Sublingual immunotherapy in pediatric allergic rhinitis and asthma: efficacy, safety, and practical considerations.
Specific allergen immunotherapy (SIT) is the only disease-modifying treatment for allergic rhinitis and asthma. Subcutaneous immunotherapy (SCIT) is the only method with a US Food and Drug Administration (FDA)-approved formulation, but safety concerns limit administration to medical facilities. Sublingual immunotherapy (SLIT), under investigation in the United States, appears to have a more favorable safety profile, which may expand its use to populations generally not treated with SIT (eg, young children). This paper reviews SLIT studies that were specifically limited to the pediatric population. Most demonstrated evidence of clinical efficacy, but approximately 29% failed to demonstrate efficacy in symptom and medication scores in the first treatment year. Efficacy was seen in a broad range of allergen doses, but optimal dose range has not been established. SLIT appeared to be well tolerated in children as young as 2 years, but serious adverse reactions, including anaphylaxis, were reported. SLIT is a promising immunotherapy that may expand the population receiving SIT because of the convenience of home administration due to its favorable safety profile. However, questions remain unanswered, including optimal therapeutic dose.
Cox
Linda
L
Nova Southeastern University College of Osteopathic Medicine, 5333 North Dixie Highway, Suite 210, Fort Lauderdale, FL 33334, USA. lindaswolfcox@msn.com
D000286:Administration, Sublingual; D000485:Allergens / Q000008:administration & dosage* / Q000276:immunology; D001249:Asthma / Q000276:immunology / Q000628:therapy*; D002648:Child; D018849:Controlled Clinical Trials as Topic; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000191:economics; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012221:Rhinitis, Allergic, Perennial / Q000276:immunology / Q000628:therapy*; D006255:Rhinitis, Allergic, Seasonal / Q000276:immunology / Q000628:therapy*; D016896:Treatment Outcome
D000485:Allergens