Poland 9 - Icahn School of Medicine at Mount Sinai Hospital, New York, US 10 - Department of Prevention of Envinronmental Hazards and Allergology, Medical University, Warszawa, Poland 11 - PTA Ann Agric Environ Med 2016; 23 (1): ICID: 1196851 Article type: Review article
SLIT (sublingual immunotherapy,) induces allergen-specific immune tolerance by sublingual administration of a gradually increasing dose of an allergen. The mechanism of SLIT is comparable to those during SCIT (subcutaneous immunotherapy), with the exception of local oral dendritic cells, pre-programmed to elicit tolerance. In the SLIT dose, to achieve the same efficacy as in SCIT, it should be 50–100 times higher with better safety profile. The highest quality evidence supporting the efficacy of SLIT lasting 1 – 3 years has been provided by the large scale double-blind, placebo-controlled (DBPC) trials for grass pollen extracts, both in children and adults with allergic rhinitis. Current indications for SLIT are allergic rhinitis (and conjunctivitis) in both children and adults sensitized to pollen allergens (trees, grass, Parietaria), house dust mites (Dermatophagoides pteronyssinus, Dermatophagoides farinae), cat fur, as well as mild to moderate controlled atopic asthma in children sensitized to house dust mites. There are positive findings for both asthma and new sensitization prevention. Severe adverse events, including anaphylaxis, are very rare, and no fatalities have been reported. Local adverse reactions develop in up to 70 – 80% of patients. Risk factors for SLIT adverse events have not been clearly identified. Risk factors of non-adherence to treatment might be dependent on the patient, disease treatment, physician-patient relationship, and variables in the health care system organization.
DOI: 10.5604/12321966.1196851 PMID 27012173 - click here to show this article in PubMed