Sublingual allergen immunotherapy for respiratory allergy: a systematic review

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Abstract

The objective of the systematic review is to provide complete and updated information on efficacy and safety of sublingual immunotherapy (SLIT) formulations for the treatment of allergic respiratory diseases (ARDs). The literature search was conducted on PubMed database, involving double-blind, randomized clinical trials published between January 1992 and 2018, written in English, and performed in humans. The number of articles finally selected for review was 112. Data from the majority of properly controlled clinical trials demonstrate that SLIT is effective not only with short-term use (first year) but also with long-term use (up to the third year of active therapy), for treating ARDs in children and adults. Both continuous and discontinuous schemes of administration showed significant reductions in symptom and medication scores. Moreover, a SLITinduced disease-modifying effect has been documented mainly with grass pollen extracts, since improvement is maintained during at least 2 years of follow-up after a 3-year treatment period. Additionally, allergen immunotherapy should also be considered a preventive strategy, especially for decreasing bronchial asthma incidence in children and adolescents with allergic rhinitis treated with SLIT. This therapy is also safe, producing only a few mainly local and mild-to-moderate adverse events, and usually self-limited in time. The registration and authorization of allergen SLIT preparations (grasses and house-dust mite tablets) as drugs by regulatory agencies, such as the United States Food and Drug Administration (FDA) and the European Medicines Agency (EMA), has represented a landmark in allergy immunotherapy research. Further long-term studies, specially designed with allergens other than grass pollen or house-dust mites, not only in allergic rhinoconjunctivitis but also on asthmatic subjects, as well as studies comparing different administration schedules and/or routes, are required in order to continue the progress in the modern development of this particularly promising therapy.

Keywords: allergen, allergic respiratory diseases, asthma, rhinoconjunctivitis, sublingual immunotherapy, systematic review.

Citation: Blanco C, Bazire R, Argiz L, Hernández-Peña J. Sublingual allergen immunotherapy for respiratory allergy: a systematic review. Drugs in Context 2018; 7: 212552. DOI: 10.7573/dic.212552

Contributions: Carlos Blanco and Jenaro Hernández contributed with the search for this systematic review. Jenaro Hernandez redacted the draft of the manuscript. All authors contributed with successive reviews of the manuscript.

Disclosure and potential conflicts of interest: Dr Hernández works at Stallergenes Greer, Spain. The authors declare that there is no conflict of interest regarding the publication of this article. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors are available for download at https://www.drugsincontext.com/wp-content/uploads/2018/10/dic.212552-COI.pdf

Acknowledgments: The authors would like to thank to Pablo Vivanco (PhD, Meisys) for assistance in preparing the manuscript.

Funding declaration: Stallergenes Greer contributed financially to cover the collaboration of Meisys as Medical Writer without any intervention in the content or development of this review.

Copyright: Copyright © 2018 Blanco C, Bazire R, Argiz L, Hernández-Peña J. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2018 Blanco C, Bazire R, Argiz L, Hernández-Peña J. https://doi.org/10.7573/dic.212552. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/sublingual-allergen-immunotherapy-for-respiratory-allergy-a-systematic-review

Correspondence: Carlos Blanco, Allergy Service, La Princesa University Hospital, C/Diego de León, nº 62, 28006 Madrid, Spain. cblague@gmail.com

Provenance: invited; externally peer reviewed.

Submitted: 26 July 2018; Peer review comments to author: 9 September 2018; Revised manuscript received: 28 September 2018; Accepted: 1 October 2018; Publication date: 5 November 2018.

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