title: Selection of patients for sublingual versus subcutaneous immunotherapy.
abstract: Allergen immunotherapy is the sole treatment for IgE-mediated allergic diseases directed at the underlying mechanism. The two widely accepted administration routes are sublingual (SLIT) and subcutaneous (SCIT). We reviewed how patients should best be selected for immunotherapy and how the optimal administration route can be defined. Before deciding SCIT or SLIT, appropriate selection of patients for allergen immunotherapy (AIT) is mandatory. To be eligible for AIT, subjects must have a clear medical history of allergic disease, with exacerbation of symptoms on exposure to one or more allergens and a corresponding positive skin or in vitro test. Then the route of administration should be based on: published evidence of clinical and immunologic efficacy (which varies per allergic disease and per allergen); mono- or multi-allergen immunotherapy, for SLIT multi-allergen immunotherapy was not effective; safety: adverse events with SLIT are more frequent, but less severe; and, costs and patient preferences, closely related to adherence issues. All these are discussed in the article.
authors.affiliation: Hospital Médica Sur, Torre 2, cons.602, Puente de Piedra 150, Colonia Toriello Guerra, Delegación Tlalpan, 14050 México D.F., México.
authors.forename: Désirée E S
authors.initials: DE
authors.lastname: Larenas Linnemann
authors.forename: Michael S
authors.initials: MS
authors.lastname: Blaiss
mesh_terms: D000485:Allergens / Q000627:therapeutic use*; D006801:Humans; D006967:Hypersensitivity / Q000188:drug therapy* / Q000191:economics / Q000276:immunology / Q000473:pathology; D007279:Injections, Subcutaneous / Q000009:adverse effects / Q000191:economics / Q000379:methods; D063729:Sublingual Immunotherapy / Q000009:adverse effects / Q000191:economics / Q000379:methods*
chemical_list: D000485:Allergens
keywords: allergic rhinitis; asthma; atopic dermatitis; house dust mite; immunotherapy; patient adherence; pollen; subcutaneous; sublingual; systemic reactions