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Increased efficacy evidence in sublingual immunotherapy

Efficacy of sublingual immunotherapy in children with respiratory or food allergy is growing, according to recent study findings published in the Annals of Allergy, Asthma & Immunology.

“This alternative, less traumatic, and safer route of administration seems especially suitable for children and after the first big conclusive trials in adults, many pediatric [sublingual immunotherapy] trials were conducted, and pediatric [sublingual immunotherapy] was appraised in several meta-analyses and reviews,” researchers wrote. “However, published meta-analyses generally only include a selection of trials based on their design.”

The study included 29 clinical trials of sublingual immunotherapy (SLIT) in the treatment of respiratory and food allergies in children aged younger than 18 years. Researchers examined the clinical outcomes and immunologic changes of each trial.

Researchers found strong efficacy evidence for the precoseasonal tablet and drop grass pollen in allergic rhinitis; however, evidence was limited for seasonal asthma. Evidence of medication reduction and maintaining symptom control also was found for house dust mite SLIT in asthma; however, there was only moderate to low evidence for house dust mite SLIT for allergic rhinitis.

Dual grass pollen-house dust mite SLIT showed moderate evidence after 12 months of treatment and 1 year after discontinuation.

Researchers also found that nasal and skin tests improved with house dust mite SLIT, but bronchial provocation testing did not. It also was noted that food oral immunotherapy was a more promising treatment compared with food SLIT.

“No new data on the preventive effect of SLIT in children have been published after initial trials of low-moderate quality,” researchers wrote. “Thus, at this moment the best evidence to recommend SLIT in children with allergic rhinitis for the prevention of asthma development is maintained at the low-moderate level, but a well designed trial is being conducted that might yield more information in this field in the future. More large randomized trials are needed, especially with [house dust mite] SLIT and mold SLIT in children.”

Disclosure: The researchers report no relevant financial disclosures.